Labor shortages are costing providers deeply, but new data finds workforce issues are also impeding their ability to collect payment for services they’ve already delivered.
Challenges including turnover among reimbursement staff, more time spent on the floor by nurses in reimbursement positions, and less-experienced new hires are “negatively impacting revenue potential,” according to a survey published Tuesday.
Market Report: The State of SNF Clinical Reimbursement found 90% of skilled nursing providers polled had issues with MDS coordinators and other billing staffing that were affecting their ability to collect. Some 57% had turnover on their clinical reimbursement team within the last six months.
“Resource strains have a ripple effect that impacts reimbursement beyond census,” said Ryan Edgerly, CEO at MedaSync, a software provider that cosponsored the survey with rehab firm HealthPRO Heritage. “We hear these scenarios all the time. A lack of frontline caregivers causes MDS coordinators to work the floor more and more, giving them less time and attention to get their reimbursement responsibilities right.”
Those demands, unrelenting during COVID and ongoing nurse shortages, are also pushing more reimbursement pros to leave the field, switch employers or return permanently to frontline nursing, adds Rosie Benbow, an MDS consultant and owner of Leading Transitions Post Acute Care Consultation and Staffing.
She’s seen the average salary for MDS coordinators increase from $60,000 to $65,000 annually, to $78,000 to $80,000 annually among clients she serves in Indiana, Michigan and Wisconsin. Still, that’s not enough to stop workers from leaving — and from taking valuable knowledge and experience with them.
Finding a replacement or committing to training someone fresh to the role isn’t any easier than retaining coordinators, Benbow told McKnight’s Long-Term Care News Tuesday.
“The absolute biggest challenge is availability of a trained nurse,” she said, noting that one client has been using her as an interim coordinator for more than a year while searching for an experienced replacement. “People feel like they need that fully trained person so that they don’t lose on the reimbursement, but you struggle to get that.”
Managed care adding to challenge
The job has become harder in recent years in more ways than just COVID and smaller teams. The rise of managed care, plan levels, the switch to the Patient Driven Payment Model and state variations in case-mix calculations are all adding to the complexity of the job.
More than half of the Market Report respondents cited an increase in managed care penetration and Medicaid rates as a chief concern. When asked to rate their level of concern about their ability to prevent missed reimbursement “in a multi-payer universe,” 65% categorized themselves as moderately or very concerned.
Half said an increase in managed care penetration was their top concern, followed by Medicaid rates at 46%. PDPM, however, only ranked 6th on the list, despite a survey window that coincided with federal officials’ announcement that they planned to trim PDPM next fiscal year.
Managed care denials and other payer factors, combined with inexperience or lack of training, may mean more opportunities to miss out on earned reimbursement.
Benbow estimated medium nursing homes could lose $150,000 to $200,000 quarterly because of missed diagnoses, poor PDPM calculations, a drop in case mix or financial penalties tied to quality reporting errors.
“It is definitely a struggle just to deal with managed care,” she said. “Another struggle of our time, outside of the staffing itself, is trying to keep up with all the angles, depending on what state you’re in.”
She encourages facilities to make a quick decision on filling a vacant MDS coordinator role – even if that means taking a savvy nurse off the floor. But the facility must then give that nurse side-by-side training for weeks, possibly months, with in-house audits and external reviews to make sure dollars that are due are actually being collected.
Providing support through technology and consulting, she said, is likely to pay off in the long run.
“Some folks don’t want to invest as much in their own financial future,” Benbow said. “Others absolutely do, and they see the value in weekly or monthly reviews to help catch opportunities.”
