Healthcare: revenue cycle: skilled nursing facility
Challenge:
The client faced intense pressure due to a wide range of adverse market forces involving mandatory patient enrollment in Managed Long Term Care, and the push to enroll Medicare and Medicaid recipients in the Fully Integrated Dual Advantage program. Identifying contractual and operational barriers impeding success required a multi-faceted strategy that included:
- Analysis of existing contract terms and reimbursement rates
- Identification of the right payor partners to align with the SNF
- Exploration of alternative reimbursement methodologies through payor partnerships
- A need to expand market profile
- Identification of new revenue streams
- Evaluation of accounts receivable for existing payors
- Review of compliance processes with payor policies and procedures
Solution:
Mazars assembled a team of contract negotiators with the ability to leverage relationships with decision-makers at key payors in the market. Additionally, a group of managed care professionals were deployed to review internal processes and identify opportunities to improve operational efficiencies.
The team:
- Proposed opportunities to improve reimbursement rates and contract terms
- Identified key market players and negotiated favorable provider agreements
- Established relationships with key payor personnel to enhance the client’s profile and increase member census
- Implemented a strategy to recover revenue due to underpayments, inappropriate denials or unpaid claims
- Recommended termination of underperforming payor agreements
- Developed a process to maintain tight monitoring of outstanding receivables with all payors
Results:
- Successfully negotiated increased reimbursement rates with the SNF’s top five targeted payors
- Facilitated the credentialing process to accelerate implementation of new agreements
- Instituted procedures to increase contract compliance via staff education to minimize denials and improve submission of timely appeals
- Designed a strategy to improve payor visibility by establishing an enhanced relationship with key decision makers at the payor organization
- Ensured the SNF was appropriately positioned with the various PPS organizations for NY DSRIP initiatives
The information provided here is for general guidance only, and does not constitute the provision of tax advice, accounting services, investment advice, legal advice, or professional consulting of any kind. The information provided herein should not be used as a substitute for consultation with professional tax, accounting, legal or other competent advisers.