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.
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.
For more tactics to build and support specialty lines, download our research report excerpt: 10 Tactics to Ensure Specialty Return on Investment, Part 1.