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| Welcome to the latest edition of the Simione Solutions
E-Newsletter. This informational newsletter will be
e-mailed to you on a monthly basis containing articles
and information on up to date industry issues. |
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 COMPLIANCE ESSENTIALS 2010
By Robin Seidman, RN, BSN, MSN, MBA, LNCC, HCS-D,
Director, Simione Consultants
Healthcare Reform is here and with it brings technologically enhanced and better funded program integrity efforts which will challenge providers to implement new compliance strategies and practices. The following article will provide you with some essentials to stay compliant in an ever changing fraud and abuse environment. Compliance Strategies:
1. Be aware of the regulatory trends and government activities
Having knowledge of what the government "hot topics" and activities are will help focus your agency's compliance efforts.
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Get to know who the "enforcers" are and which ones impact your organization, e.g., RACs, MACs, MICs, ZPICs, HEAT (to name a few)
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Read reports from the OIG regarding recent home health and hospice audit investigations, e.g., Therapy Medical Necessity [home health] and Nursing Home Relationships [hospice]
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Be RAC ready: Be familiar with the RAC process and set up an internal action plan. The CMS Website has all the answers to date and links to your RAC's website: http://www.cms.hhs.gov/RAC -
Stay up to date on industry news, for e.g. Senate Finance Committee focus on home health (5/2010)
2. Know the compliance risk areas
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Visit your MAC/RHHI website on a regular basis to check for regulatory and compliance updates. Some intermediaries will announce probe and medical review focus areas.
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Go to "MLN Matters" on the CMS website http://www.cms.gov/MLNGenInfo/ to access free learning tools from Medicare to assist providers in understanding regulatory compliance within the industry. -
Be aware of the already identified industry risk areas and complete internal monitoring of these areas for improvement: e.g., Hospice - Eligibility for Long length of stays (>180 days); Non-Cancer and Ill-defined Diagnoses (CHF, COPD, Dementia, FTT, Debility, etc.) and in Home Health - Utilization (Outliers, Therapy, 5-7 visits) and Medical Necessity in multiple re-certifications.
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Know the OIG Risk Areas identified for Home Health (31 Risk Areas) & Hospice (29 Risk Areas)
3. Identify and recognize your agency's compliance pitfalls
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Conduct internal audits to identify and quantify potential risk exposure for documentation compliance.
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Conduct focus audits on areas identified as at risk in past audits and surveys.
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Trend the data from audits and track that the action plan was implemented to ensure appropriate education and follow-up.
4. Have & USE a Compliance Program
- Implement the OIG 7 Fundamental Elements for Compliance Programs:
- Identify all risk areas: Clinical, Billing, Financial, Administrative, Human Resources.
- Monitoring and Auditing is the most critical element to implement in any compliance program and one that is often done inadequately. The following steps are recommended:
- You must perform baseline assessments to identify your agency's vulnerabilities.
- Conduct separate audits for compliance "coverage" issues that directly impact reimbursement and for compliance with "regulatory" issues that relate to COP and survey requirements.
- Based on the audit findings: implement a follow up Action Plan (must be documented) and modify the Compliance Program Audit Schedule accordingly.
- Continue to modify your agency's Compliance Program's Auditing & Monitoring based on historical findings, industry trends and government activities.
Please feel free to contact me via email at rseidman@simione.com should you have any questions regarding this article or if you need assistance in accessing additional compliance resources. |
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Two Important Cost
Report Tips
by Maureen Laskowski, Director
Simione Consultants
Cost Report Tip #1 Filing a "Low Utilization" Medicare cost report? Check with you Fiscal Intermediary to determine the threshold for Medicare Reimbursement.
Palmetto GBA, has recently increased the threshold from $100,000 to $200,000 in Medicare Reimbursement. Other Fiscal Intermediaries thresholds currently in place are as follows: - NGS $200,000
- NHIC $200,000
- Cahaba GBA $100,000
Cost Report Tip #2The Provider Audit Department of Palmetto GBA is implementing a paperless process for final settlement of the Medicare cost report. What this means is they will no longer be mailing the Notice of Program Reimbursement (NPR). They will be asking providers to update their email addresses. For more information go to: http://www.palmettogba.com/medicare. Then click the link for Regional HH & Hospice and the go to "what's new". To View Our Power Point Presentation on The Home Health Cost Reporting, click here |
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Is Your Agency Spending Too Much Or Not Enough On Marketing?
By Rob Simione, Senior Consultant, Simione Consultants
Home Health agencies on average are spending 2.7 % of their total revenue on marketing and advertising. This benchmark is from the Financial Monitor TM and includes marketing department salaries and benefits, contracts, and any other advertising promotional campaigns paid for during Q1 2010.
Effective marketing and advertising campaigns are becoming more important in the Home Care industry. With the increased competition to secure referrals and admissions, agencies must find a way to differentiate themselves from their peers. While it is important that a marketing campaign is able to generate more admissions, it also must be cost efficient to succeed. The Financial Monitor TM allows Home Health agencies to benchmark themselves quarterly and better evaluate their marketing campaigns.
To learn more about the Financial Monitor TM, please email Rob Simione at robsimione@simione.com
To learn more about the Financial Monitor TM
click here
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Does Your Agency Need A Sales Manager? By Mike Ferris, Director, Simione Consultants
Does your agency need a sales manager? Well, take this little quiz and find out:
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Are you encountering increased competition in your market?
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Are you experiencing a "plateau" or lack of growth in your referrals?
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Are you losing ground in your referrals numbers?
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If every single sales rep bringing in superstar numbers?
If you answered "yes" to at least one of those questions, you might need a sales manager, and if you answered "yes" to more than one, you definitely need one.
Home Care and Hospice sales today is much more difficult than any other time in the past. With increased competition, and greater adoption and utilization of sales and marketing across the board in our industry, it's getting harder for agencies to keep their numbers growing. Many agencies are discovering that sales management is not among their strong suits..
So what are the answers? Most of the time it does not make sense to hire a sales manager from within your team, as rarely do the benefits outweigh the negatives. If you hire from the ranks of existing sales people, first and most importantly, you will be removing your best Sales Rep from the field. This will cause the agency to end up replacing a significant asset. The referrals produced by that territory will suffer significantly in the short term and even possibly long term as well. Second, it could completely dismantle the harmony of the sales team and the rhythm they were in together, as now they are thinking that one of their own got promoted and they did not. This will lower morale and affect performance across the board. As a result of these and other drawbacks of hiring from within the ranks, many progressive and successful agencies are now outsourcing this functionality to sales and marketing experts. This allows the agency to benefit from the insight that these experts can provide, the highest quality of training, and an outside entity monitoring the efforts and results of the sales team.
In light of all of this, the answer is actually quite simple: outsource your sales management to those who have helped countless agencies go beyond their goals, and all while recruiting a topnotch replacement who will ensure the growth continues for many years to come.
If you are interested in finding out more information about how you can grow your agency's numbers quickly, efficiently, and solidly, email me at: mferris@simione.com. I will be happy to talk with you about how we can help you pass your competition, and never look back.
To learn more about Marketing, Sales and Customer Service,
click here
To sign up for the Legendary Sales Leadership e-newsletter,
click here |
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Simione Consultants Hires Kara Osborne As Senior Project Manager
Simione Consultants is pleased to announce that Kara Osborne has recently joined the firm in the role of Senior Project Manager, in our Marketing, Sales and Customer Service area. Kara, formerly a National Sales Manager for a multi-state hospice provider, is experienced in sales management and new market development with a record of successful account management. Kara brings extensive experience in business transformation, strategic planning, whole systems change, facilitation, service delivery and information management projects. She is a graduate of Southern Illinois University at Edwardsville with a BS, MBA. Kara can be reached at 800-653-4043x238 or via email at kosborne@simione.com.
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