pandemic

Article Dean Dorton

Halfway through 2021, there are millions of jobs available and millions of people out of work. So why are employers across industries having such a hard time filling vacant positions? Opinions vary, but a few factors appear to be depressing the labor market.

Caring for sick relatives and supervising kids home from school is keeping many people from returning to the labor force. Continuing fears over the pandemic also play a role, especially for older employees who elected to retire. Elevated unemployment benefits may diminish work incentives as well. Regardless of the cause, the effect is clear: The labor force is approximately five million people smaller than at the pre-pandemic peak.

Labor shortages affect some industries worse than others right now, but hiring is becoming harder across the board. Some companies have accepted ballooning labor costs to aid with recruiting efforts. Others have concluded that the skills they need simply aren’t available, leaving a necessary position unfilled indefinitely. Today’s tight labor market has made everyone think hard about recruiting, retention, and talent development. After all, if companies can’t find the workers they need, the pandemic recovery could take longer than anyone wants.

It may be time for companies to think differently about how they bring experience, expertise, and productivity into their ranks. Recruiting is one option, but there’s another.

Outsourcing in the New Normal
Labor shortages are happening at the same time that companies are embracing remote work and automation like never before. Workplaces are evolving, and having a huge staff of people in the same office doesn’t seem as mandatory as it once did. Outsourcing was made for this moment.

Outsourcing can help companies overcome short-term hiring challenges. If the local talent pool lacks the specialized skills a company needs or can’t supply enough qualified candidates to meet growing workloads, outsourcing can fill that gap on demand. Outsourcing professionals distinguish themselves through the depth and diversity of talent they offer, helping clients take on the biggest recurring responsibilities or the most complex special projects – all without recruiting headaches or the cost of a full-time hire. But doesn’t outsourcing mean shipping my company’s needs overseas? While that may be the first thing that comes to mind, there are many professional services firms locally, regionally, and nationally that have the right expertise to meet your expectations and help your organization succeed.

Take accounting, for example. Accountants were in short supply even before the pandemic. That hasn’t changed, and companies need the oversight and input of smart financial professionals most of all during periods of robust economic activity like now. Outsourcing delivers exactly that. No matter what a company sees on the horizon, outsourcing keeps the accounting capabilities aligned with the business requirements. The labor market doesn’t matter when there are accountants available on demand through the right partnership. Outsourced accountants can handle a single project, take over an ongoing workload, stand-in for an entire accounting department, or serve as CFO. Unlike the labor market, outsourcing with a professional partner promptly supplies exactly what the you need.

Make sure that accounting accelerates the recovery effort instead of slowing it down. Contact Dean Dorton to outsource the missing pieces.

Justin Hubbard, CPA, CGMA | Accounting and Financial Outsourcing Director
jhubbard@deandortonstg.wpenginepowered.com
859.425.7604

Article Dean Dorton

The post-acute industry was less than six months into a revolutionary change in payment reform (PDPM) when COVID-19 demanded everyone’s attention. But that doesn’t mean that nursing providers have to leave money on the table. With the pandemic lingering on, it’s easy to shift all focus to the daily necessary survival tasks. However, no matter the circumstances, taking inventory of your payer contracts and potentially re-imagining your charge master can, and should be a priority and is essential to effectively mange revenue cycle.

As an industry, even on good days margins run thin despite the intense care required to achieve positive outcomes and the heavy layer of regulation in the industry. In order to maintain quality care in the communities, it is critical to maintain a sound financial model that captures the hard work being done by your care team, despite having an underrepresented reimbursement system.

Understanding the nuances of each payer contract and effectively communicating “the rules” across the care team contributes toward ensuring SNFs are compensated appropriately for the care being delivered. Each facility should review and update their payer contract schedule to ensure changes are captured, particularly within the ever changing managed care sphere. It is especially critical for centralized multi-facility management teams to make an extra effort in educating community stakeholders as to the fine print within each payer contract.

Payer contract awareness is a fundamental element of effective revenue cycle management. Once you have this element locked down, try to take it a step further and evaluate the charge master. By and large, strategic management of the charge master has been historically left to acute care partners. However, as skilled payment systems continue to evolve and changes reverberate throughout the managed care stratosphere, money is being left on the table.

Through collaboration and analysis for multiple skilled providers, it is clear that opportunities are being missed. For example, based on contract terms and billed charges, payments are being made at the lessor of billed charges versus contracted rates. The difference becomes a contractual adjustment when cash is posted and C-Suite Executives often have no idea as to the dollar amount of legitimate–earned revenue being missed. As an industry, charge master maintenance has not necessarily kept pace in reflecting the increasing level of skilled care being provided in the industry.

Now may be the time to review your charge master and think beyond room & board. This article is not advocating for the charge of every nursing supply and grooming kit, however, there is a holistic need to review the charges being administered for care intensive services such as isolation, severe cognitive behaviors and various comorbidities and service lines being offered. Keys to effective oversight include routine case review of charge codes versus care provided, identification of rates below the Medicare allowable, and promoting effective communication and education for staff across disciplines on pricing and billing processes. Comprehensive maintenance is key to preventing leakage and driving healthy cash flow amidst these very difficult days.

Now is not the time to simply hope the revenue cycle team can succeed in this environment. It must be managed with intent, including the tracking of volumes, key performance indicators, benchmarks, and backlogs, but more importantly a well-managed plan to improve performance and deliver results. Revenue cycle leadership must be collaborative within your organization. Reviewing your payer contracts and re-examining your charge master shouldn’t be a hassle. Your business has changed–so too should your expectations of revenue cycle management.

  • Your hospital requires standards and protocols across its clinical service lines–are those same expectations communicated across its revenue cycle teams?
  • Do departments understand what the denials are, why they occurred, and how they can be prevented?
  • Does Health Information Management continuously complete its coding function within the allotted time to keep discharged not final billed (DNFB) at appropriate levels?
  • Do business office staff identify underpayments, capture partial denials, and escalate patient complaints to ensure revenue and patient satisfaction scores are optimized?
  • Does leadership’s questions to revenue cycle stakeholders get answered with timely, confident responses?

Hospital senior leaders are dealing with myriad issues related to COVID-19 and its impact on patient volumes, patient and workforce safety, revised budgets and forecasts. Having confidence in the revenue cycle should not be compromised. Do you have operational concerns, gaps in revenue cycle leadership, transitions in high profile roles, or simply want to discuss getting your revenue cycle back on track? Our experienced healthcare team can provide short-term and long-term assistance to help ease your pain points.

ABN Update: Newly Revised From August 31, 2020

The Centers for Medicare and Medicaid Services (CMS) revised the Advanced Beneficiary Notice of Non-coverage Form (ABN), Form CMS-R-131. The notice is required to be issued to patients/residents where Medicare payment is expected to be denied. The revised ABN replaces the form that was last released in June 2017. The form and instructions for use can be accessed below. Update your forms now to ensure you don’t get stuck with a technical payment denial due to administrative error.

ABN Update

Learn how Dean Dorton’s Healthcare Consulting team can help you with all aspects of your organization.

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Article Dean Dorton

Managing a health system’s overall revenue cycle performance requires technical skills and abilities, a trained labor force, executing strategic initiatives, reliable data and analytics, project management, subject matter vendors, and a host of other complimentary relationships and action items.

If that’s not enough pressure, now toss in the complexities and challenges associated with managing revenue cycle performance during a pandemic. If the last few months have taught us anything, it’s that we have to be flexible and adapt our management to accommodate new factors, including:

  • Managing revenue cycle teams that are increasingly virtual and telecommuting
  • Increases in Medicaid volume and other shifts in payer mix due to higher unemployment
  • Pressure from Finance to increase cash collections all while revenue is decreasing
  • Team member absence and illness, including employee turnover in key positions
  • Vendors that cannot execute your strategy due to the impacts of COVID-19 on their businesses

Are you confident in your revenue cycle management? Will you execute and reach your goals?

Now is not the time to simply hope the revenue cycle team can succeed in this environment. It must be managed with intent, including the tracking of volumes, key performance indicators, benchmarks, and backlogs, but more importantly a well-managed plan to improve performance and deliver results. Revenue cycle leadership must be collaborative within your organization. Your business has changed–so too should your expectations of revenue cycle management.

  • Your hospital requires standards and protocols across its clinical service lines–are those same expectations communicated across its revenue cycle teams?
  • Do departments understand what the denials are, why they occurred, and how they can be prevented?
  • Does Health Information Management continuously complete its coding function within the allotted time to keep discharged not final billed (DNFB) at appropriate levels?
  • Do business office staff identify underpayments, capture partial denials, and escalate patient complaints to ensure revenue and patient satisfaction scores are optimized?
  • Does leadership’s questions to revenue cycle stakeholders get answered with timely, confident responses?

Hospital senior leaders are dealing with myriad issues related to COVID-19 and its impact on patient volumes, patient and workforce safety, revised budgets and forecasts. Having confidence in the revenue cycle should not be compromised. Do you have operational concerns, gaps in revenue cycle leadership, transitions in high profile roles, or simply want to discuss getting your revenue cycle back on track? Our experienced healthcare team can provide short-term and long-term assistance to help ease your pain points.