Managed care experts wanted
Skilled nursing facilities could take major hits to their bottom lines unless a coordinator is on top of managed care contracts, a prominent healthcare consultant said last month at the American College of Health Care Administrators annual meeting in Las Vegas.
Contract exclusions are one example, said Susie Mix, president of contract consulting company Mix Solutions. Certain items, such as pricey medications, can be “excluded” from the plan's SNF per-diem rate. That is, a nursing home can be reimbursed for these items in addition to receiving the standard daily payment.
A coordinator can ensure that the SNF actually bills for excluded meds or services. With complex contracts, it's easy for these to fall through the cracks, resulting in the facility leaving a lot of money on the table, Mix said.