Nursing Home Case Study: Increasing Reimbursements
September 27, 2023
This case study showcases elevating clinical documentation and enhancing reimbursements for an Ohio skilled nursing facility. Facing documentation issues with Certified Nursing Assistants (CNAs), the facility experienced a rise in "Do Not Returns" (DNRs), a problem pervasive among both full-time and agency staff.
The study reveals the core issue within the facility's data management system – glitches that led CNAs to miss crucial care documentation. Further investigation unearthed log-in problems, causing undocumented downtimes, and issues with assignment changes.
While CNA documentation doesn't directly determine reimbursement, it significantly impacts it.
Accurate documentation informs care levels and subsequent reimbursement. CNAs document Activities of Daily Living (ADLs) and patient abilities, driving further assessments by the care team. Centers for Medicare and Medicaid (CMS) strictly adhere to reimbursement rules, emphasizing documentation's billing importance.
Through collaboration, various systemic improvements were implemented that provided:
A 57% reduction in documentation related DNRs
Enhanced messaging capabilities, reminders, and training modules to prioritize documentation for nurses.
Efficient incident resolution, investigation, and prevention while helping to improve documentation and drive reimbursements for its partner facilities.
Achieve Value, Efficiency, and Scale With Evidence-Based Clinical Content
September 21, 2023
Payers are working to design, implement, and support benefits that meet business goals and make employer groups, providers, customers, and members happy. Doing so amid rapid changes like Artificial Intelligence, rising health costs, precision medicine, and new clinical information can make these efforts complex and arduous.
Teams with harmonized, evidence-based clinical information scaled across a complex matrixed organization are in a position to improve business processes, save costs, and improve their members’ experience and outcomes. Learn how access to UpToDate clinical decision support can support payers with the latest evidence-based information.
Filling the Healthcare Education Gap: A Care Management Opportunity
September 21, 2023
80% of Americans still have questions after healthcare visits. Healthcare payers struggling to reach members can become a trusted source of educational content and programs in an untapped opportunity to improve member experience and care management efforts.
Get the five lessons from a consumer survey on what consumers want from health educational materials in the whitepaper “Filling the healthcare education gap: A care management opportunity”.
Denials are a constantly moving target due to factors often outside of a health organization’s control, such as new payer rules or patients switching medical plans. However, if left unresolved, denials can represent an average loss of up to 5% of net patient revenue.
So, how can we get ahead of denials in healthcare? With the proper insights and action, health organizations can prevent more upfront denials, empower staff with the right tools, and reduce revenue leakage.
Take a deep dive into denials, examining where they most frequently originate to the latest research and strategies to stay ahead.
What's in the report?
Research on the current state of denials
Steps to prevent, prioritize, and outsmart denials
Case study examples on how healthcare organizations benefit from purpose-built automation
Human Resources for a Changing Healthcare Workforce
September 15, 2023
As the healthcare workforce continues to evolve, so does the role of human resources.
HR leaders are no longer siloed and left to focus on only benefits programs. They are a larger part of the organizational C-suite leadership, strategizing on workplace culture, impacts on employee wellbeing, ways to combat burnout, and recruitment and retention efforts.
Learn from HR professionals in healthcare and other industries on how to keep up with the changing tides.