While increased volumes typically
unlock additional revenue, a carefully
chosen specialty can also drive
increased reimbursement by
capitalizing on the idiosyncrasies of a
provider’s payment structures.
Continue reading to learn how one SNF capitalized on a provider's payment structure to unearth additional Medicaid reimbursement. For more tactics to build and support specialty lines, download our research report excerpt: 10 Tactics to Ensure Specialty Return on Investment, Part 1.
In Pennsylvania, a 0.01
increase in a skilled nursing facility’s
case mix index (CMI) correlates with
an increase of $1.38 per patient per
day in Pennsylvania Medicaid reimbursement.
To leverage that payment
opportunity, Susquehanna Health
Skilled Nursing and Rehabilitation Center opted to specialize in ventilator
weaning. Vent-weaning patients are
measurably more complex than the
general skilled nursing population
and an influx of that patient type
increased the facility’s CMI from 1.10
to 1.18.
Blog post: One way to recapture lost volumes
As a result of a higher CMI, Susquehanna earned an additional $472,000 across a single year. They are also eligible for a $35,000 bonus payment if the facility has at least 10 ventilated Medicaid patients on each of Medicaid’s randomly chosen audit days.
vent-weaning specialty line development
Roughly two-thirds of the facility’s
ventilator-weaning patients are
Medicaid beneficiaries, but the
ventilator-weaning program’s results
are not limited to Medicaid patients.
Susquehanna has successfully
negotiated with other payers, including
Medicare Advantage and commercial
insurers, for higher carve-out rates for
ventilator-weaning patients.
The opportunity to drive reimbursement
by increasing a facility’s acuity level is
not limited to Pennsylvania. Most states have variations on
similar payment structures. Each post-acute provider should uncover and
understand the reimbursement
opportunities available in their local
market and evaluate their programs to
take advantage of these payment rules.
Market update: Trends in post-acute utilization
For more tactics to build and support specialty lines, download our research report excerpt: 10 Tactics to Ensure Specialty Return on Investment, Part 1.