Solving the Mysteries of SNF Reimbursement Juli Pascoe, CPA, Director Julie Bilyeu, Director

Case #: 1 Disappearing Medicare Payments

The Investigation Leads: The Evidence: The Investigation Leads: eligibility The Informer: Administrator Frieda Krueger The Scene: Elm Street Manor The Mystery: The SNF has a large amount of uncollected Medicare balances. Verification of _______ prior to admission & monthly for skilled residents Confirm time & ____ of hospital admission Claim status in the Medicare _____ system date DDE

Case #: 2 Puzzling Invoices

The Investigation Leads: The Evidence: The Investigation Leads: The Informer: A/P Clerk Auntie Bee The Scene: Mayberry Cottage Rehab & Nursing The Mystery: Large hospital bills from Opie General that she is not sure the facility owes. Verifying CMS major category ________ to determine responsibility Have they negotiated ________ with outside providers/suppliers Are ______ being sent to inform other providers when patients are in a covered stay exclusions contracts notices

Case #: 3 Suspect Aging Report

The Investigation Leads: The Evidence: The Investigation Leads: The Informer: CFO Cherry Pitts The Scene: Orchard Heights Senior Care The Mystery: A very large aging report that is full of suspect balances Are Medicare A rates being updated _______ of each year What is the process for 2% ___________ adjustments Is ____ being reconciled monthly to the bank statement October sequestration cash

Case #: 4 Inquiry Into Mass Recoupments

The Investigation Leads: The Evidence: The Investigation Leads: contact The Informer: DON Nancy Ratched The Scene: Cuckoo’s Nest Senior Living Center The Mystery: Received a letter noting a large recoupment pending from Medicare following post payment review. Has facility _______ information been kept up to date Who is responsible for notifying facility personnel & _______ therapy of pending review requests Does the facility ____ the status of reviews & appeals contract track

Case #: 5 Disappearing Biller

The Investigation Leads: The Evidence: The Investigation Leads: deadlines The Informer: Fred Flop The Scene: Vegas Skilled Nursing Center The Mystery: His biller has disappeared & he doesn’t know what needs to be done & what steps need to be taken to ensure billing is completed this month. Are there established ________ for when billing & month end should be completed What _______ programs does billing use for billing, submitting claims & performing follow up Is there a _______ plan software back-up

Case #: 6 Missing Accounts Receivable Benchmarks

The Investigation Leads: The Evidence: The Investigation Leads: days The Informer: Board Member Alan Sharpie The Scene: Shady Pines SNF The Mystery: The SNF is running dangerously low on cash & have had significant cash collections issues in recent years. Average _____ to collect Accounts receivable _______ Days ____ on hand turnover cash

Case #: 7 Payer Plots

The Investigation Leads: The Evidence: The Investigation Leads: The Informer: Administrator Taylor Harris The Scene: Friendship Harbor SNF The Mystery: When should payers normally remit payment to SNFs? 30 Days – Private Pay, Medicaid, ________ 60 Days – Medicare ___________, insurance If using a _____________ 90 Days – Medicare co-insurance, insurance If filing paper claims Medicare co-insurance clearinghouse

Case #: 8 Booking Bad Debt Expense

The Investigation Leads: The Evidence: The Investigation Leads: co-insurance The Informer: CFO Newbie The Location: Bendy Oaks SNF The Mystery: How much bad debt expense should a SNF book on a yearly basis? Medicare ___________ Can be collected at a _________ percentage on the Medicare Cost Report Occasional _______ balances Bad debt expense as a percentage of ______________ Expect ½% - 2% reduced private patient revenues

Case #: 9 Financial Statement Frame Up

The Investigation Leads: The Evidence: The Investigation Leads: Revenues on financial statements = What you get ____. Medicare – pays at _____ levels Use payer logs or PSR to check amounts recorded Medicaid – days X ________ rate Private – Average per day amount should fall between private rates Insurance – contract rate, __________ rate, RUG rate The Informer: Chloe Lamar The Scene: Calabasas Coves SNF The Mystery: How should a person with a nonfinancial background review & have confidence that revenues are recorded correctly on a financial statement? paid RUG per diem level of care

Case #: 10 Accounts Receivable Surveillance

The Investigation Leads: The Evidence: The Investigation Leads: aging The Auditor: Fallon Kimmel The Scene: Late View SNF The Mystery: What could have helped Late View SNF avoid this large hit to the bottom line that was discovered during their year end audit? Accounts receivable ______ review What is it? How often? Ask _______ questions Set _________ Follow established collections policy specific thresholds

The Future of Our Mystery Firm

CONTACT US: jpascoe@bkd.com jbilyeu@bkd.com http://bkd.com/ltc-resources