CARE REVIEWS
How do you prepare for a Care Review?
Create a calendar event
Send facility outlook invite if confirmed
Download and format the Care Review
Download multi service census - either print or email
Know your facility
Prepare an Aria informational packet (facility folder)
Swag bags
What compliance information are you verifying during a care review?
MCD
SR VS RP
LIST BILL VS DIRECT BILL
PML
(Responsible party name, phone number, address)
Name 6 documents found in the Aria Informational Folder (facility folder).
Contact sheet
Application
FFS form
PP form
Client portal
ePay
ACH form
EMR
Family night invitation
Role play: an enrollment conversation when the resident/family objects because the resident is already enrolled in an ISNP.
Partnering with Aria for Success: Facilities with an I-SNP
• Policies offered to all residents, including Medicaid residents
• Aria policy typically takes primary and offers more robust benefits
• Routine care team visits onsite, vs ISNP not onsite
• Separate visits for dentists & hygienists
• Outside referral network
• Dedicated point of contact
• Proactive scheduling of all care
• Dental triage available
Benefits for the Responsible Party
• Proactive scheduling, routine care, dental triage, frequent cleanings
• Single point of contact
• No pre-authorizations required
* Aria can bill most ISNP's
* Aria policy can complement ISNP - suggest dual enrollment
* Warranty value of dentures, eyeglasses, and hearing aids
Why can't we say Aria's insurance policy is FREE?
- Allowable Medicaid Adjustment
- Monthly Premium / Cost
- Paid into Social Security
- Compliance / licensed insurance agent
Describe the difference between the two Combined FFS forms and who obtains the signatures?
PRS - doctor/nurse signs
RMC - family/resident
It is the facilities responsibility to obtain signatures for FFS forms.
AM's not allowed to obtain signatures.
Facility may submit a verbal authorization.
Aria mails letter notifying family of PRS form received and includes an opt out option.
What insurances do these forms bill?
What service line is not covered on this form?
What do you do when you receive a suspicious email from a known contact?
CALL facility contact to verify email was sent
Do NOT enter your Aria credentials into any link
Click the phishing button
Do not open any attachments
Provide 3 reasons to uncheck the RCM DO NOT ENROLL box and the process to request removal of the banner.
1. From direct bill to list bill
2. New RP
3. RP or facility pays past due amount
4. SR resident enrolls in ePay
5. Clinical need
Role play: an enrollment conversation when the objection is that the Aria policy is too expensive.
Medicaid Allowable Adjustment
Program that resident has already paid into
No out-of-pocket expense
Doesn't affect personal allowance
Premiums are approved by Medicaid to reflect the level of care
House call
What is the 3-day denture protocol and how does a facility fulfill it?
Facility has 3 days to report to a dental company (us) regarding issues with a resident's denture.
Fill out the triage form and fax or email it to our team.
Role Play: Self-responsible resident is eligible for dental, vision, and hearing insurance policy (SRLB). Resident is in their room.
Knock first
Ask if you may enter their room (home) and introduce yourself
Make sure you are in a private location or ask if they are ok discussing where you are if not in room
Don't interrupt: sleeping, eating, activities (includes therapy)
Non-Negotiables:
- Lists benefits of each service line
- States premium amounts
- States this is an insurance policy
- States this is a Medicaid adjustment and how it works (allowable adjustment)
- 2 check process from facility point of view
- Doesn't affect personal allowance
- Medicaid pays facility premium amounts on the next month (back end)
State the compliance statement needed to submit a CR and application.
CR - Compliance confirmed with _________ (add facility reps name and title)
Application -
Reviewed insurance product(s) and billing
Understands 2 check process
RP SR LB DB (identify which 2)
Facility rep(add name and title) confirmed compliance
What time frame do you have to complete your onboarding call and conduct the onsite enrollment day?
5 days
between day 35 and 60
Role Play: a rebuttal statement for each of the following:
- Resident says "I don't have any teeth"
- Resident says "I have cataracts"
- Resident says "I hear fine"
Edentulous: do you want some?, oral cancer screenings, mouth swab for bacteria
Cataracts: supplemental, monitor in between specialist visits, preventative
Hearing: base line, TV, raised voice, not just about the hearing aids, wax removal
How do you effectively schedule/manage your book of business. (Quarterly CR's)
- GeoPointe
- Clustering
- Knowing special requests (ex. when to and not to come)
- Make appointments
- Fill out calendar 2+ weeks out
- Set expectations
- Limiting scheduling options
Role Play: Self-responsible resident is eligible for dental, vision, and hearing insurance policy (SRDB). Resident is in their room.
Knock first
Ask if you may enter their room (home) and introduce yourself
Make sure you are in a private location or ask if they are ok discussing where you are if not in room
Don't interrupt: sleeping, eating, activities (includes therapy)
Non-Negotiables:
- Lists benefits of each service line
- States premium amounts
- States this is an insurance policy
- States this is a Medicaid adjustment and how it works (allowable adjustment)
- 2 check process
- Doesn't affect personal allowance
- Medicaid pays facility premium amounts on the next month (back end)
- Discuss and provide ePay flyer and/or ACH form
- Ask for cell phone number
State the verbal authorization compliance statement.
Verbal auth:
“Please note you are on a recorded line for quality and training purposes. Do you (RP full name) give authorization to enroll (Resident full name) in the (dental, vision, and hearing) insurance policies, inform Medicaid of enrollment to process the adjustment, and to be able to see and treat them regularly?"
Explain the client portal, how to enroll, and who do you contact if there is an issue with registration? Role play.
Client portal flyer
Client portal online
Spencer Scheve (teams)
Role play: an enrollment conversation when the objection is that the resident has dementia/Alzheimer's.
- Our providers are specialized in treating residents with dementia/Alzheimer's.
- Family is always welcome to be present during the visit
- The provider may be able to find issues when the resident is unable to communicate. Ex pain, swelling, bleeding, etc.
Give three examples of etiquette on a "team" call.
- On time
- On camera
- Stationary - not driving
- Be in private area, not around facility staff or residents
- Respect for each other, no judgement
- Participation
- Focus, not distracted by emails/texting etc.
- Be prepared
Role play: an RP phone call: RPDB, resident eligible for dental, vision, hearing, and podiatry services.
Non-Negotiables:
- Lists benefits of each service line
- States premium amounts
- States this is an insurance policy and FFS for podiatry
- States this is a Medicaid adjustment and how it works (allowable adjustment)
- 2 check process
- Doesn't affect personal allowance
- Medicaid pays facility premium amounts on the next month (back end)
- Confirm address
How do you report a breach if you accidentally send an email with PHI to the wrong recipient?
Try to rescind email. Notify IT if unsure how.
Notify Manager with all details of incident
Notify compliance (compliance@aria.care)
What is the difference between an exception home, standard home, and EMR home? How do you conduct a CR at an exception home?
Exception: facility will not provide census and face sheets during the 45-day SSS request cadence.
Standard: facility will provide CS and FS's every 45 days
EMR: Facility provided Aria access to pull CS and FS every 45 days
Exception Home CR: normal CR process, update any info that the CR generates, and ask for any new residents and any specific care needs
Role play: an enrollment conversation when the objection is that the resident sees an outside provider.
- May have additional expenses. Ex copays, deductibles, coinsurance
- Transportation to and from outside provider
- How often are they being seen?
- Convenience onsite, bedside, emergency, no out of pocket, warranty for devices
Name 3 key components to creating/completing your calendar.
- Events must be in SF calendar, not outlook
- Calendarize 2+ weeks out
- Complete event with notes on the same day as CR, or within 24 hrs
- Follow SOP in binder on topics to address in notes