SNF Admissions Process Introduction

1 SNF Admissions Process IntroductionPresented by:1/31/20131 The Interdisciplinary TeamThe successful collection of a skilled nursing facility s revenues depends on the successful communication between the interdisciplinary team, which consists of the Business Office, nursing , Rehabilitation, Social Services and Admissions The KEY to success is working together as a TEAM. This Process will provide you with the necessary tools to function as a critical member of the SNF interdisciplinary team!!! FACT* 12-19 % of revenue is lost during the Admissions Process due to incorrect or unverified will have gained valuable knowledge and resources to help protect your facility from loss due to bad debts or regulatory non-compliance.

2 Revenue loss fact: 12-19% of revenue is lost during the Admissions Process , for incorrect or unverified information!!!!!STOPand think before the patient is admitted-these steps MUST be followed!!!!1/31/20133 admission details: Managing admission Financial Details Verification of benefits How to determine eligibility, where, what, how, why? Understanding the CWF(common working file) Medicare verification Medicaid verification Managed Care verification Commercial Insurance verification VA benefits verification1/31/20134 Managing admission Financial Details Verification of benefits(Continued)Daily Census, who is responsible and why?

3 Admissions package sign in(providing examples) admission Agreement(3 examples)Clinical ConsentsHIPAA agreementsWelcome letterFace sheet data entry and distributionFOLLOW UP1/31/20135 Managing admission Financial Details Verification of benefits1/31/20136 Admissions Process Familiarize yourself with your facility s admission documentation and Process as well as which tasks are performed by each staff member within the team: Receive Referrals, provide tours and take admission applications, coordinate financial and clinical review Verification of benefits Admissions Committee meetings or flow of an admission communication form admission Package Sign-In admission Agreement, Clinical Consents, HIPAA and other notifications, Welcome Letter Face Sheet data entry and distributionHomeManaging admission Financial Details Verification of benefits(Continued)1/31/20137 Financial admission Communication Form admission details such as date, admit from location, expected length of stay Resident demographics (DOB, Soc.)

4 Security #, contact information) Primary Payer Secondary and Supplemental (Coinsurance) Payers Verification of Benefits - requirements or limitations, contact information, authorizations, policy numbers, etc. Internal approvals per company policyHome1/31/201381/31/201391/31/20131 0 MedicaidDetermine eligibility from State Medicaid Agency Medicaid Eligibility Policy # Type of coverage (Standard) Clinical screening or authorization Other insurance (TPL)1/31/201311 Managing admission Financial Details Verification of BenefitsHomeNew York State Medicaid Benefit VerificationDetermine eligibility via: eMedNY site Self Help at Audio Response Unit (ARU) seeMEVS Telephone Quick Reference Guide 1-800-997-1111 MEVS ePACES online verification system (requires internet connection and registration) seeePACES Quick Reference Guide Contact eMedNY Call Center at 1-800-343-9000 You will need to provide your NPI# Other HIPAA options see MEVS Methods Guide at admission Financial Details Verification of BenefitsHome The Common Working File (CWF) What is it?

5 ?? How does it work??1/31/2013131/31/2013141/31/2013151 /31/2013161/31/2013171/31/2013181/31/201 3191/31/2013201/31/2013211/31/2013221/31 /2013231/31/2013241/31/2013251/31/201326 1/31/201327ePACESI nquiryePACESHelp Document -V hereLogging Into ePACESB efore logging into ePACES, you must have a UserID and Password. If you do not have a User ID or have forgotten your password, please contact your ePACESS ystem Administrator or Provider Care/Commercial Insurance/VA BenefitsDetermine eligibility via: Register for online access to Insurance Carrier s website when available Telephone Inquiry Clinical Case Management contact Policy and coverage information contact Required Eligibility information Prior Authorization # Rate/level of care Dates covered in Authorization Outliers (pharmacy stop-loss, etc)

6 Case Manager contact information and requirements1/31/201331 Managing admission Financial Details Verification of BenefitsHomeSecondary and Supplemental Payer Verification Supplemental payer must be indicated when Medicare A is primary payer Some insurance plans have an extended primary coverage when Medicare benefits exhaust Some Managed Care and Medicare Advantage plans also require a co-pay Supplemental Insurance (Medigap) coverage must be verified Carrier Name Policy # Subscriber Name and relation if resident is not subscriber Date Active Pre-certification required? Coverage limitations (ie, day 21-30 only of Medicare stay) Claims address1/31/201332 Managing admission Financial Details Verification of BenefitsHomeDaily Census Activity1/31/201333In order to report census information consistently and accurately on a daily basis, the data needs to be managed by each discipline without error and without delay.

7 Each discipline in the center, to include the nursing , Admissions , Case Management, and Business Office Departments, should be educated in each of their roles in the census reporting Census nursing Department Obtain Midnight Census Worksheet from Business Office Indicate on Worksheet all activity beginning at 12:01 am through 12 midnight All Admissions /Readmissions, Discharges, LOA, Bed Transfersmust be indicated to include time, location(from or to), date Worksheet to include midnight physical count of residents total by unit Worksheet to be signed by nursing Supervisorverifying accuracy and completion of all information Completed Worksheet to be forwarded to Business Office by 9:00 each morningHomeDaily Census Activity1/31/201334 admission Information Admissions Department Information distributed by 9.

8 00 each morning for the following day s Admissions Admissions Form/Prelim Face Sheet distributed to appropriate staff Payor verifications (Medicare CWF, Private Insurance/Coinsurance verifications, Medicaid online eligibility printout, etc) to Business Office if completed by Admissions staffCensus Entry, Verification Business Office Compile and review all documentation received for previous day census activity Calculate totals by payor using previous day s reconciled census report and reconcile to totals provided by nursing Dept. If variance exists, coordinate review with nursing for correction Enter all census changes in Revenue/Billing system Run daily Census Reports for distribution to all facility departments Run Midnight Census Worksheet for currentdate and forward to nursing for use at end of day.

9 Maintain signed Midnight Shift Worksheet along with daily Census Report in a file marked Census for each month and keep with Month End Financial files for audit purposesHomePre-Billing1/31/201335 Policies for billing and collecting Private Pay charges vary greatly. Your facility policy and Resident admission Agreement must be reviewed carefully prior to submitting any billing or instituting any collection activity. Private Pay Room and Board payment-Just like paying RENT!!!! Due on the first of each month Collected upon arrival of private pay Admissions Collected on the first day of Medicare or Managed Care non-coverage (conversions)

10 Statement should indicate the date that payment is expected Ongoing pre-billing Each month around the 25th Room and board charges for the coming month Usually contain any ancillary charges incurred during the previous month Patient Liability can be pre-billed Payment due no earlier than the 3rdof the monthHomePre-Billing1/31/201336 Common Private Pay Collection Processes Collection begins 10 days following due date Telephone call to the person responsible for making payment Mailed reminders within 30 days of billing Other actions to prompt payment can include: Petitions for conservators for residents who are not competent Notices of Involuntary Discharge Property liens Use of collection agencies Legal court actionsHomeMedicaid Billing and CollectionNY State Medicaid Billing and Collection Approval and notification of Resident admission and discharge Level of care approval obtained for admission DMS-1 assessment (pre and post- admission )