Nurse assessment coordinators are a vital part of ensuring a compliant physician certification process, even when they aren’t directly involved in the minutiae of that process.
That’s according to industry experts with the American Association of Post-Acute Care Nursing, specialists who deal in assessment matters day in and day out.
Compliance with certification and recertification regulations can be a high-stakes game for senior care operators since missteps with certifications can lead to heightened scrutiny of a facility’s billing processes and, ultimately, payment denials.
Nurse assessment coordinators (NACs) are often thrust into the role of Medicare case management because of their responsibility over the payment rate, but it’s always vital for facilities to ensure there are expert backups in place, according to Jennifer LaBay, curriculum development specialist at AAPACN.
“I always say that this process has to be pristine,” she told McKnight’s Tuesday. “There are very specific requirements … that say when it [a certification] has to be done, who has to sign it, when all of that needs to be in place.”
NACs are uniquely situated to handle those complex regulatory requirements, according to Scott Heichel, RN, director of clinical reimbursement for healthcare consultant group LeaderStat.
“The NAC is the gatekeeper of the many different facility processes that fall under the umbrella of skilled services,” Heichel said in a March 20 AAPACN online post. “You are the manager — whether or not you are the person directly completing the task.”
AAPACN experts highlighted several key areas that can often be confusing, such as the timing of when physicians need to sign certifications, how to handle delayed certifications and what additional information needs to be present on recertifications.
“The issue is, it needs to be more than one person — I can’t stress that enough,” LaBay said.
LaBay also acknowledged that turnover in the long-term care sector, including among NACs, has made this issue even trickier. In 2023, 26% of assessment coordinators had two years or less experience, compared to only 7% in 2014.
“Maybe that one person who had all of the knowledge and was taking that upon themselves — if they leave or get sick so they’re not there, do you have something in writing that gives you that breakdown of what needs to be done, when it needs to be done, do I know where I need to look?” she said.
