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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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Insufficient
Adoption Syndrome By Suzanne Sblendorio, BSN, MA, Director, Simione Consultants
Does this sound like your
organization?You installed an enterprise-wide,
back office and clinical system several years ago, you are "fully rolled out"
and everyone is trained. You start
hearing complaints: "We can't get the information we need", "We need more
clerical help to input everything", "Our
clinicians are taking notes on paper and then entering them in at night at home." You start talking to your staff hoping that
you do not need to find another system. You
quickly notice that there are lots of ancillary subsystems in place which
include logs, spreadsheets, whiteboards, Access data bases and lots of papers
being put in bins and baskets. You are
uncomfortable with the amount of work that is done external to your core system
and you quickly realize you are not maximizing your Return On Investment (ROI). Simione Consultants often sees this
"Insufficient Adoption Syndrome" with its non-value-add work effort, inability
to access data critical to management, high error rates and unnecessary
regulatory exposure. It is important to
find the root causes such as insufficient training, process misalignment,
system configuration issues, product issues and user mistrust. Identifying and addressing these will help your
organization determine its best solution and maximize ROI. Contact Suzanne at ssblendorio@simione.com to learn more.If you would like more information about our IT Division Consulting Services, click here |
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What do Providers Need to Know about PECOS? By Robin Seidman, RN, BSN, MSN, MBA, LNCC, HCS-D, Director, Simione Consultants
The regulation for all
physicians referring to certified home care providers to be enrolled in the Provider Enrollment, Chain and Ownership
System (PECOS) became effective July 6, 2010. At this time, CMS has announced they will not
automatically reject claims based on orders, certifications, and referrals made
by providers that have not yet had their PECOS applications approved by July 6,
2010.
As CMS reviews the
final comments submitted from the industry, they recommend providers do the
following:
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Ask the referring physicians whether he/she is
enrolled as a participating or non-participating physician, has attempted to
enroll or is in the process of enrolling.
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Document the physician responses in the patient's
record
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Initiate/continue care if the physician responds
"yes" to any question in the first bullet.
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Provide information on enrollment to the physician if
the they have not begun the enrollment process, and document the initiation of
the enrollment effort prior to accepting the patient into care.
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Be attentive to Press Releases from CMS and NAHC for
any update to the PECOS regulations.
If you would like more information about our Compliance Consulting Services, click here |
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How Does Your Medicaid Collection Compare With Other
Home Health Agencies? By Rob Simione, Senior Consultant, Simione Consultants
One of the biggest challenges in the Home Health Industry is
timely billing and collections which have a significant impact on the cash flow
of an agency. Evaluating your processes
quarterly is of the utmost importance.
One metric to use is Days Sales Outstanding (DSO). To calculate your DSO, take your accounts receivable,
divide it by your revenue and then multiply it by the amount of days your
revenue covers. It is also important to
break down your DSO by different payer types.
The National Average DSO for Medicaid in the first Quarter, per the
Financial Monitor, was 73 days. Your
agency's goal should be to remain under this benchmark. Processes that may help to lower your DSO for
Medicaid claims include: -
Checking Medicaid eligibility
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Tracking unbilled Medicaid claims
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Verifying claims have no missing information
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Timely communication between clinical staff and
billing department when there is a
change in payer
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Management approval for bad debt write offs
An agency should consistently review its billing and intake processes to
make sure that they are as efficient as possible.
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 Important Cost Report Tip
by Maureen Laskowski, Director
Simione
Consultants
Reminder:
Important News Recently Released by CMS Home
Health
CMS announced changes that will affect Home Health
Payments for 2011. The proposed rule
represents approximately a 4.75% decrease in Medicare payments to Home Health
agencies. The base episodic rate would
be reduced from $2,312.94 to $2,198.54.
Also addressed in the proposed rule are: -
Therapy documentation
and coverage requirements
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Changes to the capitalization policy
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Home Health face to face encounters
The
proposed rule can be found in the Federal Register dated July 23, 2010 which
can be located at
http://edocket.access.gpo.gov/2010/pdf/2010-17753.pdfAlso addressed in the proposed rule are: - Changes to
Hospice certifications and recertification requirements
- Solicitation
of comments on the potential Hospice Cap changes
MLN Matters #MM7077 released on July 23, 2010
provides you with the updated FY 2011 Hospice Payment Rates updated cap
information. The Hospice Cap for the
period ending October 31, 2010 is $23,874.98. The payment rates are as follows:
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Description
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Rate
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Wage Component Subject to Wage Index
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Non-Weighted Amount
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Routine Home Care
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$146.63
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$100.75
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$45.88
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Continuous Home Care
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$855.79
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$588.01
| $267.78
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Inpatient Respite Care
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$151.67
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$82.10
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$69.57
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General Inpatient Care
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$652.27
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$417.52
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$234.75
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The
full MLN matter can be accessed at To learn more about our Cost Reporting Consulting Services, click here To View Our
Power
Point Presentation on The Home Health Cost Reporting, click here |
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 Marketing, Sales and Customer Service Tip
of the MonthBy Mike Ferris, Director, Simione Consultants Great ad campaigns and an aggressive sales force increase
your amount of referrals, but are your referral centers converting those calls
into admissions?
Here are just a few helpful hints:
DON'T Over Screen the Consumer Calls
Many
times we receive calls where "dad is having a tough time with a cold/flu, and we
dismiss it as not medically eligible for our services, and thus never send
someone out or log the call in as a "real" referral. The unspoken
underlying prospect could be a serious exacerbation of CHF or COPD. The same
over screening could be said of other calls, such as slips and falls. Be
mindful, ask questions and make sure there isn't anything more there before
hanging up the phone.
DO Ask for the phone number!
It seems completely
obvious, but when we are asked to implement our mystery calls program we
uncover a great number of referral centers not asking for name and telephone
number. These calls never get turned into a "real referral" because the
referral center is waiting on a call back that never comes.
DO Have enough referral people
While even the most
top notch referral coordinators can handle 10+ referrals a day, having this
level of constant workload is a recipe for things to fall through the cracks or
an excuse for them to over screen or dismiss any calls that aren't readily
apparent as referrals. Whether it's a CTI, a consent or a potential
admission, things will get missed. This is also an excuse since they don't want
to add anything "strenuous" to their workload. So find out what your
coordinator's workload is and figure out how to best distribute it. This
may include adding one or more coordinators.
We can help you double, triple and in many cases
quadruple your current conversion rate.
To sign up for the Legendary Sales Leadership e-newsletter,
click here |
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