“Whatever the challenge, Case Management Solutions is here to persevere for our success.”
“Finances aside, it’s been a relief having the headache off our shoulders.”
“No more working overtime…
No more chasing authorizations.”
Your success could be featured here.
“Whatever the challenge, Case Management Solutions is here to persevere for our success.”
364
Bed Facility
$2M+
Recouped
98%
Success Rate
Background
A reputable nursing home operator contacted Case Management Solutions for assistance with the case management of a newly acquired facility.
The Challenge
The facility had been mismanaged for a while under the previous ownership, accruing a 24 months backlog of authorizations and denied MLTC/MLTSS claims. The social worker responsible for the paperwork was largely overwhelmed and an extensive portion of the necessary documentation had never been filed. This resulted in the loss of millions of dollars in reimbursements and revenue.
The Outcome
Reviewing the facility’s case management processes in detail, Case Management Solutions worked tirelessly to get the facility back on track. Aged claims were checked for accuracy and eligibility. Appeals and grievances were filed and chased. Every last dollar was negotiated, until Case Management Solutions successfully cleaned up $2M+ dollars of previously denied MLTC/MLTSS claims, take-backs, and retroactive authorization payments. The facility is now running smoothly with precise paperwork, regular reporting, and optimal reimbursement.
“The results have far exceeded our expectations. Case Management Solutions’ involvement was so successful that we’ve since handed over a couple of other facilities in their expert hands. We love knowing that whatever the time, whatever the challenge, they’re here to persevere for our success.”
“Finances aside, it’s been a relief having the headache off our shoulders.”
409
Bed Facility
80%
Level 2 Increase
60%
Level 1 decrease
Background
A SNF facility with a fragmented case management process transferred their case management to Case Management Solutions.
The Challenge
The facility’s case management involved numerous staff members, leading to a mismanaged process that reduced staff productivity and caused repeated low levels of authorizations. This resulted in lower levels of reimbursement, which largely impacted the facility’s bottom line.
The Outcome
Once Case Management Solutions stepped in to manage the facility’s authorizations, they took special care to ensure that paperwork reflected clinician recommendations for each patient in accordance with HMO guidelines. As a result, the facility’s stats increased significantly.
Level 1 |
Level 2 |
Level 3 |
Level 4 |
|
Before |
62% | 38% | 0% | 0% |
After |
2% | 78% | 15% | 5% |
“What they’ve done for us sounds simple, but our revenue has increased substantially. When Jeff initially analyzed our facility his predictions seemed unrealistic. Today, we have the results to prove it. Finances aside, it’s been a relief having the headache off our shoulders.”
“No more working overtime… No more chasing authorizations.”
520
Bed Facility
$70.33
Average daily rate increase
5.7 days
Average HMO length of stay increase
Background
The COO of a National SNF group contracted Case Management Solutions to take over the case management of another facility under their care.
The Challenge
The nurse responsible for the facility’s case management was unable to handle the heavy workload on her own, necessitating the employment of a second full-time nurse. The COO considered their options and decided that hiring Case Management Solutions would be more effective than hiring another full-time employee.
The Outcome
With Case Management Solutions on board to manage their case management process, the facility was able to transfer the nurse to the nursing floor, where she was put to better use. This relieved the workload of 2 full-time employeesand reduced the facility’s ongoing stress around case management. At the same time, Case Management Solutions managed to raise their average daily rate by $70.33 per patient, and increased their average HMO length of stay by 5.7 days. Overall, the facility’s average HMO revenue increased by $3,205 per patient stay.
“It’s been a really successful move. The freed-up staff member is a valuable member of our nursing team now and our entire case management process is so much smoother. No more working overtime to tackle the paperwork pile. No more chasing authorizations. The staff are really breathing easier without the burden.”