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Perlu Network score measures the extent of a member’s network on Perlu based on their connections, Packs, and Collab activity.
Diversifying payor mix can increase opportunities to offer continuity of care to patients and referral sources, and increase market share • Understand payor rules to ensure current technology and processes can adapt to increased payor population • Utilize technology to automate certain revenue cycle processes for payor specific rules Evaluate current technology platform to determine appropriate set-up for current and future payors • Engage with individuals from the payor that can influence the contracting process • Leverage vendors, partners, state and national associations for knowledge of state and federal mandates
Operation Cash Flow Improvement: Best Practices and Benchmarks for Managing Unbilled A/R Hospice Orders are not required to be signed before b Monitor unbilled A/R on a daily basis to identify any potential impacts to cash flow Use the valid primary diagnosis received with referral when billing RAPs Create a tracking log for both no-Pay RAPs and NOEs to ensure they are billed timely to avoid any payment penalties Key RAPs and NOEs in DDE on day 5 Operation Cash Flow Improvement: Best Practices and Benchmarks for Managing Unbilled A/R Inside the Numbers of PDGM’s First Year RAPs in 2021: Everything You Need to Know About the New RAP Billing Rules
2020 Year in Review: Inside the Numbers of PDGM’s First Year CMS projected a High Functional Impairment level of 31.5%, SHP shows 44.1% for CY 2020, which is much higher than anticipated. Low Functional Impairment 23.9%, compared to CMS prediction of 35.1% Overall LUPA rate of 8.9% for CY 2020 LUPA rate of 18% for patients that were only on service for one period. Therapy visits consisted of 3.99 of the total average visit utilizations of 8.51, which equals 46% of all visits Increase from prior year at around 45% LUPAs by HHRG and Sequence- % of 1st period COVID-19 patients drastically increasing towards the end of 2020 2% in October compared to 4.9% in November and 9.1% in December Slightly skewed by lower number of SOC in November and December due to holidays 2020 Year in Review:
Payment penalty is equal to 1/30th reduction of the HIPPS code HIPPS code on the RAP must match the HIPPS code on final claim, but the primary diagnosis code on RAP does not have to match primary diagnosis code on final. Bill all RAPS and final claim with the same generic HIPPS code, keep in mind the RAP does have to match the final claim. Key RAPS into DDE if the EMR does not support timely submission of RAPS Make sure you are using any kind of valid diagnosis code if you do not have an acceptable diagnosis code. if your Medicare Advantage plans are adopting the 5-day timely filing rule Medicare advantage claims should be billed with the actual HIPPS code Prioritize patients to ensure OASIS is completed before the 5-day timely filing.