How do I reduce Bad Debt?  [clue: the Perfect Admission]

Why you should start improving admissions

There are 2 reason to start with your admissions process to reduce your bad debt:

Reason 1:  You have almost total control of your admission process (which begins the long string of events that leads to payment).  In contrast, you have almost no control over appealing denied claims from payors, when it’s too late to meet the payor’s requirements.  So you’re being proactive, rather than reactive.

Said differently:
good paperwork + process up front
=
clean claims + good payments at the end

Think: quality in, quality out.  (Not garbage in, garbage out.)

Reason 2: With improved admissions, we estimate around 50% of bad debt can be avoided.  As an example:

• • • • • • • A Nursing Home does $5m revenue / year.
            • If their bad debt is 4%, that’s $200k/year in bad debt.
            • With a better admission process, half of that bad debt can become cash i.e. $100k/year extra cash flow

The investment to improve the process is low (see the 3 steps below), when compared with the $100k/year in extra cash flow.  Therefore the ROI for improving your admissions process is a no-brainer.  And is only multiplied if you have multiple homes.

How to create the Perfect Admission process

There are 3 steps to making the perfect Admission workflow.

Step 1: Design the Admission Workflow

Begin with the end in mind.  Ask your team: what will you need to supply the payor in order to get paid?  

Get your AR/billing people, Auth person, BOM, Admit person, Admin (NHA) and Regional in the same room (or Zoom call).  Go through all the steps needed.  Write down: the Tasks needed, how to do them, who must do it, and by when (meaning: how many days after the admit is each Task due?).

                Standard Admissions Workflow

Here’s a standard Admissions workflow that you can adapt (free download containing all workflow details at the bottom of the article):

1. 1. 1. 1. 1. 1. Signed Admission Agreement uploaded to EMR.
               2. Admission Checklist signed and uploaded to EMR.  
               3. POA paperwork for anyone not their own person
               4. Copies of insurance card, medicare, and drivers license or State ID obtained
               5. Authorization request uploaded to EMR
               6. Hospital Face Sheet uploaded to EMR
               7. All prior admit eligibility checks uploaded to EMR
               8. Hospital History and Physical labeled and uploaded to EMR
               9. Patient Financial Form completed within 72 hrs
               10. Resident added to Managed Care or Pending Workflows if applicable

                Custom Admissions Tasks

Optional: yoy may need to add state-specific or payer-specific Tasks, depending on their requirements.  For example, some operators have an “Admissions IL” and an “Admission NJ” Workflow with these Tasks:

1. 1. 1. 1. 1. 1. Check eligibility status for "Fail" or "Deny" verifications (applicable for a Transfer In)
               2. Get OBRA screening
               3. HFS 3654 completed and signed
               4. RFMS enrollment completed
               5. Welcome Letter completed by BOM (optional)
               6. Get NOMNC form
               7. Census Workflows per payer type

Extra credit: create workflows for changes and events mid-stay that affect reimbursement later. For example:        

1. 1. 1. 1. 1. 1. Payer Changes
               2. Get Continuing Authorization
               3.  Weekly Eligibility Check

Step 2: Implement the Admissions Workflow in Your Homes

To implement, share the workflow with staff in a simple-to-read, checklist format. This increases adoption and is better than a hard-to-read manual.  

Practically, here’s how you can share it (ranked from worst to best):

1. 1. 1. 1. 1. 1. Paper - a Word doc that the BOM/Admit person prints, completes and scans to EMR/shared drive. (worst)
               2. Excel - an Excel tracker per Home, per Month that is manually populated with new Admits.  
               3. Shared Excel - same as above, but using Office365 Excel (or Google Sheets)
               4. Workflow Tracking Tool -  a tool which automatically grabs the newly admitted Residents, emails your staff about their Tasks, and let’s you see where each admit is at. (best)

General points to make sure staff do the workflow:

• • • • • • Simply worded Tasks, with extra “How to” instructions, to help your new hires.
          • Initial training and follow-up training will make sure staff actually do the new workflow
          • Only one assignee (Owner) per Task.  For example, only the BOM or the Admit person should be responsible for the Task.  So that everyone knows who’s doing what.  No blurring of responsibilities.

Step 3: Monitor and measure

During the home’s weekly meetings, review the progress on the Admissions Workflow for the previous week’s new admits.  This should be done by the BOM, Admit person, Admin (and Regional if needed).  The idea here is: you can only expect what you inspect.

There are 2 goals to this meeting:

1. 1. 1. 1. Fix resident issues: meaning, fix tasks that are stuck at the Resident level.
         2. Fix workflow issues: meaning, how could we improve the process for next week? What are other homes doing about this issue?  

Ideally, compare this home’s Admissions performance compared with other homes. And then transfer best practices from top-performing homes to this home.

What you can do next

Download our free Perfect Admission Workflow in Excel format.  Edit and use it.  

Done right, it can yield ~$100k/year in extra cash flow.  

If you want to make sure you’re doing it right, chat with us about how AR Proactive can help with:

• • • • Automating your Admissions Workflow
      • Task Reminders to staff
      • Dashboard visibility and best practices from other operators

Keep up the good work and be good,

Rich Handler
rich@arproactive.com, c. 414.699.2541
CEO, AR Proactive