One of the costliest errors a SNF can make is not engaging proactively with the Medicaid application review process. By not accessing all possible advantages and leveraging an understanding of key regulations and their application to the Medicaid process, SNF operators risk forfeiting reimbursements that can annually cost facilities millions of dollars.
When a SNF leaves money on the table, those are dollars not going to patient care.
There are many tips for avoiding mishaps in the Medicaid process, says Gina Dizzia, co-founder of Cowart Dizzia LLP, a cloud-based, multi-jurisdictional law firm focused on regulatory health care counseling including reimbursement and account receivables management.
Here are the firm’s top three.
Appeal all Medicaid denials — especially in applicant-friendly jurisdictions
Medicaid denials can be heartbreakers for SNFs, but those denials are often not as hard-and-fast as they may seem. Some jurisdictions have case law that sets clear parameters that can give SNFs a second chance to finish resident applications.
As such, Dizzia advises operators to appeal all Medicaid denials, especially in jurisdictions with case law precedent that is favorable to applicants, such as in New York and Pennsylvania. Certainly this brings more work to the plate of a SNF’s Medicaid coordinators, who probably process hundreds of thousands of Medicaid applications every year, but benefit awards recaptured through the appeals process help the bottom line.
“We recommend that the application process doesn’t just end when the business office of the facility has completed providing all of the information to the agency,” Dizzia says. “That’s when applications can fall through the cracks.”
Receiving a denial can feel so absolute and overwhelming that a facility may accept a “no” or denial when there is actually an actionable appeal. Because every state is different and both regulations and applications are constantly changing, being proactive is essential.
On top of that, denials can sometimes turn out to be the result of simple processing or analysis errors from Medicaid agencies, not from the SNF, and are easily corrected in the context of the appeals process.
“The best practice is to keep track of all pending applications and their status,” Dizzia says. “You’ll want to keep track of the date that an application is completed, the length of time an agency is taking for review and the length of time you’ll have to appeal a denial. If you receive a denial, you’ll want to quickly appeal within the timeframe to avoid forfeiting benefits an applicant is entitled to.”
Don’t let counties fail to implement their COVID rules
In the wake of the COVID-19 pandemic, many states obtained waivers from the federal government that permitted them to streamline certain Medicaid application processes with which the states could otherwise not reasonably comply due to business closures and increased demands on staff and personal time. For example, some states permitted personal attestations of assets and resources in lieu of documentary evidence, while appeal deadlines were substantially lengthened to give applicants more time to respond to denials.
“All the hoops that you would usually have to jump through, the guidelines coming out of the approved waivers took some of those hoops away,” Dizzia says.
This is great news for applicants and for SNFs, but it also means that operators must stay on top of those changes and ensure that agencies are abiding by the COVID era rules in real time but also in the context of an appeal.
“If facilities had cases in 2020 that were denied that met the requirements in place during the waiver period but were not properly treated as a COVID application, for example, then those need to be appealed and subjected to the rigors of a fair hearing,” Dizzia says. “We’ve seen many cases where a county failed to apply the state COVID rules and denied an applicant their due benefits, and we have been able to reverse that denial.”
Facilities responsible for applications should not accept an agency ignoring those special standards, she says. Instead, they need to engage with agencies in that review process and hold them accountable for applying what are essentially “crisis-time” rules.
Work with a law firm that can provide invaluable Medicaid insight
Much of this is easy to understand on a high level but difficult to execute. Time is tight, and the devil is in the details. That’s where partnering with the right law firm becomes paramount.
“The entire mission of our firm is to form productive partnerships with facilities and providers,” Dizzia says. “We really think of ourselves as providing technical legal assistance. It’s our job to stay on top of the rule and interpretative changes, market changes and trends at the county and state level, and then help our clients look through what’s happening in their jurisdictions. We’re really trying to help facilities understand how these rules are implemented so they can know the standards that apply to them and to their residents.”
In the end, Cowart Dizzia’s attention to detail ties back to their founding principle.
“We’re here to create a long-term relationship with our clients,” Dizzia says.
This article is sponsored by Cowart Dizzia LLP. To learn more about how their firm can help ensure your SNF maximizes its Medicaid reimbursements, visit cowartdizzia.com.
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