Responsibilities and Duties:
1.
Develop census through careful and selective admission of residents.
2.
Establish positive relationships with discharge planners at community hospitals, doctors’ clinics, and other referral sources.
3.
Carries out duties as requested by the Administrator.
4.
Obtain copies of Insurance Cards upon admission of resident, or as soon as possible.
5.
Updates Census map daily.
6.
Facilitates admission meetings each morning to present all inquiry and admit info to the committee. Makes recommendations regarding admission.
7.
Gives tours and answers questions for potential admits.
8.
Maintains and updates a waiting list for potential admits.
9.
Completes admit paperwork (within 72 hours), phone calls to family, and notify roommates of admissions.
10.
Explains and/or reviews Resident Rights, POA and Living Wills with resident and family/guardian.
11.
Completes notification paperwork and packets for all related department heads prior to admit of new residents.
Admission Process:
When a patient inquiry comes in (usually by fax), it is the Admission Coordinator’s responsibility to facilitate a thorough patient review and give the referral source a ‘yes’ or a ‘no’ within 30 minutes. If that is not possible, the admissions coordinator must keep in regular contact with the referral source until a decision is reached. Administrators must review all denied admissions. A thorough review includes:
Medical Review—The Director of Nursing (or designee when DON is not available) must determine whether the facility can meet the resident’s medical needs.
Social Review—The Director of Nursing or Social Services Director must determine whether the facility can meet the patient’s mental health needs and decide if the patient would fit the current facility population.
Financial Review—The Admissions Coordinator must verify that the patient has insurance coverage through Medicare, Medicaid, or a Third-Party Insurance by calling the insurance company, or verifying Medicare/Medicaid coverage online or via phone prior to admit. If a patient is paying privately, funds must be collected prior to, or upon admission for the remainder of the month. Admissions Coordinator must also verify that a potential patient’s medications/therapy/supplies costs do not exceed estimated daily payment received for a resident.
If a resident is coming from home, the facility must receive a recent workup from the potential resident’s doctor that includes medical history, current medications, and a doctor’s order to admit to the nursing home.
Once a patient has been approved, the admissions Coordinator must notify all related staff of pending admission, by providing a Notice of Admit to all department heads, and a copy of the patient packet to the RCM and the Therapy Director. Also, the room selected for the resident must be prepared for the resident (clean, organized, and attractive).
Once a patient is admitted, the admissions Coordinator must make a copy of all insurance cards to give to the business office. The patient admission packet must be signed within 72 hours.
Medicare/Medicaid/Insurance Quick Facts
Medicare will pay a resident’s Skilled Nursing Facility benefit when they meet all the following criteria:
The patient has had a 3-midnight hospital stay within the last 30 days (they must have been admitted, not ‘under observation’).
The Resident has a skilled need (i.e., Skilled Therapy, IV treatments, etc.).
The Resident has gone at least 60 days since receiving SNF benefits under Medicare for a prior hospital stay.
If the patient meets these criteria, Medicare will pay:
Days 1-20: Full-Coverage
Days 20-100: Requires a $141/day co-pay, which periodically increases (Medicaid and most insurances will pay this).
Days 100 and beyond: No coverage, and 60 must pass before a new 100 days becomes available. A new hospital stay and a new diagnosis is required first.
As soon as a patient plateaus in therapy, or no longer needs skilled treatments, Medicare coverage ends.
Medicaid is available to patients who have below $2000 in assets (other requirements apply as well) and who have a long-term medical need. It pays a set daily rate, which changes quarterly according to the facility case mix, and the government budget environment. It is typically around $155/patient/day at Willow Springs. Medicaid will pay for the resident stay (does not include therapy) for as long as the patient resides in the facility.
Insurance coverage varies greatly from company to company. Each different plan must be evaluated prior to admission to determine coverage. Many only pay as a supplement to Medicare, and most require a previous hospital stay.