Financial Advocacy in Discharge Delays AKA: How to Avoid Patients Establishing a Permanent Residence in Your Facility

Emily Arias Regional Vice President MedData January 2017 Nicole Redman Director – Patient Access Sanford Health

Question – of all the Discharge Planning regulations proposed by CMS from 2015 to present – how many were adopted? 33 I was going to try and read them all (roughly 70 pages) – before this presentation and then decided…that’s crazy.

Does discharge planning feel like financial hot potato between facilities?

Hint: Cool Down the Potato

First Steps Estimate of Eligibility Application Copy Verifications Copies as Able & When Needed Pending Status Tips From the Field

Barriers To Coverage Family Responsiveness Immigration Status Need for Social Security or State Based Disability Determination Unknown Details Requiring Investigation State to State Transfer/Residency Discrepancy Tips From the Field

Medicaid Variance by State

Patient-Focused Experience Patient Responsibility Patient-Focused Experience Financials aren’t to be forced – they are mutual discussions with dialogue between families and hospitals. Hear the concerns, provide clarity and resources, make decisions that ensure continuation of care while setting family expectations of financial implications.

Communicate Continuously Build Community Relations Communicate Continuously What do your local resources need? What do county and state agencies need to make determinations faster? Why are LTACs and SNFs slow to admit or shy from Medicaid pending? Ask ‘why’ and then provide what’s missing.

Transparency Fear of the Unknown Many financial barriers to discharge delay stem from the unknown. Make the unknown, known. Provide transparency and often the discharge will follow.

LTC Facilities Educate Long Term Care facilities often have a smaller staff who wear many hats and possess less access to outside resources. Acute hospitals & large health systems bear a responsibility to collaborate and connect. He who holds the potato first, takes on the most heat.

Contractual payment Arrangements Advocacy Plan Contractual payment Arrangements Proceed with caution – ensure a screening up front gives the green light to commit, establish a full service advocacy plan for case approval, and confirm the SNF has no internal billing barriers delaying payment beyond your control.

All Clinical with no Financials, All plow with no Salt!

Foresight Today on Finance, Avoid Care Plan Disruptions in Future!

Process In Action Nation Wide LTAC System Inpatient Facility - ND Multi State System – ND/MN/WI

Medicaid Screenings Income & Household Program Type Verifications Processing Time Determines paperwork needed and asset limit Important determining factor on all cases Advocacy efforts in gathering needed documents Dependent on county and case specifics, often 30-90 days

A Word From Kristin McNeely SD Long Term Care *Note: She holds most of these cases in her hands, literally Delay LTC Admit Income Trusts The most common delay is missing verifications. Frequently misunderstood is that LTC coverage cannot be opened until in LTC – and even then, its another 30 days+ to approval. DHS provides instruction – but cannot assist. Must be established before LTC payment can begin.

Medicaid Hot Topics Over Asset Over Income Spousal Protections Benefit Recovery

Medicaid, Private Pay, or Change in Clinical Plan?

Questions? emily.arias@meddata.com