LTC Consulting

billing

Business Office Services

Billing and Collections

Account collections, billing, and the efficient running of your business office are crucial to your organization, but how often do they measure up to the unique needs of your facility? SMS delivers full-spectrum business office services, customized to your unique needs, including:

  • Claims Submission for Medicare / Medicaid / Insurance
  • Billing and Collection Training
  • Medicare Intermediary Software Training
  • Accounts Receivable Management
  • DMERC Billing or Part B FI Billing
  • Medicaid Room and Board, Oxygen and Therapy
  • Software Selection and Conversion Consulting
  • Business Office Assessment
  • Temporary Business Office management and staff
  • On-site seminars or training

 

Let SMS review your Medicare Part A and B claims and aging report and give you a free call to review findings and issues.

Outsourcing Services

SMS eases the challenge of moving to an outsourced billing mode l by providing services to meet all or part of your receivable management requirements including Medicaid, Medicare Part A and Medicare Part B, Medicare Co-Insurance as well as HMO and insurance. SMS can also close the loop on running month end reports on A/R software, allowing you to operate more efficiently and profitably.

Compliance Servicescompliance

SMS delivers a full range of consulting ser vices to the long-term care industry. The mountain of regulatory and compliance requirements you face in the long term care industry requires a well-thought-out compliance plan which is clearly understood and followed by your staff.

SMS offers on-site compliance survey follow-up that include a full circle approach to ongoing compliance planning and quality care delivery. We can deliver training through in-service programs for your new and existing staff, versing them in federal regulations, systems for quality care, and understanding the survey process.

SMS offers qualified assessment of your facility practices with an eye toward design and implementation of new or revised systems of quality of care delivery. Once these systems are designed, SMS follows up with implementation of these systems and monitoring of the plan of correction, working on an ongoing basis with your facility personnel to motivate, teach and mentor. The result of this process is compliant, efficient, high quality care programs.

MDS/RAI ProcessMDS-RAI

In the SNF and Swing-bed segments of the health care industry, it can be challenging to complete MDS assessments accurately and on-time. SMS recognizes that you face issues in these areas, ranging from in adequate training to understaffing, ever changing directives from CMS, and the burden of staff turnover that only increase your challenge.

SMS to the rescue. We deliver training and/or comprehensive audits to help you through the RAI process. SMS understands the RAI process, providing MDS validity audits and delivering training and mentoring to pass this understanding on to your clinical team. Our training includes RAP documentation, Care Plan development, Transmission/Submission requirements, MDS Validity and follow-up. SMS provides you with quality indicator and quality measure review, care- and action-plan development, helping to define and implement effective team interaction and responsibilities.

Medicare Operational Auditsmedicare-audit

SMS provides unparalleled expertise in the area of Medicare compliance, delivering full- or limited-scope review capabilities for clinical and financial Medicare operations. We enable you to customize the specific area(s) of review your as your needs dictate, focusing on particular targets of concern, and providing a written report at the conclusion of the audit process detailing findings and recommendations for compliance improvement.

Compliance requirements change with staggering frequency; SMS can help you to know that your Medicare programs are in line with the law.

Trainingtraining

It’s a proven fact that well-trained individuals are more effective and efficient in their roles, which in turn allows their employer organizations to be more efficient and profitable. SMS offers a full range of training for health care organizations to help them achieve the results they require from their staff.

SMS offers training programs that address a full range of services, all of which can be tailored to your unique needs. SMS training can be delivered on-site or at a common location for multiple facilities. Current program tracks include:

Financial/Billing Clinical Medicare
  • Medicare A Billing
  • Medicare B Billing
  • Advanced Medicare Billing
  • Medicaid Principles
  • Collections
  • Business Office Steps to Efficiency
  • Advance Directives
  • Restraint Use and Reduction
  • Social Service in Long Term Care
  • Fall Assessment and Management
  • Abuse Identification and Investigation
  • MDS/RAP Care Planning Can be departmental-specific
  • Quality Indicators and Quality Assurance
  • Leadership/DON Mentoring
  • Specialty Unit Development
  • Skin/wound care assessment and documentation
  • Nursing Documentation
  • Medicare Basics – Technical Requirements
  • Clinical: Nursing and Therapy
  • Medicare and the MDS
  • MDS Coding
  • MDS Reasons
  • Setting Assessment Reference Dates
  • RUG’s- Resource Utilization Groups
  • Documenting Medicare Skilled Serviced
  • Denials: An Interdisciplinary Approach

SNF Hotline/FAQhotline

Sometimes you need the answers to tough Medicare or SNF operational questions quickly, but you might not know where to turn. SMS delivers the expert knowledge to give you rapid, reliable answers to your Medicare, corporate compliance, survey preparation and return to compliance, plan of correction and SNF clinical, financial and administrative operations questions.

SMS guarantees same day or next business day return of your phone call (email and fax are included) with prompt, accurate, friendly answers to your toughest questions about:

  • MDS’s
    • Assessment Reference Date Setting
    • Combination/Replacement Assessment
    • MDS Coding
  • Medicare Billing
    • Claim Completion
    • Medicare Secondary Payer
  • Medicaid Billing
  • DMERC Billing
  • Medicare
    • Coverage Decisions
    • Medicare benefit determinations
    • Ancillary Services liability
  • Survey and compliance issues
  • Clinical Operations
    • Restraint Reduction
    • Wound/Skin Care
    • Restorative/Rehab nursing
  • State Regulations
  • Federal Regulations

Survey Preparedness and Responsesurvey

There’s really only one effective way to go into a survey expecting positive outcomes, and that is to go into the certification and licensure survey well prepared. There is no better way to get prepared than to plan for your next survey