Long Term Care: Value-Added Services
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Census and Caseload Development
The marketing team at Valir Long Term Care Therapy pursues growth opportunities for our partners by promoting their facilities and services to our vast network of physicians, case managers and discharge planners. These marketing efforts are always closely coordinated with the host facility to help increase the facility's census.
Valir's management routinely monitors Medicare Part A and B therapy census and length of stay, and we offer training and education to support positive trends in these areas. We also meet regularly with our clients to address any opportunities for improvement.
Our staff understands the difference between Medicare Part A and B caseloads and we offer an effective screening process, interdisciplinary communication, and an unwavering commitment to quality patient care as cornerstones of our professional therapy management in your facility.
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Case-Mix Management
Valir’s strategy for capturing rehabilitation patients for case-mix indices and maximizing reimbursement begins with screening every skilled nursing resident at the time of admission. Communication with the admissions coordinator helps determine if we can capture a case mix with extensive nursing and rehabiltiation services in the five- and 14-day assessments. Valir manages this at the regional management level, as well as the facility level through its rehab-team coordinators. Our goal is to provide comprehensive care in conjuction with nursing while capturing the higher reimbursement to offset the greater costs of caring for more medically complex patients.
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Medicare Part B Therapy
Valir believes that patients receiving Medicare Part B rehabilitation services are under such strict regulation and scrutiny that, if our therapists determine that skilled therapy is necessary, then the patient will qualify for an automatic therapy-cap extension. Every month, Valir tabulates year-to-date Part B therapy dollars. We then initiate a communication form stating that the case qualifies for the automatic exception and attest to amending the KX modifier with the therapy billing. If a patient has received therapy at another facility prior to admission, we contact our internal billing division to get the common working file information regarding cap amount per discipline. Valir's therapists are responsible for monitoring the cap status of each of their patients throughout the course of treatment.
Our philosophy is to approach each beneficiary's Medicare Part B dollars as a limited bank account, and we use those dollars carefully to ensure the patient receives the most benefit for the limited funds. All Part B patients review and acknowledge the Advanced Beneficiary Notice (ABN) at the time of their first visit so that they are informed of the therapy caps and the exception process.
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Denial Indemnification
Valir Health will partner with each facility it serves during Medicare audits or denials. We believe it is not only our duty, but also another competitive advantage we offer our clients. As the world of regulations continues to change and evolve, Valir Health and its partners will be prepared. The key to our success is a compliance program designed to catch errors and minimize mistakes. Additionally, we actively prepare each day by completing meticulous documentation that exceeds industry standards. We provide ongoing education and training that covers the latest federal and state updates, and we regularly perform audits to monitor performance. These actions ensure that any potential denials have strong support when appealed.
If denials occur, Valir Health will help prepare appeals, if necessary, and will provide strong support throughout the appeals process. If Valir is found to be responsible for a final denial, you will be remunerated for any lost revenue.
Valir's compliance program is based on the Office of the Inspector General's "Seven elements of an effective compliance program" and includes the following components:
- Standards of conduct
- Compliance officer
- Compliance committee
- Education and training
- Hotline
- Auditing and monitoring
- Disciplinary actions
- Response and prevention
This compliance program helps Valir maintain its commitment to a higher standard of care.
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RAC Preparedness and Responsiveness
Valir is already preparing for the new programs Medicare is developing to enhance their payment audits. In 2008, we began training long term care management relative to the recovery audit contractors and we have been developed response teams and systems to join forces with the facilities we serve in the event they are contacted by a RAC.
Valir's Compliance Program provides education and training to all management staff regarding the latest updates and trends concerning the RACs. We pass along the most pertinent and beneficial information to all of our partners. From the first day a RAC contacts a facility regarding therapy services, Valir will be there, dedicating our many resources to help rebut any claims.
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