Transcript Generated by AI 00:01 Hey, 00:01 Mark Parkinson back with Park Place, 00:03 and we're very excited today to announce a new sponsor of the site. 00:08 It's reimbursement reimagined, 00:10 sometimes goes by R2. 00:12 Reimbursement reimagined exists to help people make sure they 00:16 get paid what they deserve with both Medicare and Medicaid 00:19 by providing MDS services and other services. 00:22 It's a perfect sponsor for our website because of course, 00:25 our mission is your success 00:27 and 00:28 our too can be a big part of that. 00:30 So, 00:30 Amy, 00:31 we're here with Amy Goldsmith today who's 00:33 the chief operating officer of reimbursement Reimagined, 00:35 and Amy, 00:36 first of all, 00:36 thank you for your sponsorship, 00:38 and it's, 00:38 it's great to have you here with us today. 00:40 Thank you. 00:41 Thank you for having me. 00:42 Amy, 00:43 tell us a little bit about the challenges that providers face and the reasons that, 00:47 that are to exist. 00:49 I think the largest challenges in the sniff world today are really 00:54 the 00:55 reimbursement systems are so complicated. 00:57 There's so many different 00:59 um 01:01 Reimbursement levers out there that need to be captured, 01:04 and I think it's just challenging for these teams 01:07 that they wear multiple hats in these communities and they're 01:10 strapped for time and we've gone from a rug system to a PDPM system that 01:15 is 01:16 Triple the amount of reimbursement drivers, 01:19 and it really does take a village. 01:20 I think R2 01:22 really comes in because they've identified that that's a real need in the industry 01:27 and that 01:28 there's no way these communities are gonna capture everything, 01:31 um. 01:32 Without help, 01:33 you know, 01:34 they, 01:34 everybody needs to be looking at these 01:36 reimbursement opportunities as these um 01:39 residents come into our communities, 01:41 and 01:42 our whole mission is really to help improve the success of these communities, 01:46 capturing 01:47 all the acuity, 01:47 all the care that they're delivering, 01:49 and really working alongside them to really improve their overall 01:53 processes to make sure that they 01:55 improve over the long run, 01:56 to be able to capture all the care that they're delivering. 01:59 Great. 01:59 And you've created an army of MDS support. 02:02 Tell us about your team that you have there before we talk about your services. 02:06 Tell us what you've put together there. 02:08 Yeah, 02:08 we have. 02:08 We've, 02:09 we've 02:09 really created an army of MDS nurses and therapists 02:13 that have a multitude of experience. 02:15 They've been in the industry, 02:17 um, 02:18 worked 02:19 in operations, 02:20 worked as regionals, 02:22 worked as MDS nurses, 02:23 so they really understand the flow and the operations of the facility. 02:27 They really know what the community's struggles are, 02:30 and so they're really 02:31 able to partner right alongside the community teams, 02:35 really identify their specific barriers, 02:37 pivot 02:38 to their needs, 02:39 communicate with the facilities, 02:40 kind of, 02:40 and, 02:41 and see what works best with them because it's different for every community. 02:44 Sure. 02:44 So let's talk about some of your specific services. 02:47 I know remote monitoring is one of the things that your MDS nurses do. 02:50 Tell us about your remote monitoring service. 02:53 Remote monitoring is really for Medicare and Medicaid. 02:56 Um, 02:56 our nurses and therapists, 02:57 they get access to the community's electronic medical record, 03:01 and we really work alongside the teams looking at all of the new admissions 03:06 to see 03:06 what reimbursement opportunities there are to capture. 03:09 We're not there to audit. 03:11 We're really there looking proactively before 03:14 the MDA. 03:14 has been completed 03:16 so that they have time to 03:17 query the physician, 03:18 make sure that the documentation is in place, 03:21 make sure that they capture all of the supporting documentation that's needed 03:25 so that they can get reimbursed. 03:27 And really 03:27 the same is on the Medicaid side for CMI, 03:30 you know, 03:30 we review all of the Medicaid patients. 03:33 We're working in a model that sort of. 03:36 Right along with the assessment reference date 3 weeks out, 03:39 2 weeks out, 03:40 1 week out to make sure that nothing is missed and 03:42 that they have time to gather all the documentation that's needed, 03:45 and then we communicate that information right over to 03:47 the community so they have time to work that 03:50 um before the assessment is completed. 03:52 That's great. 03:53 And what, 03:53 what kind of returns, 03:55 what kind of results are you seeing with your remote monitoring? 03:58 With Medicare, 03:59 you know, 04:00 we 04:00 have seen on average $40 a day. 04:03 Um, 04:03 some of our communities have gotten up to $100 a day. 04:06 It just depends on where they begin, 04:08 which really is a large impact. 04:09 If you're looking at 04:11 $40 a day for 10 Medicare, 04:13 you know, 04:13 that's 04:14 $144,000 a year, 04:16 you know, 04:17 that can be huge. 04:18 And on Medicaid, 04:19 we're able to improve their CMI, 04:22 Medicaid reimbursement dollars from $4 to $5 a day, 04:24 which 04:26 For a 100 bed facility can be up to $180,000 a year. 04:29 I mean, 04:29 it's, 04:29 it's a big impact. 04:31 That's huge. 04:32 Now, 04:32 I know in addition to remote monitoring, 04:35 you're also doing case management. 04:37 The, 04:37 the managed care companies, 04:38 both on the Medicare and Medicaid side are driving providers crazy, 04:42 but you have an additional service that works to help solve that problem. 04:46 Tell us about your case management. 04:48 Yeah, 04:48 case management, 04:49 um, 04:50 we really take over the entire process sort of soup 04:52 to nuts from admission to discharge and even beyond with 04:55 denials management. 04:57 So 04:57 we really, 04:58 um, 04:59 work with those teams 05:00 looking at. 05:02 You know, 05:03 what 05:04 is needed in the contract for every one of the managed care 05:07 companies. 05:08 We pull that information, 05:09 we look at their high-cost drugs, 05:11 their carve-outs, 05:12 we communicate with them, 05:13 we, 05:14 um, 05:14 submit all of the ongoing authorization, 05:16 pull the documentation, 05:18 work with the insurance companies. 05:20 Um, 05:21 I think the thing that really stands out for us when it comes to managed care 05:24 is our volume. 05:25 You know, 05:25 we have over 300 facilities that we service, 05:28 and so, 05:29 When you have 05:30 over 100 different payer types and multitude 05:33 of case managers at those insurance companies, 05:35 we know just who to speak to at every one of those, 05:38 um, 05:39 with every one of those providers. 05:41 So, 05:41 if I'm an MDS coordinator or a nurse in a facility and I don't have that support, 05:45 I call an insurance company and I, 05:47 I get who I get on the phone, 05:48 where we You know, 05:49 you know, 05:50 we can circumvent that and we know exactly who to speak with 05:53 at those companies to make sure that we can get the ongoing authorization, 05:56 fight for the level, 05:57 understand the contracting so that we're really able to help the community, 06:01 um, 06:01 with, 06:02 you know, 06:03 that management of that case as well as to really 06:05 advocate for the residents to get the care they need. 06:08 That's great. 06:09 And what kind of results are you seeing with case management? 06:13 You know, 06:13 we, 06:14 we have seen a great improvement in length of stay overall. 06:17 Um, 06:17 we, 06:18 we take the baseline information of the facility and 06:20 we're really able to extend that length of stay. 06:22 I think purely because 06:24 we are gathering the right documentation. 06:26 We're able to understand the contract, 06:29 um. 06:30 Able to communicate with that payer type to get the ongoing authorization, 06:33 so we're able to improve the length of stay, 06:35 improve the levels, 06:36 and then I think 06:37 our big 06:38 takeaway has been our overturning of denials. 06:42 You know, 06:42 a lot of these insurance companies are denying 06:45 ongoing care when residents really aren't ready to go home, 06:48 and we have a 70% overturn rate for our denials management. 06:51 So I'm really proud of that. 06:53 Um, 06:54 and I think that we've really 06:55 honed in on understanding that the management of managed care comes from, 06:59 you know, 07:00 at admission, 07:01 managing to discharge, 07:02 making sure that they are, 07:04 um, 07:04 ready to discharge at that safe functional level that they were prior. 07:08 Great. 07:08 Well, 07:09 whether it's remote monitoring or case management, 07:11 you have to be a specific size of a provider 07:15 to do this. 07:16 Who do you work with? 07:17 Um, 07:18 no, 07:18 you know, 07:19 um, 07:20 we 07:21 No size is too small or too large, 07:23 I guess I would say. 07:24 Uh, 07:24 we have some mom and pop communities that are 40 07:27 bed facilities with just one or two skilled patients. 07:30 We also have providers that 07:32 have up to 150 communities that they operate and they can have 07:36 up to 50 managed care patients a day. 07:38 So it really doesn't matter. 07:40 We get in and we understand the pain points. 07:42 We look at what would make the greatest 07:44 impact on their operations from a reimbursement standpoint, 07:47 and we take that, 07:48 um. 07:49 And are able to work with anybody of any size. 07:52 Great. 07:53 So what are the next steps if somebody wants to get 07:54 involved with R2 for either case management or remote monitoring? 07:59 You can contact us and we'll do a free analysis. 08:01 We'll take your data and we'll see where you fall. 08:03 Um, 08:05 you're welcome to give me a call or you can contact me via email, 08:08 and then, 08:09 um, 08:09 we can get started. 08:11 Amy, 08:11 that's great. 08:12 And thanks again for your sponsorship of Park Place. 08:15 It's, 08:16 it's a perfect match 08:17 because again, 08:17 our mission is the success of providers and your mission is to make sure 08:22 that they're capturing the reimbursement that they deserve. 08:24 So, 08:25 I hope that you'll reach out to Amy and R2 to, 08:28 to use that free inquiry to figure out how, 08:30 if they can help you. 08:31 I'm sure that there's a very good chance they can. 08:34 And in the meantime, 08:35 we appreciate your continued support of Park Place.
