Long-term care facilities looking to make the most of their Medicaid reimbursements utilize Medicaid billing software, which is used for the process of accepting Medicaid patients and residents.
Medicaid billing software helps providers check a resident’s Medicaid eligibility, submit and track Medicaid claims, as well as receiving payments for those claims. This senior care software can also help providers manage their Medicaid patient populations and submit electronic claims when billing Medicaid. This is because it helps improve the speed and accuracy of the billing process while reducing the likelihood of rejected claims.
Providers can submit electronic claims to Medicaid through third-party companies or clearinghouses, which usually have contracts with Medicaid and other insurance companies, making the billing process easier for providers. The problem with this is that clearinghouses can be costly, especially for smaller nursing homes where every dime counts.
The alternative and more cost-effective option for most facilities would be to use Medicaid billing software that offers direct claim submission capabilities. This means that the software will connect directly with the Medicaid system, allowing for fast and easy claim submission.
No matter which method of submission providers choose, it’s important to make sure that their Medicaid billing software is compliant with HIPAA regulations. This will ensure that their data is protected during transit and that the facility is reimbursed for services offered.
How Medicaid varies from state to state
One thing that facilities should be aware of is that Medicaid is state-controlled and jointly funded by states and the federal government. This means that Medicaid reimbursement rates are set by each state and influenced by a variety of factors.
Most state reimbursement models use fee-for-service, managed care, or a combination of both. The Medicaid fee-for-service reimbursement model is commonly used by states. This model allows Medicaid to pay healthcare providers a set fee for every service that they provide to a Medicaid patient. This can include services, such as a doctor visit, hospital stay, or prescription drugs. Critics of this reimbursement model argue that it hurts patients and drives up healthcare costs.
As a result, some states have instead moved to a managed care reimbursement model, where healthcare providers enter into contracts with third-party entities. These managed care organizations (MCOs) are then responsible for paying healthcare providers for the services they provide to Medicaid patients.
The Medicaid managed care reimbursement model gives Medicaid more control over how much money it spends on each patient. This is because the state sets a per-member per-month (PMPM) rate for each Medicaid patient. The MCOs are then responsible for ensuring that they do not spend more money on a patient than the state allotted.
Whatever reimbursement model your state uses, you will need to adopt an effective Medicaid billing software with some essential features. We will discuss some of those features next.
6 Must-Have Features in Medicaid Software for Nursing Homes
We have mentioned why Medicaid software is an essential part of long-term care billing and reimbursements. In this section, we will look at must-have features that administrators and long-term care leaders should look out for when selecting Medicaid billing software, which include:
1. Accurate, automatic billing
This means that the software will automatically read patient and resident care information and translate it into a claims form. By reading customer profile windows, the software can automatically generate claims and submit them according to pre-set weekly, monthly, or bi-annual billing cycles. The benefit of automated Medicaid billing software is that it helps increase accuracy and speeds up the claim submission process.
2. Seamless connection to payors
Automatic billing is pointless if a facility’s senior care software lacks the ability to connect to payors. This means that the software should be able to connect directly to the Medicaid system, allowing for fast and easy claim submission. A good Medicaid billing software will have built-in clearinghouse capabilities that can help providers with claims submissions.
A clearinghouse software system acts as an intermediary between the provider and the payor. It can help with claim submissions, denials, and appeals. The benefit of a Medicaid billing software system with clearinghouse capabilities is that it can help increase claim submission accuracy, as well as reduce the time it takes to be reimbursed.
3. Real-time eligibility checks
Real-time eligibility checks are important because Medicaid benefits and eligibility can change over time, and if a patient is no longer eligible for Medicaid benefits, the provider may not be reimbursed for services rendered. Real-time eligibility checks can help avoid this problem by alerting the provider if a patient’s Medicaid benefits have changed.
The benefit of real-time Medicaid eligibility checks is that they can help facilities avoid claim denials. It can also help give MDS nurses a better understanding of a resident’s Medicaid coverage so that they can provide them with the appropriate level of care.
4. Customizable reports and templates
Facilities are not all the same and they need different things. For instance, the needs of a nursing home for Medicaid billing will be different from that of an assisted living facility. Thus, customizable reports and templates are a must-have for the best Medicaid billing software. Such reports allow facilities to track the status of their Medicaid claims and see how much money they are owed. And these templates allow facilities to create customized invoices that reflect the services they have provided.
5. Supports multiple fee schedules for payors
Medicaid reimbursement rates vary from state to state, so the best Medicaid billing software will support multiple fee schedules to allow facilities to get the most accurate reimbursement for the services they provide.
6. Integration with other software
Integration of long-term care software makes it easier to transfer data between the different software systems to reduce data entry mistakes. It ensures the continuity of care during resident transfers as well as the coordination of care. This also holds true for long-term care pharmacy software, which is to connect a pharmacy and a facility for accurate medication management and prescription.
That is why medicaid billing software must be able to integrate with other software used by the facility, such as accounting software and electronic medication administration records (eMAR) software. Medicaid billing software should also be able to integrate with other external long-term care software to provide a comprehensive overview of the patient’s care. This integration will help to ensure that all aspects of the patient’s care are considered and will help to improve overall care coordination.
Want to learn more? Contact us here to test drive our Medicaid billing software designed to ease eligibility checks, Medicaid claims submissions and billing of payors.
Challenges With Implementing EHR and EMR Billing Software
While EHR and EMR billing software such as Medicaid billing software offer great advantages, there are also challenges involved in implementing such senior care software. Some of these implementation challenges include:
- The technical know-how of the staff: Medicaid billing software is designed to automate various tasks related to Medicaid eligibility, claims submissions, and billing. However, this automation—designed to be in line with Medicaid requirements—can only be achieved if the staff members responsible for using the software have the necessary computer knowledge and technical skills.
- The cost of use of the software: According to the Commonwealth Fund, the average implementation cost of elder care software, such as EHR, is $32,606 per full-time physician. Thus, some nursing homes consider Medicaid software too expensive to acquire and maintain.
- Generational resistance by staff: Medicaid billing software represents a generational shift in the way nursing homes are to operate and abide by Medicaid requirements. As such, some members of staff—especially those who have been in the industry for a while and have used paper records for a long time—may resist using long-term care software, as they are less comfortable with the adoption of technology.
- Workflow transfer challenges: EHR and EMR billing software are designed to automate tasks related to Medicaid eligibility, claims submissions, and billing. However, some facilities may find it difficult to transfer their existing workflow into the new software. This can be particularly troublesome if the facility lacks an IT specialist or chooses an EHR vendor with poor customer service.
- Cost and time of training: As with any new software, some staff members are less familiar with the system and will require more training to use the Medicaid software properly. This can be challenging for nursing homes, as they may not have the budget or time to train all of their staff on the new software.
- Privacy concerns: Privacy and integrity of resident medical information is always a concern for nursing homes. There are real threats from hackers, as medical information is considered a major target for individuals with malicious intent. As such, some facilities may be hesitant to use EHR and EMR billing software due to privacy breaches.
Fortunately, there are actions nursing home administrators and long-term care leaders can take to ensure the successful implementation of EHR and EMR billing software in their facilities.
The Keys to Successful Medicaid Billing Software Implementation
To ensure the successful implementation of Medicaid billing software, there are some actions that long-term care leaders should first take. These include:
- Understand the needs of staff: A requirements list should be created by staff and used as a guide for analyzing any potential software. This will ensure that the software being purchased meets the specific needs of the facility.
- Find a reputable long-term care software vendor with excellent customer support: The vendor you choose to purchase your nursing home software from is just as important as the software itself. You’ll want to partner with a vendor who is knowledgeable about the long-term care industry and can offer excellent customer support. Furthermore, the vendor should have a good reputation in the industry and should be able to provide references from other satisfied customers.
- Demo the software with real scenarios: A senior care software demo is a great way to analyze how the software will work in your facility. Be sure to ask the vendor plenty of questions and run through as many care scenarios as possible. This will give you a better understanding of how the software can be used in your specific long-term care facility by your staff.
- Look for training resources: Any reputable software vendor should offer training resources to get your staff up to speed on how to use the long-term care system. These resources can be in the form of webinars, tutorials, or even on-site training.
The six challenges we previously listed are not insurmountable, but they do require administrators and long-term care leaders to take action in order to ensure a successful implementation of EHR and EMR billing software. By understanding the needs of staff, finding a reputable vendor with excellent customer support, demoing the software with real scenarios, and looking for training resources, nursing homes can increase their chances of successfully implementing nursing home billing software.
For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast.