How Simione Consultants Can Help You: Frequently Asked Questions

1. Since the cutback in PPS reimbursement, our agency has been losing money every month...
2. We have a significant number of long term wound care cases...
3. Our PPS case mix has dropped over the past 6 months...
4. We are very unhappy with our current Information System and are considering purchasing a new system...
5. My Board of Directors is considering diversifying into private duty/private pay services...
6. Several months ago our agency began the process of HIPAA implementation...
7. We are experiencing large peaks and valleys in our monthly Medicare revenue...
8. My DSOs are rising...
9. How can I use my cost report for more than compliance...

"Since the cutback in PPS reimbursement, our agency has been losing money every month. We have looked at our operational processes, but still can't find the reason for our losses. What could Simione Consultants do to help us?"

Many agencies are struggling for survival after the recent cutbacks in PPS reimbursement. Simione Consultants, LLC as consultants, are able to take an objective and detailed look at all workflow processes including administrative, clinical, business, and financial operations. Using a multi-faceted approach, we will identify the reasons for your financial loses by scrutinizing your operations from referral intake through claim submission. With agency-specific recommendations, we can help you streamline all your clinical and financial operations so your agency will prosper under the PPS rate cutbacks.

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"We have a significant number of long term wound care cases. With the required frequent skilled visits and increased cost of providing medical supplies, caring for these patients is having a negative impact on our bottom line. How do we provide excellent care while controlling our costs?"

Wound care management can be particularly challenging for a home care agency. To assist agencies balance the cost and care of wound care patients, Simone Consultants, LLC, developed a wound care management program for our clients. Our assessment includes investigation of the OASIS scoring for accuracy; LOS and factors that impact on LOS; current agency wound care protocols; physician preferences and referral patterns; current clinical practice patterns; cultural influences; medical supply management; and additional educational needs of staff. Using the results of our analysis, we develop custom recommendations for your agency that will be successful in decreasing the costs of providing wound care treatments for this patient population.

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"Our PPS case mix has dropped over the past 6 months. The clinicians have been trained in OASIS assessments, but I suspect the drop in case mix may be related to the way they are answering the OASIS items. What can we do to be sure we are answering the questions accurately and maximizing our case mix?"

We encourage agencies to routinely monitor their PPS case mix to ensure that they receive the reimbursement they deserve. Simione Consultants, LLC has performed many OASIS Validation Audits for agencies who had the same question and concerns as you. An OASIS Validation Audit by our clinical experts will provide you with an objective analysis of OASIS completion decisions. Using the results of our audit, you will be able to compare your actual case mix to a derived case mix, quantify your reimbursement potential, identify trends and patterns that affect reimbursement, and recognize the further educational needs of your staff.

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"We are very unhappy with our current Information System and are considering purchasing a new system. But we did this 4 years ago and I am not sure if we will be better off buying a new system. And beside the expense, implementation always takes so much out of our organization. What can we do?"

Simione Consultants, LLC encourages organizations to be sure they really need to move to a new system. As you noted, this is not cheap or easy. We can support your decision making process by assessing how completely you are using the current system, and how that system is addressing your IS needs. You will know whether or not you are getting all you can from the system and if it is capable of meeting your needs. In the end, if a decision is reached to purchase a new system, you will know it is the right one. We also can assist you in the search for the new system.

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"My Board of Directors is considering diversifying into private duty/private pay services. How do I make this a viable program?"

Private duty services are an excellent complement to a Medicare certified program. As a first step to success, Simione Consultants would do an in-depth market analysis to determine current competitors and services offered, pricing, market saturation, and unmet needs and wants of the community. Using that information, we would work with you to develop agency-specific programs, design an organizational structure to support those programs, lay out clinical and financial operating procedures, and provide you with proven marketing strategies.

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"Several months ago our agency began the process of HIPAA implementation. Just recently the chairperson of the task force became ill and found it necessary to take a leave of absence. I now understand that we are behind in the implementation, particularly in developing our policies and procedures and actually implementing the p&p's in our agency. I need help quickly. Do you have someone with strong HIPAA knowledge that can lead the task force to the completion of our implementation projects?"

Simione Consultants, LLC has a team of HIPAA experts who have devoted the last year to HIPAA implementation. Simione Consultants can provide a knowledgeable HIPAA consultant to take over the leadership of your HIPAA team and assist you in the completion of the remaining tasks, including developing your policies and procedures and educating your staff. Give us a call and learn how we can help you to the finish line.

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"We are experiencing large peaks and valleys in our monthly Medicare revenue. What can I do to prevent this?"

As there are several different methods (i.e., 60 day episode, average length of an episode, published charges, visits, etc) agencies are using to recognize Medicare revenue under PPS, it would first be essential to review the methodology your agency has chosen to record revenue, as well as the way adjustments for intervening events (LUPA, SCIC, PEP, Outlier, Therapy Utilization) which have an impact on revenue are accounted for. Simione Consultants, LLC has assisted many agencies with revenue recognition validation assessments which review methodology and source documents in addition to operational processes affecting information timing and flow into all Information Systems utilized.

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"My DSOs are rising. How can I reduce my days in receivables without jeopardizing my current billing?"

Under PPS Medicare billing is no longer tied to a monthly cycle and closing process. This has necessitated changes in the workflow processes for billing staff. First, we would determine if you have the appropriate number of staff as well as the right level of staff, and then look for inefficiencies in all areas that impact the billing and collection process. Simione Consultants, LLC recognizes that many stumbling blocks to successful billing and collection activity are produced in "front office" areas such as intake, insurance verification or patient registration procedures, as well as OASIS processing. Getting clean claims out timely requires cooperation and efficient processes from many areas outside of the control of the billing staff. Simione Consultants, LLC offers Accounts Receivable Management Reviews utilizing a combination of clinical, operational, and financial consultants to evaluate where processes, systems, or your staff needs improvement, in addition to training in all areas found to be lacking.

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"How can I use my cost report for more than compliance? I would like to use it more as a management tool"

Due to the delay in submission requirements for Medicare Cost Reports with the implementation of PPS, many providers have abandoned the practice of preparing monthly or quarterly cost reports for internal use. It is not necessary to follow the Medicare regulations and complete the entire cost report when preparing a cost report for internal use. Simione Consultants, LLC can assist providers in identifying the key data elements from the cost report that are useful to management, and actual cost report preparation and analysis. The strategic advantage is the ability to monitor volume trends in addition to costs and gains or losses by discipline and by pay source. Having accurate and comparative information can help providers adjust operationally to trends in a timely manner.

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