The Challenge

The challenges of operating a rural, community-owned, Medicare-certified skilled nursing facility continue to grow. As a result, Pioneer Nursing Home realized the need to properly organize and implement an effective billing and reimbursement accounting system. The organization needed a system that would allow it to successfully collect reimbursements owed them from Medicare and coinsurance. The result would be increased cash flow, and would ultimately determine how competitive Pioneer Nursing Home could remain in the industry, while keeping its business functioning properly.

The Strategy

Pioneer Nursing Home was fully aware of the inefficiencies in its current system and in the need for a solution to its reimbursement struggles. It reviewed its use of an outside consultant for Medicare Part B claims billing, and evaluated overall methods for collecting coinsurance monies owed to the organization. It discovered billings that were not being processed through Medicare Part A and Part B due to the lack of a formal billing process and an inadequate tracking system. Pioneer Nursing Home determined there was a need for an internal billing specialist who would be responsible for all billing and reimbursement procedures and processes, and ultimately, the successful collection of those monies. 

Pioneer Nursing Home called on the experts at Wipfli for assistance. Wipfli quickly made an effective impact relying on an extensive knowledge of billing and reimbursement procedures and systems.

• Evaluated the organization’s processes and procedures 
• Recommended improvements to help create efficiency and effectiveness in its system 
• Streamlined billing processes by establishing in-house procedures
• Trained newly hired billing specialist on the basics of PPS, the Medicare reimbursement program, and the Medicare coinsurance program

The Results

Pioneer Nursing Home has realized greater efficiencies and effectiveness in collecting monies. Due to the hands-on application and training performed by Wipfli, over $50,000 of coinsurance claims were properly billed and successfully collected. In addition, the responsibility of processing Medicare Part B billings is now performed in-house by the internal billing specialist, saving the expense of using an outside consultant. Medicare Part A and Part B coinsurance billings, which once were largely unprocessed by the facility, are now successfully collected.