Understanding Long Term Care Revenue Cycle Management

Long-term care (LTC) revenue cycle management processes are an important part of managing a successful LTC business. It involves understanding the complexities of long-term care billing and reimbursement, from initial patient registration to final payment collection. With so many processes involved in the cycle, it can be difficult for even experienced professionals to stay on top of all the details.

By knowing how each step fits together and looking for potential red flags or places to improve, you can make sure your LTC organization runs smoothly and efficiently, which will lead to more money and delivering quality care for patients. Here, we explore the basics of long-term care revenue cycle management and provide tips on how to get started!

What Is Long Term Care Revenue Cycle Management (LTRCM)?

LTC Revenue Cycle Management is an organized system for managing the financial transactions in long-term care settings. This includes all aspects of patient billing, insurance claims processing, collections, payment receipts, and reimbursements from third-party payers such as Medicare and Medicaid. It also involves tracking and analyzing key performance indicators to help identify areas where improvements can be made.

LTRCM Challenges

Long Term Care Revenue Cycle Management (LTRCM) faces several unique challenges that can make it difficult for LTC facilities to maintain financial stability and compliance. Some of the key challenges of LTRCM include:

Complex Billing and Reimbursement Systems

Long-term care Billing and reimbursement systems are complex and can vary based on factors such as patient insurance, medical conditions, and services provided. Billing errors and coding mistakes can result in denied claims and delayed payments. This can have a major impact on an organization’s cash flow and revenue.

Staffing Shortages

Many long-term care facilities are struggling with staffing shortages and understaffed departments. This can make it difficult to manage the revenue cycle in an efficient and timely manner, resulting in delays or lapses in billing, coding, collections, and payments.

Changing Regulations and Compliance Requirements

The healthcare industry is always changing, so LTC facilities must keep up with the latest rules and regulations to avoid getting fined or getting in trouble. Compliance can be especially challenging in LTC, as there are many rules and requirements specific to long-term care facilities.

Limited Technology Resources

Most long-term care facilities don't have the technology they need to run their revenue management processes well. This can cause big problems for the organization, like late payments, lost money, and less work done by the staff. At the end of the day, this means that the organization can't collect payments on time and correctly, which hurts their bottom line.

Delayed Payments and Cash Flow Issues

Long-term care payment cycles can be long, which can cause payments to be late and cause problems with cash flow for LTC facilities. This can be especially hard for healthcare providers that don't have a lot of money or cash on hand.

Long-Term Care vs. Acute Care Revenue Cycle Management

While both long-term care (LTC) and acute care (AC) facilities manage revenue cycles, there are several key differences between the two that impact revenue cycle management. Some of the main differences include:

Payment Sources

Acute care facilities typically receive payment from private insurance plans, Medicare, and Medicaid. Private insurance plans may cover medical services such as doctor's visits, hospital stays, surgeries, and prescription drugs. Medicare provides health care coverage to people aged 65 or older as well as those with certain disabilities. Medicaid is a program that helps people with limited incomes pay for medical expenses.

Long-term care facilities, on the other hand, usually get money from Medicaid, private insurance plans, and other sources like charitable donations or payments made out of pocket. Payment sources for long-term care can be harder to figure out because there are so many different kinds of services and insurance companies need to give permission ahead of time.

Billing Processes

Most of the time, acute care facilities bill insurance companies by sending claims and waiting for payment. This can be done automatically with the help of technology, and it is often easier to do than billing for LTC services.

On the other hand, medical bills for long-term care can be complicated because there are many ways to pay and different permissions that need to be given. Additionally, patient eligibility must be checked on a regular basis, as it can change over time. Long-term care facilities must also be aware of the different medical billing codes and reimbursement rates for each type of service they provide.

Length of Stay

The length of stay at an acute care facility is typically shorter than that of a long-term care facility. This means that the time frame for payment collection and billing processes is often much shorter for acute care facilities. Additionally, the number of services provided may be lower due to the shorter stay.

In contrast, long-term care facilities often have longer stays and more services to bill for. This can result in a longer payment cycle and increased complexity for billing processes.

Level of Complexity

Most acute care services are more complicated and involve a wider range of procedures and tests. This makes the billing process more complicated. LTC facilities, on the other hand, offer more routine services, but billing can still be complicated because they have to charge for multiple services over a long period of time.

Compliance Requirements

Long-term care (LTC) and acute care (AC) facilities must both follow federal, state, and local rules about health care. However, the specific regulations and compliance requirements for each can be significantly different. Compliance requirements for acute care facilities usually focus on safety, measures of care quality, patient privacy, and other standards related to healthcare.

Compliance rules for long-term care facilities focus on patient rights, quality of life issues, health and safety standards for residents, and other rules that have to do with LTC. Close attention must be paid to these requirements to make sure the facility meets all the necessary standards.

Strategies for Successful LTRCM

Long-term care (LTC) facilities face unique challenges when it comes to revenue cycle management optimization. However, there are several strategies that can help ensure a successful LTRCM:

Accurate and Timely Billing Processes

It is essential to ensure that all billing processes are accurate and timely in order to avoid delays in payment collection. To do this, LTC facilities must be aware of the different coding requirements for each type of service they provide as well as any changes in patient eligibility.

Leveraging Technology

Long-term care facilities present unique challenges in revenue cycle management, including multiple payment sources and authorization requirements. Using technology solutions like EHRs can help make billing easier by automating processes to cut down on mistakes and make them run more smoothly.

Developing a Systematic Process for Follow-Up

LTC facilities must have a system for following up on unpaid claims and other problems in order for their revenue cycle management to work well. This can help reduce payment delays and incorrect payments.

Proper Staff Training and Education

It is important for LTC facilities to teach their staff the right way to bill, how to code, and what the rules are about compliance. This will help make sure that all processes are done right so that the revenue cycle management works as well as possible.

Compliance Monitoring

Regular monitoring of compliance with regulations and industry standards is essential for successful LTRCM. This includes regular audits of billing processes and ensuring that staff are aware of and trained on compliance requirements.

Contract Negotiations

Negotiating contracts with payers and other providers can be a key element in successful long term care revenue cycle management. Contracts should be negotiated to ensure that LTC facilities are adequately compensated for all services provided, including services such as physical therapy, occupational therapy, hospice care, and home health care. Negotiations should cover not only the rates of reimbursement but also the terms and conditions of payment.

Cash Flow Management

Effective cash flow management is essential for long-term care (LTC) facilities to ensure financial health stability. This includes monitoring accounts receivable, managing expenses and the collection of payments, and maintaining adequate reserves. To effectively manage cash flow, LTC facilities must have an efficient revenue cycle process that takes into account all sources of revenue, including government funded programs.

Proactive Management of Denied Claims

Denied claims can be a major source of lost revenue for LTC facilities. Proactively denied claims management by identifying the reasons for the denials and addressing them can help reduce losses and improve revenue. This can include implementing processes to ensure that all claims are properly coded and submitted with accurate information, as well as proactively filing appeals when necessary. 

The Future of Long Term Care Revenue Cycle Management

The future of long-term care (LTC) revenue cycle management (RCM) is likely to be shaped by several trends:

Increased Use of Technology

Long-term care facilities are presented with unique challenges when it comes to revenue cycle management optimization, but there are a variety of strategies that can be employed for successful LTRCM. These include leveraging technology such as Electronic Health Records and proper staff training and education; developing systematic follow-up processes, compliance monitoring, and contract negotiations; managing cash flow; and resolving denied claims proactively—all leading up to the expected increasing use of cutting edge technologies like AI and machine learning in future implementations.

Value-based Care

The healthcare industry is moving towards a value-based care model, which places a greater emphasis on outcomes instead of the volume of services provided. This change is likely to have an effect on LTC RCM because facilities will have to show the value of the back office services they offer in order to get paid.

Regulatory Changes

Changes in healthcare regulations and policies are likely to impact LTC RCM. For example, changes to Medicare and Medicaid reimbursement policies could impact the revenue streams of LTC facilities. It is important for facilities to stay abreast of changes in regulations and policies to ensure they remain compliant. 

Increased Focus on Patient Experience

As patients learn more about their own care and become more involved in it, long-term care facilities will have to focus on giving patients a good experience. This will require attention to billing transparency and patient communication around billing processes.

Continued Staffing Challenges

Staffing shortages in the LTC industry are likely to keep happening in the future, so LTC facilities will need to come up with creative ways to handle RCM processes with limited resources.

Set Up an Appointment With Enter.Health Today!

If you are looking for recommendations on how to optimize your LTC RCM process, an experienced team of professionals is here to help. Contact Enter.Health today to schedule a consultative appointment and start the process of improving your revenue cycle management.

We know that running long-term care (LTC) facilities can be hard and that optimizing the revenue cycle process is key to making money. With our experienced team and cutting-edge revenue cycle solutions, we can help your LTC facility streamline its RCM processes and make the most money possible. Contact us today to get started!