There are two fundamental reasons healthcare leadership is different from leadership duties in other industries: 24/7 demands and the immediacy of the customer to the enterprise. Healthcare and senior housing never closes, exhibits no true seasonality, and has a demand that can increase and decrease, with equal force and equal pace, almost entirely as a result of external factors. Pricing for the most part, other than housing, is almost immaterial and unrelated to revenue. No other non-governmental business is as regulated, scrutinized, and mandated to be transparent like senior healthcare. Likewise, no other business is required to provide its full array and intensity of services 24/7, on demand, with no ability to defer or limit that service.
There are five major categories of consolidated billing (CB), each with specific compliance criteria. As each category is delineated, you should frame the individual service scope and billing requirements it contains in the context of your facility’s unique population demographics and operational realities to understand the immediate relevance, determine any potential implications, and earmark specific points that may inform future education and training initiatives.
For the last three years, nursing homes associated with CMS’ Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents have been working to prevent residents from making unnecessary trips to the hospital. Beginning in October 2016—the kickoff month of the pilot program’s second phase—these participants will be reimbursed for their efforts.
In just six months, SNF providers will begin ushering in a new era of value-based payments and quality reporting, thanks to several proposed policy and payment changes for the coming year. Although facilities won’t see reimbursement changes based on these proposals until fiscal year (FY) 2018, both of the new programs outlined in the Federal Register propose data collection time tables that begin January 1, 2017, which will be used to make value-based payments in subsequent years.