Benefit Blast-September 2021

Volume 9 | SEPTEMBER 2021

Benefit BLAST

News You Can Use

from your Benefit Coordination Partner!

Benefit Results is proud to work with many nursing facilities around the country. Given all the other areas that need to be handled by social workers and case managers, securing Medicaid benefits can be an additional daunting task. These tasks include such efforts as educating residents, using correct procedure in the application process, working with families regarding eligibility issues and following necessary policy to secure eligibility and a consistent revenue stream.

Yet, even when a resident has been approved for Medicaid (ALTCS in Arizona) there still may be some revenue loss challenges. Collecting “Share of Cost” or “Patient Liability” can often prove difficult. In collaboration with the facility team, Benefit Results works to find solutions to these non-payment issues.

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Benefit Update:

Share of Cost-Patient Liability

Share of Cost (SOC) or Patient Liability (PL) is the amount a Medicaid recipient must pay towards the cost of his / her nursing home care. In Arizona, this amount is called something different when the member lives in an Assisted Living (HCBS) but the premise is the same. It is called a “Room and Board Payment”. Each member is assessed a part of their monthly income to pay for care.

Medicaid is always payer of last resort, which mean the member must pay “what they can” towards their cost of care. In most situations this is the member’s gross monthly income minus the allowed personal needs allowance ($119.10-2021) . It is important to note that there are rules that allow the well spouse to keep some of the ill spouse’s income, called Community Spouse Monthly, Income Allowance, which we discussed in a previous Benefit Blast.

Management and collection of the Share of Cost can be difficult. What does your facility do if you find that the resident is not paying their assessed Share of Cost? What is your action if you feel the Share of Cost is assessed incorrectly? How long do you wait to ask WHY the resident isnt paying? What strategies do you have in place to investigate and fix these non-payment issues?

Benefit Results encourages a very proactive approach to these issues to avoid unnecssary revenue loss.

Share of Cost Explanation

RECENT RESULTS!

One of our newly contracted facilities sent over two referrals for residents that had not paid their Share of Cost in over a year. We were asked to evaluate and assist.

In both cases, after our evaluation, it was found that the reason for the revenue loss, was that the SOC was assessed incorrectly by ALTCS. Once issue was identified, proper proof provided to the state, Benefit Results was able to fix the error. Both residents are now able to pay their full SOC. The revenue loss on both these cases could have been completely avoided had these issues been addressed the first month the discrepancy was identified. Proactive and focused management of these issues can save a lot of time, stress and money!

Click HERE to read what our clients are saying about Benefit Results!

What is coming up?

Benefit Results is offering a free monthly training series called "Benefit Buffet". The web-based training is held on the last Wednesday of each month. We will focus on one specific benefit issue. Our hope is that these "bites" of information will help you better educate your residents, staff, and organization allowing for more successful utilization of the benefit within your facility process.

The next Benefit Buffet is Wednesday, September 29 at 3 pm Arizona time.

The September Buffet is about Social Security Benefits (SSA,SSI, SSDI) and how to help families understand and avoid mistakes. If you are interested in attending the Zoom presentation click HERE.

Click HERE to for a list of topics and to preregister for future months of the training.

The annual National Assisted Living Week is celebrated in September.

This year’s National Assisted Living Week was very special because of the enormous challenges of the past year. Compassion, Community, Caring reflects the hard work and dedication of all the caregivers in assisted living communities.

We are so grateful for all who work so hard in assisted living communities. Now more than ever, you truly make a difference.