Like Public, Managed Care Plans Fear What’s Happening in Nursing Homes Amid COVID-19

As skilled nursing facilities across the country locked down to try to curb the spread of COVID-19, try to stay on top of constantly changing guidance from both the state and federal level, and navigate new mandates to report COVID-19 cases, it might be easy for them to overlook reaching out to insurers working as their Medicare Advantage payers.

But those managed care companies are just as worried as the general public, according to Longevity Health Plan CEO Rene Lerer, and SNFs need to make sure they’re communicating accordingly.

“There’s a real concern from the insurers about what’s going on in the nursing homes,” he said on a Thursday webinar hosted by Skilled Nursing News. “Whether it’s appropriate and whether it’s just fear, we can decide that separately — but when you look at buildings, particularly that have been hard-hit with COVID, and you see readmission rates that are four or five times what they’ve been, when they look at buildings that are totally locked down … they don’t know anything about their patients.”


The concern about what’s going on inside the walls of SNFs — and whether a given patient is safe or not — is likely driven by the patients’ families, he explained. The fear of what is happening is palpable, especially in a state such as New Jersey, where nursing homes have logged 11,000 positive COVID-19, and the setting accounts for about 40% of the total novel coronavirus deaths in the state.

And because of the news cycle, there’s no escaping that concern, Lerer added.

“It’s often not deserved, but perception is reality,” he said.


The worries about this patient population on the short-term side runs alongside the drive to manage utilization, he said, adding that carriers are among those pressuring state attorneys general to call for SNFs to release statistics on their COVID-19 case totals.

That means that SNFs have to make sure that, in addition to reporting on their cases to the Centers for Disease Control and Prevention (CDC) and to families and the public, they’re communicating openly with their insurers on what’s going on, Lerer said.

He recommended that SNFs take time to develop a strategy for talking to the press, creating a public relations campaign with thoughtful responses on what the buildings are doing — while also acknowledging that nursing homes have “played second fiddle” to other segments of the health care continuum.

“This all comes out anyway, and I think this is a time to communicate; it’s not a time to hide,” Lerer said.

Documenting everything

In addition to the fact that insurers are looking for information, there’s another good reason for SNFs to make sure that they’re staying on top of communicating with their managed care partners: the need to document everything for billing purposes, Susie Mix, the CEO of the Medicare Advantage consulting firm Mix Solutions, explained on the webinar.

While the Centers for Medicare & Medicaid Services (CMS) has offered substantial waivers of its rules governing Medicare coverage during the crisis — from the expansion of telehealth to the suspension of the three-day stay rule for skilled nursing coverage — managed care plans are free to create their own rules, or ignore some of CMS’s changes.

Because each plan behaves differently, and a given facility could have residents covered by any number of Medicare Advantage plans, navigating the subtle differences adds another layer of strain on a nursing home workforce already stretched to the brink in many areas.

With the cost of personal protective equipment (PPE) and temporary labor skyrocketing, most nursing homes can’t afford to leave Medicare Advantage money on the table through billing errors or confusion.

Mix recommended ensuring one point of contact to streamline communication from the facility to the health plans and vice versa, as well as making sure the information from the health plan gets to the rest of the team in a SNF. Developing “cheat sheets,” or summaries of each plan’s specific needs and policies, can help ease the process, Mix suggested.

And when it comes to the new revenue codes issued by some health plans, the biggest concern has always been that every company has its own practices. That makes documentation of every single aspect of the communication related to claims essential, Mix said.

“Don’t wait for when we have to bill this in a couple weeks; don’t wait for when this crisis is over,” she advised.

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