Assessment of Current Systems

A thorough review of documentation systems, billing logs, labor logs/time sheets and management systems can be performed including.

• Patient Admission Process
• MDS Process
  • including choosing ARD, reporting of and tracking of minutes
• Certification/re-certification Process (Both Medicare A and B)
• Patient Record
  • What information is collected from patient, family and previous placement?
  • Evaluation format
  • Progress notes
  • Support Medical necessity and skilled need
  • Discharge process
  • Communication and support of other disciplines
• Billing System including:
  • How billing information is collected by treating staff (logs)
  • Coding; both diagnosis and procedure
  • How it is submitted to billing personnel?
  • How it is entered into the billing software?
• Administrative Oversight
  • Who is responsible to whom? Chain of Command
  • What management tools/systems are in place
• Appeal/denial process
  • When there is a request for additional information or denial by the Medicare Fiscal Intermediary, what is the process?
• Observation of treatment delivery

This allows us to determine what may be effective, what realistic targets for utilization and staffing may be, and where changes need to occur. It can also help answer questions such as:

1. Whether moving a contract arrangement to in-house is advisable?
2. Whether an in-house program is cost efficient?
3. Are lengths of stay appropriate?
4. Is the facility capturing all Medicare Part B revenue it can?
5. Do the RUG scores indicate appropriate utilization?
6. Will the facility be at risk in an audit?
7. Is the facility missing Medicare A PPS revenue?

Training and Implementation

Training can be provided on the following topics separately or as a package. An initial analysis as described in Assessment of Current Systems will measure the level of knowledge and understanding of Medicare guidelines on the part of staff and help determine what areas should be focused on.

Training topics provided:

• A series of training on Medicare
  • Medicare A guidelines and PPS system
  • Train on concepts of Medical Necessity, Reasonable and Necessary, and Skilled need
  • Medicare Part B guidelines
  • Denial and Appeals Process
  • Train to new documentation system if a change is recommended
• Clinical training on special programs
  • RNA
  • Contracture management
  • Pain management
  • Wound Care
  • Balance/falls
  • Wheelchair management
  • Urinary incontinence
  • Wellness
• Coding and billing
  • Procedure coding (CPT)
  • Diagnostic coding (ICD-9)
  • Counting of minutes and units
  • Coding edits
  • Dealing with caps
• Techniques for managing rehabilitation department
  • Case building
  • Scheduling of staff and treatment
  • Group treatments
  • Management of productivity
  • Recruiting therapists
  • Marketing
  • Setting and tracking performance goals

Continuing Management

Oversight by a third party can be beneficial to a facility. We assist the facility by providing ongoing management oversight so that quality of services, compliance with regulations and fiscal targets may be maintained. This is accomplished as described below and may change based on the skills, knowledge and capabilities of the facility staff or shifting regulatory environment.

• Review of performance goals through the use of Management tools on a weekly, monthly and quarterly basis.
  • This will include checks for productivity, efficiency, lengths of stay, case mix, and utilization.
• Audit of resident records.
  • To be accomplished at facility visits but also can be done remotely when facility uses a electronic resident record system.
• In-service training on issues for rehab staff and nursing when warranted such as:
  • Medicare,
  • Licensing,
  • Scope of Practice
  • Clinical techniques
• Weekly visits to the facility
• Provide updates to the facility on new regulations as they are implemented
• Provide policies and procedures
• Review Medicare Part B future claims before they are submitted.
• Audit of a sample Medicare Part B submitted by facility within past year.
• Assist in the appeal/denial process for any claims under review by CMS or its representative

for more information, call us at 888-66-AXIOM