How Does the Care Crisis Impact Your Organization’s Reimbursement?
By Maureen McCarthy, Founder, President and CEO, Celtic Consulting, LLC
Having enough nurses to provide care for patients is not the only difficulty healthcare operators face during the ongoing nationwide care crisis. Clinical reimbursement nurses are leaving key positions that drive revenue and are essential to a provider’s operational and financial success.
The cost of most post-acute health services is reimbursed based on the results of an assessment. In-home health agencies, nurses complete the outcome and assessment information set (OASIS) to report assessment scores for reimbursement. Nursing homes are required to complete a minimum data set (MDS) for clinical assessment of all residents. Many states are transitioning to a nursing home payment model for their Medicaid program, with Medicaid reimbursement based on an assessment.
These assessments are typically completed by clinicians, with most healthcare organizations assigning the task to nurses. But when the position responsible for completing the MDS assessment (called an MDS coordinator) is vacant, nursing homes are at a significant disadvantage. MDS coordinators are highly skilled nurses, many with advanced certifications, who properly code and optimize reimbursement. A high attrition rate in this position often decreases an organization’s efficiency and negatively impacts revenue.
Existing staff shortages on nursing units have been amplified by vaccine mandates, forcing providers to perform a balancing act. Many operators pulled reimbursement nurses from their primary revenue-related responsibilities and asked them to provide patient care. As a result, some providers were unable to complete monthly billing, causing delays or reductions in payment. In some nursing homes, for example, assessment delays or omissions resulted in denied payments and even provider liability scenarios.
Addressing the care crisis will require thinking outside the box. One option is bringing in temporary staffing assistance. You can find temporary assistance through an agency or temporary employment firm, or you can hire an independent consultant. Another option is to contract with an assessment completion service such as MDSRescue.
Providers should consider their unique needs when deciding how to obtain temporary staffing assistance. For example, many agencies do not employ nurses with reimbursement experience because of the specific training and coding requirements. In addition, traditional agencies and temporary employment firms generally operate by assigning staff for a full day, which can lead to unnecessary expenses for the provider. An MDS completion service eliminates downtime expenses by only billing its client for productive time.
MDSRescue provides remote interim MDS completion services for facilities nationwide. Subject matter experts ensure assessment completion conforms to regulations and is accurate and timely, which improves five-star ratings. The MDSRescue team is comprised of high-level qualified staff, including many RAC-certified nurses as well as master teachers. Rescue your revenue and improve accuracy with MDSRescue.