AutoGov

AutoGov Releases Updated Risk Management Software for Medicaid and Healthcare Reform

Leveraging analytics driven by more than 30 million cases, CaseVue allows healthcare providers, states and insurance companies with a comprehensive solution to managing risk in eligibility, enrollment and insurance exchanges.

CaseVue v5.0

CaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility, enrollment and exchange decisions.

Austin, Texas (PRWEB) January 14, 2013

AutoGov Director of Technology and Analytics, Taylor Phillips; announced today a major release of his company’s flagship healthcare risk management software, CaseVue 5.0. This important version introduces improvements and tools designed to ensure that information necessary for Medicaid eligibility and enrollment is available in real time on a caseworker’s desktop.

Business office managers and caseworkers are often saddled with making decisions without the benefit of data necessary to prevent mistakes or errors. In these times of rate pressure and uncertainty in the healthcare reimbursement structure, mistakes and errors often mean money – significant write-offs and even fines. Phillips says, “CaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility and enrollment decisions.” CaseVue gathers case data and fuses information from third party data providers to feed an algorithm designed facilitate decisions. A remarkably fast turnaround…this process takes less than one second.

Thanks to AutoGov’s new financial partner, Ontario, Canada based Fusebill (fusebill.com); CaseVue can now be priced to suit our client’s needs – by the score, in packages or on a monthly basis! AutoGov’s specialists can create a custom pricing structure to support any healthcare business.

The software also features new self-service sign-up, administration, training and reporting designed by Phillips and an amazing development team at Rochester, NY based Netsmartz (netsmartz.net).

CaseVue is part of a comprehensive platform used by healthcare providers and government agencies to provide decision support solutions with a base in predictive analytics. CaseVue provides users with fast, accurate decision support tools that improve both the timeliness and quality of eligibility, enrollment and exchange related decisions.

AutoGov’s CaseVue software has provided scores to healthcare providers and government organizations since its launch in 2005. AutoGov’s algorithms are informed by data mining and statistical analysis of more than 30 million Medicaid, Food Stamp and TANF cases. The company’s firm belief is that solutions for its clients must be affordable, practical, and harness technology to support day-to-day operations without major disruption or unnecessary expense.

Contact one of AutoGov’s CaseVue specialists for a demonstration at 512-439-2900 or sign your company up today at http://www.casevue.com.

Resources For Finding an Assisted Living Facility

                The search for the perfect Assisted Living facility for your loved one can be time consuming and confusing. With so many options, it’s hard to know where to start or how to begin to narrow down the search. There are many resources on the web for you to be able to check out and do research. We have gathered 3 websites that have important information to be able to make this process easier for you.

Memberofthefamily.net - http://www.memberofthefamily.net/

This website offers a rating system of 16,000+ Medicare/Medicaid- certified nursing homes across the United States. You can also look at a national watch list they have compiled. This can help you build a list of possible facilities and know which ones you should steer clear of.

AARP- http://aarp.us/wl1QsR

AARP is a valuable and respected site for senior citizens. The link above will take you to an article on “The “Do’s” of Due Diligence” concerning choosing a nursing home. Before you start the nursing home selection process, you should know what it is you are looking for and how to find it.

Medicare.gov - http://1.usa.gov/zuWwn4

Medicare.gov has compiled a detailed check list for you to be able to take it with you on your assisted living search. It offers questions to ask, reminders of what to look for, a detailed area for recording information gathered, and a rating system.

Hopefully these websites answer any questions you may have on choosing the best assisted living facility and make the process less confusing and less time consuming.

Inspector General Introduces Provider Compliance Training Videos

Daniel R. Levinson, Inspector General for the U.S. Department of Health and Human Services, introduces OIG's compliance training videos and audio podcasts. This series will have 11 videos and audio podcasts that are part of the award-winning Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative. The videos cover a variety of healthcare fraud laws, common abuses, and what to do when a compliance issue arises. These presentations will be posted on the OIG website at the start of each week for the months of December, January, and February. These videos are part of the OIG’s Provider Compliance Training initiative.  AutoGov will post these videos as a series.

Health Reform Hits Main Street

This simple, easy to understand explanation of healthcare reform provides an opportunity to understand the basics of the new law without reading 1,000 pages of legislative lawyer language.

Solving a Medicaid Claim Mystery

Believe it or not there are some things about the Medicaid program that are simple.  For example, while there seems to be a great mystery surrounding what makes a Medicaid claim payable, it is it is really not a mystery at all.

Three simple fact items must be present to pay a Medicaid claim.  A claim must be submitted:

1. by an Eligible Provider: A provider submitting a claim for Medicaid reimbursement must be properly enrolled as an official Medicaid provider.   Each state conducts separate provider enrollment providers must enroll in every state where they provide services.

2. on behalf of an Eligible Recipient: To become eligible for Medicaid, a person must be determined eligible by the state in which he or she lives.  A Medicaid application must be completed and a variety of documents must be submitted. Generally, there are five specific components of the determination. The applicant must prove their identity.  They must be a citizen of the U.S. and a resident of the state in which they are applying for assistance. Finally, the applicant must meet certain maximum dollar amounts for assets and income. Once eligibility is determined, the individual will remain eligible until a change in circumstances renders them ineligible. Redeterminations are conducted on a regular basis, generally annually.

3. for an Eligible Service: Medicaid program services that are available to recipients vary from state to state. Providers have some flexibility but must render services in accordance with approved services.  Many rules and regulations govern the provision and frequency of these services.  For example, many states require high cost or unusual services to undergo a process called prior authorization before the service can be rendered and payment remitted.  

With each of these three items properly documented, Medicaid claims should sail through a state’s Medicaid payment system.

SNF Medicare Reimbursements

Doug Walker from Caring Forward offers a very helpful perspective to the Nursing Home Industry regarding SNF Medicare reimbursements.  A must read for our clients.  Visit his site at http://caringforward.typepad.com.

When 11.1% isn't really 11.1%: What will Medicare cuts actually cost SNFs?

Many smart folks in the SNF industry have spent a lot of time analyzing and discussing the pending Medicare SNF reimbursement cuts, including some dire predictions about pushing SNF operators to the "economic brink."

We have talked to many SNF providers that are putting projects on hold and deferring strategic decisions while they sort out the impact of the cuts. These cuts present yet another challenge for providers trying to provide exceptional care in a competitive environment with already thin margins.

But I just ran across a sharp analysis by Luke Fannon on the LTL Magazine blog that SNF providers should consider. The key point here: This is not a uniform 11.1% cut in Medicare reimbursements. With the "panic number" of 11.1% continuously kicked around, folks seem to overlook this important fact.

Fannon's analysis points out that, although the reimbursements for rehab RUGs will take a big hit (north of 18% in some cases), the non-rehab RUGs will actually reimburse at an average of 2.6% higher than before. Because of the way the cuts are distributed, your mileage will vary as to how it affects your facilities. It will depend on current and future case mix.

It seems doubtful, though, that any facility would take an overall reimbursement hit of 11.1%—it would represent a disproportionate existing level of rehab patient and reimbursements. For many facilities, because of the distribution of the case mix, overall Medicare reimbursements actually stand to increase under the new rules.

We also agree completely with Fannon's recommendations for SNFs seeking to offset the Medicare rate cuts:

• Stay focused on increasing your Medicare census--even with the cuts in the rehab RUGs, boosting Medicare census will significantly increase the revenue for your SNFs. (We would add to that: If your payer mix is OK, but your overall ADC is in the 80s or low 90s, then you also need to focus on marketing and increasing your overall admissions.)

Investors see health reform's potential by Sarah Kaliff POLITICO

Now we're seeing more talk about the business opportunities and possibilities for insurers and managed care organizations with health care reform.  "The Congressional Budget Office estimates 32 million Americans will gain health insurance by 2019 if the law stands."

Read more: http://www.politico.com/news/stories/0111/47534.html#ixzz1B1ka1P2n

The Medicaid Perspective

We launched a new blog today – The Medicaid Perspective (www.medicaidchip.com).  Focusing on Medicaid and CHIP, the blog will focus on analysis, opinion, and news on the runaway spending program that may bankrupt the United States.   Already thousands of people have visited the blog!  Please join them in learning more about Medicaid, the politics of healthcare and healthcare reform.

TIME Magazine "Newly Elected Republican Governors: Ready to Unleash Some Pain"

"The public is more willing to accept pain and difficulty, more than they have ever been before," Christie told his compadres in San Diego, and the new governors insist they are willing to bet on that judgment being correct.

Now a majority of states will have Republican Governors  who bring lots of promises about rolling back health care reform and no new taxes.   New Jersey Governor Christie’s has enormous confidence in his party’s ability to inflict pain on the public.  Wonder how willing the public really will be to have pain inflicted when they truly understand what tax cuts and health care cuts really mean?   Here is Time Magazine’s article “Newly Elected Republican Governors:  Ready to Unleash Some Pain,” which chronicles this newly elected confidence. 

http://www.time.com/time/politics/article/0,8599,2032465,00.html?xid=newsletter-weekly

CAHSAH and AutoGov Partner to Offer Online Training

CAHSAH and AutoGov, Inc. creates e-learning opportunities.

California, August, 2010 On July 1^st, job seekers will have access to cost-effective training allowing entry into the exciting world of home care.  The California Association of Health Care Services at Home (CAHSAH) now offers on-line training available 24/7 to home care workers.

The Department of Labor, Bureau of Job Statistics rates this profession among the fastest growing in the U.S.  California requires 75 hours of training, which is now available for as little as $80 for each enrollee. 

“Workforce development in the home care industry is critical to keeping people in their homes rather than in sterile, expensive settings,” says Joe Hafkenschiel, CAHSAH President.  “Our training offers people an affordable career opportunity in a critical sector of the home care industry.”

Using the California Uniform Standards for Home Care Aide Paraprofessionals (CUSHCAP) model approved by the CAHSAH Board, CAHSAH is offering two different levels of online training for the non-medical home care workers.  These non-medical home care services are defined as assistance with the activities of daily living which require no medical intervention and are non-invasive.  These activities include but are not limited to, companionship, baby-sitting or environmental type services which provide care, understanding, protections, supervision and assistance with feeding, dressing or bathing for a child or adult who by reason of advanced age, physical disability or mental deficiency, needs supervision.

The California Association for Health Services at Home (CAHSAH) is the leading statewide home care association in the nation and the voice of home care for the western United States.  CAHSAH represents more than 556 members and 850 offices that are direct providers of health and supportive services and products in the home.  Their provider members represent Medicare-certified home health agencies, licensed home health agencies, hospices, private duty organizations, home medical equipment providers, home infusion pharmacy providers and interdisciplinary professional services.  The affiliate members include computer companies, consulting firms, insurance providers, and suppliers.

AutoGov, Inc. is an Austin, Texas based provider of health and human services training and consulting.  Decades of experience inform AutoGov’s training solutions, offering practical customized solutions to its public and private sector clients.  Their e-learning solutions have trained more than 100,000 people since 1995.  Please visit our learning site www.autogovlearning.com

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For more information please contact AutoGov at inquiries@autogov.com or CAHSAH at 916.641.5795