Covisint – Central Management Corporation

Central Management Corporation, owner of numerous nursing homes throughout Louisiana uses Covisint to expedite Medicaid communications.

Situation

Like all nursing home chains, Central Management Corporation (CMC) encounters many industry pressures including pandemic preparations, infection control, optimized staffing ratios and cost containment. When it comes to Medicaid patients, costs have exceeded rate increases by two percent.* It is not an easy task to contain growing costs, while simultaneously improving and increasing revenue. That led Jamie Shelton, chief operating officer of CMC, to look to Covisint. CMC’s challenge was how to communicate more effectively with the Louisiana Medicaid Long-Term Support and Services Office.

The entire Medicaid eligibility and certification workflow was paper-based. For example, forms to evaluate the patient’s medical and mental condition required by Medicaid were completed on paper and communicated via fax machines. Hand-written forms provided little data validation control. Often, Medicaid would send the form back requesting additional information. The cycle time on additional information requests originating from both sources, and their responses was long and had no built-in accountability. What if a bookkeeper is on sick leave? Where can alternate staff go to bring themselves up to speed on the workflow? Quickly, the paper-based workflow becomes a management challenge. Within the State of Louisiana, nursing homes cannot begin billing Medicaid until they have received notice of medical certification for each Medicaid patient. CMC’s additional challenge was to transform this notice of medical certification into an e-form. An accelerated form cycle time permits the facility to receive the 18 LTC (Medicaid) contract faster so they can begin billing more rapidly.

Solution

CMC turned to Covisint’s ProviderLink solution for comprehensive, Internet-based communication and workflow management. Over five CMC facilities representing 31 users and eight Medicaid regions representing 32 users employ Covisint for inter-organization communications. With Covisint ProviderLink’s e-forms, medical and mental health evaluations are completed online and checked for errors through built-in data validation rules prior to submission. Once ready, the forms are sent to Medicaid online via Covisint. On the Medicaid side, if additional patient information is needed, requests and responses are sent through Covisint, employing an e-form. Once finalized and approved, Notice of Medical Certification, which originates from Medicaid, is sent to the nursing homes through Covisint and the billing process begins. The entire Medicaid communication workflow, including form creation and transport, is accomplished within a single environment.

Better Health and Lower Costs

Notice of Medical Certification turnaround time reduced by 12 days
The CMC facilities involved reported a 13-day average response time for receiving Notice of Medical Certification from Medicaid using the paper-based workflow. Using Covisint ProviderLink, these same facilities report one-day average response time. With this rapid turnaround time, the nursing facilities can expedite Medicaid billing. Shelton comments, “Our nursing home staff can now directly communicate with Medicaid in reference tocertification forms, reimbursement forms and claims attachments. Approval from Medicaid was taking, on average, three weeks and now it is being received within one day.”

35 percent reduction in medical and mental health form creation time
Using paper-based forms, the CMS facilities report it took approximately 23 minutes to fi ll out the Medicaid-required medical and mental health evaluation forms. With Covisint ProviderLink’s e-forms, the facilities report an average form creation time of 15 minutes.

Four-day response time improvement on Medicaid claim attachment requests
Prior to Covisint, when the Louisiana Medicaid Long-Term Support and Services Offi ce requested additional patient information from the nursing homes they would receive a response within an average of five days. Using Covisint, information request and response time has dropped to one day.

“Shortfalls on Medicaid Funding For Nursing Home Care,” BDO Seidman, LLC Accountants & Consultants for the American Health Care Assn., April, 2005, Page 8.