Overcoming Reimbursement Challenges through Training

October 2011 new rates went into effect for Medicare reimbursement at skilled nursing facilities, meaning SNFs across the country could see an average 11.1% overall rate cut depending on factors such as patient care needs and facility location. Even before the new rates went into effect the proposed changes were already having an impact on facilities nationwide, where scores of projects were cut and employees let go in anticipation of the changes.

Now more than ever it is vital that facilities take steps to minimize risk and unnecessary expenses in order to ensure optimal reimbursement—and the answer lies in developing a highly skilled staff that knows what to do and how to do it most effectively. Here’s how to begin:

• Identify Training Needs. Gaps in training (and documentation) give surveyors and attorneys a negative assessment of the facility. Use electronic tracking to create reports to help determine who has and has not completed training.
• Identify Expense Sinks. An expense sink is an area that takes money down the drain. One major expense sink under scrutiny lately is unnecessary hospital readmission. Studies show up to half of residents readmitted to the hospital within 30 days of discharge could have been cared for at the facility.
• Identify Revenue Boosters. An overlooked revenue generator is restorative nursing. Restorative nursing programs not only generate revenue from Medicare, but they also improve quality of life for facility residents. A well-managed restorative nursing program can bring profit to the facility’s bottom line.
• Identify Risk Areas. Minimizing risk will almost always maximize revenue. Two common risk areas are falls and pressure ulcers—the leading causes of lawsuits in skilled nursing facilities. All staff should have training in behavioral and personality issues that affect falls, and pressure ulcer prevention methods should be trained and retrained.

In addition to incorporating federal and state requirements, your training program should take into account the risk areas you have identified. From there you can develop a curriculum based on the needs of your staff.  Be sure to communicate clear expectations so staff members know what is expected of them, and remember: The best learning strategy is to develop a ‘culture of learning’ in the facility—one that advocates ongoing education and its importance for optimal patient care and facility success.