Americans with intellectual and developmental disabilities (IDD) face a funding crisis. There is a lack of Medicaid waiver slots to meet the need. Spending cuts are affecting other public and private IDD funding sources. Even Special Olympics may be on the chopping block.
One thing is clear: we can’t expect to meet the problem with more public revenue. Medicaid already accounts for nearly 20 percent of all spending from state general funds. Here are five steps you can take to protect your agency and your clients from this funding crisis.
1. Make the best case for your client
Intense budget pressure leads states and MCOs to scrutinize every service you deliver. Many providers experience cuts in authorized services when their clients do not demonstrate progress toward their goals.
Electronic documentation can support best practices that ensure each assessment delivers the optimal summary for your client. A system makes it easier to track progress on goals and run progress reports.
Providers that continue to use paper documentation may find it harder to ensure tracking of every achievement or impediment to progress, and even more difficult to collate information into regular reports. This hurts both you and your client.
With the right electronic system, you also gain clinical guidance and access to a broader range of assessment tools that may help you make a better case for your client.
2. Deliver all authorized care
Under-utilized authorizations happen for many reasons: staff scheduling issues, poor authorization tracking, or failure to renew and maintain authorizations promptly. A payer might use these under-utilized authorizations as another opportunity to cut services.
Electronic documentation can eliminate all of these obstacles. With a scheduling system built for the unique world of IDD care, you can see all the appointments your team has with a client. If someone calls in sick or the client needs to reschedule, you can make the change easily, without fumbling though multiple spreadsheets or calendars. You can also view authorizations before you schedule appointments.
You also gain reports that track service delivery and highlight underutilization so that you can schedule additional care where appropriate. And by tracking every authorizations electronically, a system can send alerts when authorizations expire or are close to depleted.
3. Bill for all the care you deliver
Many agencies struggle to compile complete and accurate service documentation. A staff member may forget to document care immediately after a long shift, miss a billable unit, or fail to document a separately authorized service they provided. Collecting paper documentation from field staff can also be a challenge. All of these factors can reduce your reimbursement.
By equipping your team with an electronic system, they can use on their smart phone or tablet, you’re able to add verifications that ensure all care is documented, and every visit is submitted, without requiring people to make a special trip to the office. Staff can view pending items on a dashboard that have not been submitted to billing.
4. Validate every claim you submit
Many states are hiring companies to scrutinize claims for reasons to issue a denial. These reasons can include minor mistakes like a missing name or credentials, erroneous dates, mis-coded units, and many other issues caused by typos or manual entry.
The right electronic system will check your coding, decrementing against the authorization, the units of service scheduled in the appointment, the credentials of the provider, and other critical pieces of data. Alerts let your billing team know where errors exist and recommend corrective steps. In most cases, claims cannot be submitted until these errors are corrected. This leads to the best possible reimbursement rates from your payers.
5. Expand your funding sources
Schools, foundations, and other non-Medicaid-based state programs also provide vital funding for IDD clients. Many agencies find it difficult to work with these other payers because of bureaucratic challenges. Each of these funding sources require a different set of assessments, billing reports, and compliance measures.
With an electronic system, you format billing configurations to meet the requirements of every payer once. Then the system pulls the service details from your documentation every time you’re ready to file a claim. It also tracks the rules for each payer and the common denial reasons to monitor. This makes it easier to work with a broader range of funders.
With the right system — one that has flexible templating and full Electronic Health Record capabilities — you can approach even more funding sources. Many of your clients may be dually diagnosed with mental health, substance use, speech language pathology, or other conditions. A company like WellSky that works in many areas of health care can equip you, should you choose to partner with other providers or expand service offerings to your existing client base.
The funding crisis is likely to get worse. Service agencies can expect even more scrutiny and tighter reimbursement standards going forward. Your agency may not feel the need to add technology today, but now is the time to discover all the ways an electronic system can pay for itself with greater efficiency and reimbursement.