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Long Term Care Financial Review

Comprehensive Reviews That Maximize Recoveries.

Improper Payment Health Plan
As baby boomers require more long term care services, expenditures will increase. HMS’s financial reviews identify improperly paid claims and report the findings to you for recovery.

Long term care facilities present a particular challenge for overpayment identification and recovery efforts because of unique situations that can often lead to overpayments. These include facility transfers, discharges, hospital, and therapeutic leave bed holds, as well as coordination with Medicare and other insurance.

Medicaid nursing home residents are also required to pay a portion of their monthly income —called patient liability — toward the cost of their care. Improper payments stemming from patient liability applications can occur when income increases are not reported timely to eligibility case workers, or there are changes to the residents’ allowable deductions, which affect the net income.

HMS Long Term Care Financial Reviews address these difficulties, administering improper payment identification and recovery services. By working closely with providers throughout every phase of the audit process, we have developed a global understanding of the systemic issues that can create overpayments in each state.

Our unique approach also gives us insight from the providers, the direct users of the claims payment systems. Today, as a provider liaison, HMS makes recommendations for improvements to our customers based on the experience from both our best practices and provider experience.

We also review long term care community-based waiver programs, including home healthcare and assisted living facilities. We ensure payments are accurate and paid within the program’s policy allowances.

Our national networking with the long term care facilities has helped us build the reputation for excellence we enjoy today. Since 2009, our team has conducted Medicaid nursing home overpayment projects in 14 states and has identified more than $320 million in overpayments on our customers’ behalf.

Contact HMS today for more information about Long Term Care Financial Review.