Reimbursement Tech Curbs Admin Costs, Claim Denials

During the course of its 19-facility expansion — in the middle of a pandemic — Texas operator Creative Solutions in Healthcare avoided hiring additional accounts receivable personnel by utilizing a health care payment automation platform.

Fort Worth, Texas-based vendor CoreCare supplies reimbursement automation technology to make this feat possible, while the SNF industry faces a 5% claim denial rate, the company said. Operators could be losing more than $120,000 per facility, per year in write-offs.

With so many pandemic-related variables added to the mix, minimizing potential denials because of administrative error (plus a reduction in admin costs) is a good game plan for operators, CoreCare said.

Last year, managed care companies issued additional documentation requests (ADRs) or denials due to crucial gaps in the care record, Therapy Management Corporation’s Christina Bruenderman said at a February webinar.

Audits and denials related to inaccurate compliance of the three-day-stay waiver could be next for operators, Bruenderman added.

The initial rule change was made by the Centers for Medicare & Medicaid Services (CMS) at the beginning of the pandemic in order to allow hospitals to reserve beds for severely ill patients, discharging those who could recover at a SNF.

Prior to the COVID, a patient needed to have a three-day inpatient hospital stay before Medicare would cover the SNF stay that followed.

Gary Blake, chief executive of Creative Solutions, said that such tech helps operators “grow smart.” Creative, founded in 2000, owns and operates more than 100 facilities in Texas, with services across the care continuum. Besides skilled nursing, Creative offers assisted living spaces, memory care, and ventilation services.

“Never before would I have imagined I’d be able to expand my operations without having to add additional AR staff to ensure timely reimbursement,” Blake said in a statement.

Major electronic medical record providers like PointClick Care (PCC), American HealthTech (AHT) and Matrix work well with the CoreCare portal, the vendor said, and are usually up and running in a little more than a month.

“An AR team’s day is spent on manual and repetitive processes that do not provide value, but instead hinder it,” CoreCare co-founder Mehrdad Shafaie said in a statement. “We were able to automate the busy work of the revenue cycle so that Gary’s team could focus on the knowledge work that delivers results.”

Existing ARs can continue to file claims for reimbursement through CoreCare tech without as many manual processes, the company said on its website. The vendor also claims clients get paid faster because of a streamlined billing process.

CoreCare recently expanded its platform to serve home health providers, in addition to the skilled nursing sector. Other SNF clients include Advanced Healthcare Solutions, Focused Post Acute Care Partners, Outreach Health and Summit LTC Management.