Maureen McCarthy of Celtic Consulting, a solution provider at the marcus evans LTC & Senior Living CXO Summit Spring 2015, on care coordination in the healthcare industry
NEW YORK, NY, Jan 26, 2015 - (ACN Newswire) - "Many long-term care (LTC) facilities are multi-disciplinary, not inter-disciplinary. They are not working together towards a common goal," according to Maureen McCarthy, Chief Executive Officer, Celtic Consulting.
There is a general lack of care coordination and effective compliance plans. This must be addressed, otherwise they will be at risk of losing revenue," she believes.
A compliance and clinical reimbursement services provider, Celtic Consulting is attending the marcus evans LTC & Senior Living CXO Summit Spring 2015, in Los Angeles, California, February 9-10.
- What is missing in the LTC industry today? What could be done better?
Coordination between the various levels of health providers is a major gap. We all have to learn to work together and it will be a bumpy road until we get there.
One of the missing pieces in LTC is effective compliance plans. Many providers do pieces of a compliance plan, make sure to follow the sanctions rule list, hire a compliance officer and set up a 1-800 line, but then they do not audit internal operations to ensure compliance with state and federal regulations.
Although the Centers for Medicare & Medicaid Services (CMS) is holding back the auditors, they will be coming back out. It is in every facility's best interest to correct these issues to avoid revenue losses.
- How could facilities bring in more revenue?
By following all the regulations, not leaving dollars on the table, and having a team that is cohesive, coordinating and communicating on a daily basis.
- How could billing and denials management be done better?
Communication is key. It all starts at the front door. Before a resident gets to the facility, consider whether all regulations on admissions paperwork are followed, if the proper notices are given at the time of admission, and if all the departments understand the care plan for that patient. Many times the various disciplines are not coordinating their work.
To improve billing and denials management, all the pieces from the admissions card to the nursing document have to be there, for billing to capture what it needs to and for the coding on the claim to be correct.
- Rehospitalization rate reduction is a key focus. What can be done?
LTC providers can be that secondary unit for hospitals - that is what they bring to the table. If a patient recently had a three-day qualifying stay and was looking to be readmitted within the 30-day window, he can go to a skilled nursing facility instead of the hospital.
Skilled nursing facilities must ensure their local and referring hospital understand what services they can provide, so the patient can leave the emergency room and have a direct admit to their facility, where those services are closer and less costly.
- What advice could you share on boosting reimbursement?
Potentially there will be a three percent reduction from Medicare related to rehospitalization. CMS will next look at home health then skilled nursing. Providers should take a good look at reducing rehospitalization and if they could have cared for the patient in-house. Sending a resident back to the hospital for a treatable condition does not say much about what care they can provide.
To stay solvent as a provider, look at where healthcare is going and make sure you can get there.
About the LTC & Senior Living CXO Summit Spring 2015
The 8th Long-Term Care & Senior Living CXO Summit is the premium forum bringing senior level executives and solution providers together. The Summit offers an intimate environment for a focused discussion of key new drivers shaping the long-term care industry. Taking place at The Ritz-Carlton, Marina del Rey, Los Angeles, California, February 9-10, 2015, the Summit includes presentations on improving efficiency and profit margins, reimbursement management and strategy, catering for the baby boomers and reducing readmissions.
For more information please send an email to press@marcusevanscy.com or visit the event website at www.longtermcaresummit.com/MaureenMcCarthyInterview
marcus evans group - healthcare sector portal - www.marcusevans.com/reviews/healthcare
Please note that the Summit is a closed business event and the number of participants strictly limited.
About Celtic Consulting
Celtic Consulting provides compliance and clinical reimbursement services to long term care, post-acute providers, and education and training services to promote overall efficiency and revenue optimization. Celtic Consulting commonly provides services in the following areas: Rehospitalization Rate Reduction, Billing & Denials Management, Compliance Auditing, PPS/MDS/RAI/CMI Management, Quality Improvement (QM/QAPI/5-star), ICD-10 preparation and training, and Revenue Optimization. Additionally, Celtic Consulting provides educational seminars in a variety of service areas, specific to each organization's needs, including corporate training events. www.celticconsulting.org.
About marcus evans Summits
marcus evans Summits are high level business forums for the world's leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, think tanks, seminars and one-on-one business meetings. For more information, please visit www.marcusevans.com.
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