Financial Verification Through Dorado

A Message from Brandon Ribar, Senior Vice President of Operations

 

Recently, GLC has experienced an increase in patients we were unable to admit based on financial profiles that may have been incomplete or inaccurate. Please run the Dorado report to check benefits for every admission and readmission. Even if you obtain financial information on the hospital face sheet, you must run a Dorado report to verify the benefits for SNF coverage. In addition, we want to explore opportunities to admit patients where drug cost is carved out under certain state, managed care plans or Medicare reimbursement. 

 

For our Direct Connect offices, please ensure the consistent and thorough review of both new admissions and patients being readmitted to our facility and note any changes in reimbursement coverage.

 

To successfully meet our goal of caring for as many patients as clinically possible, we will increase scrutiny of our financial review process. When an admission is not offered for financial reasons, please talk with your Area Vice President prior to the denial. In an operating climate where admissions continue to be extremely competitive, we must be diligent in reviewing patient information and finding solutions to offer admission when clinically and financially appropriate. Thank you as always for your commitment to our patients, employees and our local communities.  

 

If you or the Area Vice President have questions about the potential options, the following people can help: 

 

High Cost Medications, Exclusions, Managed Benefits and Equipment Needs:

 

Sheila Blair – Medicare (479) 201-5711 direct, (479) 652-3251 cell

Chrissy Armstrong – Managed Care (479) 201-5747 direct, (918) 315-0641 cell

Michele Self – (972) 372-6359 direct, (317) 258-1534 cell

 

Medicaid Related Questions – Business Office Consultants

Celebrate Our Nurses May 6-12

With National Nurses Week around the corner, May 6-12, the marketing and communications teams along with our Vice President of Clinical Operations Wanda Prince have created a special campaign A Work of Heart to help celebrate our nurses across the Golden Living family of companies.

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Profile Your Nurses

We want to showcase the incredible nurses across Golden Living and AseraCare by including their stories in a special social media campaign during Nurses Week. Please send the following items to Carol Harber by April 10 to ensure we can recognize the individual nurses who give such wonderful care to our patients and residents.

• Name and title
• Year they graduated from nursing school
• Year they joined your agency or LivingCenter
• Picture or video (if picture includes a patient/resident, include a signed AseraCare or Golden Living consent form)
• Touching story about why you want us to profile them
• Nominator’s name and email address

T-Shirts and Giveaway Items

On the Gold Mine, you can order the custom t-shirts we designed for the campaign or use the “A Work of Heart” logo on any other items you may want to order to celebrate your nurses this week and every week. Some items you may want to order with this special logo:

• T-shirts
• Tote Bags
• Frosted Votive
• Mobile Pocket
• Over-the-Shoulder Lunch Cooler
• Bobble Iced Tumbler
• Other items available

Community Celebration Tools

To help you celebrate your nurses in your community, the following tools are available for you to download, customize and distribute to your local blogs, newspapers, radio stations and television stations.

• Letter to the editor to submit to the newspaper (GLC & AseraCare)
• Media Alert for Nurses Week Event (GLC & AseraCare)
• Informational Article to submit to the newspapers (GLC & AseraCare)
• Celebrations ideas for LivingCenters and Agencies (GLC & AseraCare)
• Thank You Letter (Marketing has provided thank you cards on Print Services – GLC & AseraCare)   

Preventing Avoidable Hospital Readmissions

A Message from Wanda Prince, Vice President of Clinical Operations

We understand that there are plenty of instances where hospital readmissions are the right thing to do at the time, and where the circumstances leading to readmission[s] were neither predictable nor preventable.  It is consistent with our mission and values to always do the right thing by the patient.  However, we must take clinically appropriate action to do what we can to prevent unplanned, avoidable hospital readmissions when we can by improving our patient monitoring, care, and communications.

When a frail, elderly patient is readmitted to the hospital, some undesirable outcomes could include:

• Increased risk for hospital-acquired infections
• Pressure sores
• Medication Errors
• Delirium when transferred between settings of care (transfer trauma)
• Long periods of time without appropriate medication or nutrition

We can help prevent readmissions through the following actions:

• Increasing attention to medication reconciliation and adjustment of meds accordingly
• Proactively identifying those patients with acute conditions that may warrant additional medical treatment and interventions
• Review diagnoses, prognoses and advance directives to effectively guide health care decisions
• Proactively communicating with physicians, residents and patients or health care surrogates and decision makers, as well as members of the IDT
• Greater communication with the emergency room personnel prior to and during hospital transfers and being clear about our capabilities to care for patients
• Using tools, such as the CNA communication tool “Stop & Watch” and SBAR to improve communication between caregivers during a change of condition
• Use of eInteract4 to “improve care by early identification, assessment, documentation and communication about changes in the status of a resident’s condition” with the attached QRC for use of eInteract4 (see attachment)

We have additional tools available to help you and your caregiving team better monitor, evaluate and assess whether a patient or resident needs to be admitted to the hospital and to prevent future hospitalizations when issues can be identified early enough to prevent a hospital visit.

Resources to equip your team to prevent hospital readmissions include:

• Thursday Triage Purpose (attached checklist)
• Golden Living SBAR Tool
• Golden Lviing COC/CHS Guideline
• CSU Guideline
• CSU Checklist for Weekdays
• CSU Checklist for Weekends

If you have any questions, please contact your Field Services Clinical Director.

Golden Living Announces 2015 GLC Medical Directors of the Year and Celebrates Doctors’ Day

National Doctors’ Day is Monday, March 30. this is a great time to announce our 2015 Golden LivingCenter Medical Director of the Year award winners.

This is the fifth year for this award, and it’s a wonderful way to recognize how essential our Medical Directors are to the quality of care provided by Golden Living. They are aligned with our company mission and strive to make decisions based on our Golden Living values of integrity, accountability, excellence, and quality. These outstanding Medical Directors practice with clinical excellence that epitomizes Golden Living’s long-term and post-acute care.

The winners were nominated by our Executive Directors and Directors of Nursing Services. These nominations were reviewed by Golden Living administrative, nursing, and medical leaders. Our winners demonstrate clinical excellence in patient care, facility leadership, make contributions to quality of care in the LivingCenter, and are involved in the community.

We announced these Medical Directors at the Golden Living Gala earlier this month in Louisville, Ky., where the American Medical Directors Association (AMDA) held its Long Term Care Medicine 2015 Conference. Each one of these physicians is unique but all share one distinguishing professional attribute: an unwavering dedication to our patients and their care.

My congratulations goes to our 2015 GLC Medical Directors of the Year:

TEAM 1 – WEST

Dr. Deepak Shrivastava

GLC-Portside, Hy-Pana & Chateau, Calif.

TEAM 2 – NORTHEAST

Dr. Alfred Baum

GLC – Plymouth, Mass.

TEAM 3 – SOUTHEAST

Dr. Aysha Habib

GLC- Elizabeth Adam Crump, Va. & GLCommunity-Elizabeth House, Va.

The nominees this year were:

NAME	LOCATION
Dr. Thomas Bailey	GLC-Lincoln Hills, Ind.
Dr. Alfred Baum	GLC-Plymouth, Mass.
Dr. William Blume	GLC-Brentwood, Ind.
Dr. Joel Bolen	GLC-Montgomery, Ala.
Dr. Domenick Brasile	GLC-Western Reserve, Pa.
Dr. Jerry Bruggeman	GLC-Glasgow, Mo.
Dr. Monica Brunelle	GLC-Brookview, Ind.
Dr. Richard Chung	GLC-Independence, Kan.
Dr. Brian Clonts	GLC-Branson, Mo.
Dr. Darwin Davis, Jr.	GLC-Bloomfield, Mo.
Dr. Stuart Edmiston	GLC-Richmond, Ind.
Dr. Nathaniel Grow	GLC-Petersburg, Ind.
Dr. Aysha Habib	GLC-Elizabeth Adam Crump, Va. & GLCommunity-Elizabeth House, Va.
Dr. Peter Halmos	GLC-Cumberland, Md.
Dr. Travis Henderson	GLC-Mobridge, S.D.
Dr. Randall Horine	GLC-North Willow, Ind.
Dr. Linda Mazour	GLC-Franklin, Neb.
Dr. Tamara McCue	GLC-Wellington, Kan.
Dr. R. Cecil McInnis, Jr.	GLC-Riverchase, Ala.
Dr. Parvez Memon	GLC-Bakersfield & GLC-Shafter, Calif.
Dr. John Middleton	GLC-Westminster, Md.
Dr. Abdul Mohiuddin	GLC-Petersburg, Va.
Dr. Dana Nash	GLC-Southaven, Miss.
Dr. Ward Paine	GLC-Morgantown, W.V.
Dr. Tiffany Reed	GLC-Greensboro, N.C.
Dr. Frank Reusché	GLC-Walnut Creek, Pa.
Dr. Chester Rogers	GLC-Mishawaka, Ind.
Dr. Aaron Shives	GLC-Watertown, S.D.
Dr. Deepak Shrivastava	GLC-Portside, GLC-Hy-Pana & GLC-Chateau, Calif.
Dr. Daljeet Singh	GLC-New Haven, Mo.
Dr. Tarlochan Tagore	GLC-Sanger, Calif.
Dr. Luther Thomas, III	GLC-Augusta, Ga.
Dr. Teofilo Vinluan	GLC-Merrillville, Ind.
Dr. Mark VogtDr. David Weintrab	GLC-Westwood, Mo.GLC-Wedgemere & GLC-Oak Hill, Mass.

 

 

Doctors’ Day

National Doctors’ Day provides us an opportunity to honor all of our Golden LivingCenter and AseraCare Medical Directors for their dedication in serving our patients and residents and being such an integral part of our team.

Our Medical Directors are responsible for ensuring that all patients and residents receive compassionate and appropriate care that enables them to live life to the fullest. Their knowledge of geriatric care provides patient care teams a valuable source of guidance and insight. Their leadership also helps create supportive work environments and community partnerships.

Benefits News 3-30-15

• Benefits News & Quick Links
• Spend Down Your HCSA and DCAP – Deadline Coming Soon
• Don’t Forget to Schedule Your 2015 Annual Screening
• Know Your Numbers Winner Announced
• March is Save Your Vision Month
• 2015 Summary Plan Description Now Available Online
• Golden Perks: AT&T Special Offer and Verizon Wireless Discount

Safety Incentive Program: Apply for First Quarter 2015

• Executive Directors
• Directors of Nursing Services
• Directors of Clinical Education
• Safety Committees

SAFETY AND LOSS CONTROL

Starting April 1, 2015, submit your documentation if your LivingCenter has earned the First Quarter 2015 Safety Incentive Program (SIP) award.

Step 1.  To Qualify for the SIP:

• Your LivingCenter must not have had an injury that caused the employee to miss work beyond the state workers’ compensation waiting period in the first quarter of 2015 and was paid by workers’ comp for lost wages unless the facility had offered modified duty to the injured employee and either the injured worker turned down the modified duty or the modified duty of 60-90 days had been exhausted. This criteria also will apply if your facility earned the third quarter Safety Incentive, but within the fourth quarter, the claim from January, February and March now does not meet the above criteria. (S&LC will help with a review of the claims and notifying you if your facility is eligible and should submit the additional documents to qualify for the SIP, since this is new way of reviewing eligibility!)
• Your LivingCenter must not have had an injury where the cause was manual lifting of a resident from the floor in the first quarter.

Step 2. No later than Friday, April 24:

1. Send Rita Harris ONE e-mail notifying her that your LivingCenter is eligible for the first quarter 2015 SIP.
2. Attach to THAT SAME e-mail a copy of your OSHA 300 log for 2015 YTD.
3. Attach to THAT SAME e-mail a copy of your January, February and March 2015 Safety Committee Minutes (minutes only, no other attachments/handouts).

Step 3. Watch for an announcement in a May 11 issue of InnerCircle, with the names of the LivingCenters that earned the SIP and the amount to be allocated to each LivingCenter. 

Safety Committee minutes are required.

An active Safety Committee is a vital part of the entire safety program, and Safety Committee meetings are where discussions about safety incentive expenditures should be taking place. Please note that submitting your January, February and March 2015 Safety Committee Minutes is now an eligibility requirement of applying for the SIP. When applying for the SIP, please make sure your LivingCenter name and location number are clearly stated in the subject line of your e-mail, on the OSHA log and on the Safety Committee Minutes  If you are unclear about Safety Committee requirements, please contact your Safety and Loss Control consultant.

Need to submit documentation for first quarter 2015 SIP?

 Send ONE e-mail to Rita Harris: rita.harris@goldenliving.com

Note 1: Attach to the e-mail your 2014 OSHA log YTD and your January, February and March 2015 Safety Committee Minutes.

Note 2: The OSHA 300 logs for 2015 are to be kept in electronic format using the Excel file that is available via the intranet, on the Departments/S&LC/OSHA/OSHA Facilities Log 2014 Template.

 Questions

If you have questions about the Safety Incentive Program, contact your Safety and Loss Control Consultant or the Safety and Loss Control department.

Medicare First Quarter Credit Balance Reports Due by April 23

• Executive Directors
• Directors of Nursing Services
• Business Office Managers
• CBO Managers
• Medicare Billing Specialists
• Business Office Consultants
• Facility Business Office Coordinators

Distribution and due dates for Medicare credit balance reports for the quarter ending March 31 are provided below. The CMS-838 spreadsheet(s) and/or Certification page must be faxed to the Medicare Claims Unit at fax 479-478-2107 (or alternate fax 479-478-2121) by the due date indicated.

FORT SMITH CBO

1. Medicare billing specialists review the Medicare aging and complete the CMS-838 spreadsheet if there are “true” credits that must be reported. A Certification page is completed that must be signed by the ED.
2. The CMS-838 spreadsheet and/or Certification page is e-mailed to the ED and BOM by Thursday April 16.

FACILITIES

1. The ED will sign the Certification page and, unless specifically instructed otherwise by the CBO or BOC, will fax it directly to the Medicare Claims Unit by Thursday April 23.
2. The Fort Smith CBO Medicare manager will review and sign the completed CMS-838 spreadsheet for the Medicare billing specialist.

MEDICARE REGULATIONS

Medicare requires the executive director’s signature on the Certification page. If the ED is scheduled to be out of the building or if the facility is currently without an ED, the person designated as acting ED must sign the Certification page.

A provider will be placed on payment suspension if the credit balance report is not received by the filing deadline. A signed Certification page is required even if your facility does not have any Medicare credits reported on the CMS-838 spreadsheet. A payment suspension will be assessed if the Certification page is not received.

Additional information on the quarterly credit balance report process can be found in Chapter 12, Credit Balance Reporting, in the Medicare Billing Manual.

QUESTIONS?

Contact your Medicare Specialist  877-823-8375

FAXING IN CERTIFICATION PAGE OR OTHER FORMS?

Fax to Patient Accounting/Medicare Fax 479-478-2107 or 479-478-2121

Announcing New Resident Trust Statement Distribution Process

• Executive Directors
• Facility Business Office Coordinators
• Resident Trust Fund Custodians
• Business Office Consultants
• Directors of Business Office Operations

First quarter resident trust fund statements will be distributed as follows:

• National Data Care (NDC) will mail statements to recipients whose address in RFMS is not the LivingCenter address. This eliminates the need to mail statements from the LivingCenter.   
• NDC will continue to send two complete sets of statements to the LivingCenter.

New LivingCenter Distribution Process

Effective immediately, the process below must be followed for quarterly trust statements that must be delivered to patients in the LivingCenter:

• ED or designated employee, other than the Trust Fund Custodian, will distribute quarterly trust statements to patients who are to receive the statement in-house.
• Trust fund custodian will print the RFMS Resident Address Report that lists patients with active trust accounts and provide the report to the ED or designated employee for statement distribution.
• Designated employee will provide quarterly trust statements to patients listed on the RFMS Resident Address Report that have a LivingCenter address.
• The ED or designated employee must initial the patient’s duplicate statement copy and note the method of delivery and date delivered (e.g., hand delivered to patient on 4/8/15). If a cover letter is used listing patients to whom statements were delivered, the ED and designated employee must sign the cover letter as attestation that the quarterly statements were delivered.

NOTE:  If more stringent state laws and/or policies exist regarding verification that the quarterly statements were issued, refer to and follow your state procedures. For example, if your state requires that the LivingCenter obtains the patient’s and/or representative’s signature on a copy of the quarterly statement to verify receipt, that policy is more stringent than company policy. In this case, it is not necessary for the ED and designated employee to initial and date another copy of the quarterly statement.

Questions:

Contact your business office consultant or director of business office operations

 

April Business Office Training Schedule Announced

Instructor-led training will be provided during April on the following business office topics:

• Medicaid Pending
• Direct Deposit
• Resident Trust
• Deferral Strategies
• Bad Debt
• Authorizations and Notifications
• Missing Documents
• Business Office Duties and Frequency
• Weekly Business Office Meeting Template
• Private Collections

Business Office Consultants will conduct the training sessions on the dates provided in the “April Training Schedule” attachment.  Employees can sign up for the sessions by going to the company website and accessing them in the Learning Center.

The following attached reference guides provide information on how to register for and join a training session in the new Learning Center:

• Learning Center – Search and Register for a Course
• Learning Center – Joining a Training Session using WebEx

Questions:

Contact your Business Office Consultant or Director of Business Office Operations

Clinical Operations Names Sue Spirk to Field Services Director

A Message from Wanda Prince, Vice President of Clinical Operations

I am pleased to announce that the Clinical Operations team has promoted Sue Spirk to a Field Services Director overseeing Pennsylvania, New Jersey and Ohio.

In this new role, Sue will direct and develop our Field Services Clinicians, helping them with skills development as well as supporting them in responsibilities around ensuring the quality of our clinical care. She also will help monitor the implementation of company initiatives, as well as oversee compliance with regulatory requirements and company standards and policies. In addition, her role will include development of risk management plans and support of the clinical service we provide to patients and residents in our LivingCenters.

Sue joined Golden Living in February 2012 and brought over 30 years of nursing experience with her. Immediately prior to joining Golden Living, Sue served as the concurrent review nurse for Capital Blue Cross in Harrisburg, Pa. where she performed clinical reviews and utilization management oversight for members in skilled nursing facilities, acute rehabilitation hospitals and acute hospitals. Sue also spent six years as the staff development coordinator for Beverly Healthcare in Lansdale, Pa.

Prior to Beverly, Sue worked as a nurse at the Good Shepherd Rehabilitation Hospital, St. Luke’s Hospital, Easton Hospital and Christian Hospital Northeast. She holds a Bachelor of Arts Liberal Studies from Thomas Edison State College and an Associates Degree of Applied Science in Nursing from St. Louis Community College Forest Park.

Please join me in supporting Sue as she assumes her new role as a Field Services Director.