Don't Be Afraid of Monsters Under the Bed...It's Just Reimbursement.

Don't Be Afraid of Monsters Under the Bed...It's Just Reimbursement.

For many Long Term Care and Continuing Care organizations staffing challenges, thinning margins, and end to pandemic led government financial assistance and inflation continue to cause cash flow issues, that have unequivocally intensified to a degree that have organizations reeling and many on the brink of failure. For all organizations, effective reimbursement processes and use of beneficial technologies remain incredibly vital in helping to ensure cash flow, compliance and ultimately organizational stability and sustainability. However, the reality is that many organizations fail to routinely scrutinize their processes used for reimbursement. And this is a mistake.

Reimbursement is an area that all organizations have a stake in and an area where they can take action! Many organization leaders I have spoken with have communicated to me that they “believed” reimbursement and compliance in their organization is being optimized and is compliant. Yet, when pressed, many were unsure of how reimbursement and compliance is being routinely assessed or even who is responsible for this. Organizations would do best to ensure that their reimbursement processes and the compliance needed to keep that reimbursement are fully intact and functioning at the highest level- at all times. This can be accomplished by completing routine all payer Revenue Integrity Reviews.

A Revenue Integrity Review will focus on key processes such as coding accuracy, documentation, appropriate charge capturing and more to improve reimbursement. It will identify trends and opportunities for appropriate development and implementation of improved processes including needed training and education. A Revenue Integrity Review will also help you maintain a proactive approach on denials. Routinely reviewing reimbursement processes that identify opportunities for improvement should become the norm especially given the current financial environment. Leaders should not and cannot shy away from closely examining reimbursement. And, if organizations do not have the expertise or the band-with in-house to do this then they must admit this and consider outside consulting expertise for needed guidance and support. Don’t be afraid -there’s only a monster here if you choose to do nothing.

For more information, please contact:

Michael F. Masse, OTR/L


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