better business intelligence and

more efficient processes

drive improved case mix and reimbursements

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With changes in Medicare reimbursements looming as RUG-IV approaches, skilled nursing facilities must focus now more than ever on optimizing case mix and reimbursements. Our skilled nursing facility customers are using the Referral Management System to achieve both. Learn more . . .

RMS helps SNFs improve case mix and set smarter strategies for reimbursements

With changes in Medicare reimbursements looming as RUG-IV approaches, skilled nursing facilities must focus now more than ever on optimizing case mix and reimbursements. Our skilled nursing facility customers are using the Referral Management System to achieve both:

  • Payer analysis reports provide live, accurate account of payer mix
  • Reports also correlate liaisons and referral sources with payer types to determine where optimum payer mix is generated.
  • Greater process efficiency frees critical time for more thorough payer and reimbursement assessment while still maintaining a competitive edge in response times.
  • Trend and analysis reports help set smarter marketing strategies, and SNFs can manage liaison activity to ensure that the community and referral sources are aware of specialized clinical services with higher reimbursement rates.

Real-world benefit examples:

Greystone Healthcare Management, a 26-facility provider:

  • 71% of new referral admissions in key region are now Medicare
  • Overall Medicare mix up 23% after six months

 

A seven-facility provider in Massachusetts:

By reporting reasons for declined referrals, this provider has identified high-demand clinical services that its facilities did not offer. Many such services align with favorable reimbursements under RUG-IV rules. The provider now offers or plans to offer specialized, niche clinical services that will increase overall admissions and offset declines in other RUG-IV reimbursements.

Examples of System Reports:

1) Lost Business Report: This report provides information to the organization about reasons for lost business, showing lost referrals and related notes. Valuable business intelligence can help pinpoint potential problem areas with response times, business lost to competitors; services requested not offered by your organization, physicians suggesting other facilities, and more.

2) Payer Analysis: This report provides a detailed breakdown of each facility’s payer mix relative to payer type and carrier for the date range requested. It also provides the status of referrals for that same date rang, all essential for internal financial analysis.

3) Referral Decline Report: This report filters referral declines by reason. This simple example shows two patient declines, one because of bed availability and the other being outside of the service area requested. With complete data over time, these reports let providers assess and analyze reasons they are turning patients away, and adjust their processes, offerings or acceptance criteria accordingly.

4) Referral Management Report: This report provides a snapshot of the referrals requested within a date range.  Information includes the patient, gender, diagnosis category, primary payer, referral source, referral contact within the referral source, the referring physician, assigned physician, status of the referral and the status reason. This report is great for reviewing during team meetings.

5) Referral Trend Analysis: Designate a year and the report provides trends of referrals and admissions for each referral source and referring physician for each facility. This report also shows how many patients were assigned per physician for each facility.

6) Win/Loss Analysis: This valuable analysis provides an instant view of performance for one or multiple facilities over a user-defined date range, breaking down all referrals by status, as well as wins and admits, to provide a clear win percentage.