The Advis team of experts assists providers in working through a variety of scenarios, from decertification and expanding service lines to building micro-hospitals and understanding the latest regulations. No project is too big or too small for the Advis experts. We offer practical guidance to pressing regulatory, operational, and fiscal issues in healthcare; we supply the vision required for sustained success. Our innovative, low cost approach to problem solving helps clients meet today’s demands in a rapidly changing industry environment.
In our latest Q&A, we learn how the team helped turn around a suburban mid-size healthcare facility facing decertification by CMS because of numerous compliance deficiencies. This facility was also facing significant financial losses, which in turn threatened its overall financial viability.
Susan Maupin, Advis Vice President, gives us an inside look at how the team joined forces with the client to go from a facility not bringing in any money to one collecting significant revenues and in full compliance with applicable regulations, in less than six months.
Ms. Maupin specializes in healthcare operations, management, and strategy. She has been with Advis for 13 years.
What happened after Advis got the call from the healthcare provider facing decertification from CMS?
“As with all clients facing these same issues, we deploy our team to do a rapid assessment of the facility from top to bottom. In this situation we also did a mock survey and turned every stone. There were three layers of assessment that resulted in a lot of training and recommendations.”
Is this a typical call?
“We receive calls from facilities of all sizes in danger of losing Medicare certification or their state license to operate. The issues range from life safety to operational inadequacies. Quite often, we help clients who face reorganization or closure due to reimbursement, documentation, and business office deficiencies.
But this particular call was urgent because of the severity of actions threatened in the CMS letter and the fact that very little revenue was coming in the door.”
What were the largest issues this provider was facing?
“There were many issues but most had to do with billing, compliance, and clinical restructuring.”
What is typically the biggest issue that finance teams face?
“Many healthcare financial teams are lacking the knowledge in the reimbursement regulations. They also are dealing with slow accounts receivable departments. A lot of times they face audit issues which further complicate the already sensitive issues surrounding healthcare provision and reimbursement.”
What was this facility in jeopardy of losing?
“They were in danger of losing lots of money, their Medicare certification and state licensing, and closing.”
What happens if a healthcare facility loses Medicare certification?
“Depending on the payer mix, if Medicare is a significant part of the facility’s patient population the loss of these patients can be catastrophic. Providers who lose Medicare certification cannot bill Medicare for services. Medicare certification is usually a prerequisite and requirement for Medicaid program participation as well as third-party payer participation; thus, a domino effect is triggered, causing massive problems for the provider.”
How did Advis turn this facility around so quickly?
“No one wanted to waste any time, so the provider allowed us to manage the location. For approximately six months, we deployed our own Advis experts to take over the billing office. Rather than just telling clients what to do, we were there to show them. We made sure things were done right and quickly. Time is of the essence in these situations. We become part of the team and are there to help the team succeed.
We don’t just come in, tell you what to do, and leave. We are boots on the ground, building trust and relationships and achieving consensual success. Most firms wouldn’t take over a billing office, but we do whatever it takes to turn around a facility. We are a small but mighty firm that comes in and turns things around quickly.
After six months I am happy to report the facility is turned around. We addressed all the outstanding compliance issues, completed staff training, and revenue is coming in the door.”
Is this a typical outcome?
“Yes. In fact, this provider is now making plans for the future with an expansion and adding service lines.
We are here to help. We don’t want to see these facilities have to close their doors because they have no other choice. In the past 25 years we have helped a variety of healthcare venues, including LTACH’s, ASC’s, SNF’s and IRF units with turning a challenging business operation into a thriving venture.”
Is there a point where Advis would consider it too late to provide assistance?
“No, we can always offer assistance and help work through the issues a provider is facing. We can also prepare them so they won’t face these issues again. Advis is there to provide support, but also to ensure things run smoothly when we are finished.”
What has the feedback been from the client?
“They were surprised at how quickly we were able to achieve positive outcomes which were better than they anticipated. In six months we successfully addressed and remedied every compliance issue. They went from losing money to collecting millions in under a year.”