Managing Medicare Advantage Plan Challenges with Your Hospital’s Swing Bed Program

KENNESAW, GA / ACCESSWIRE / December 16, 2024 / Swing beds can be an important tool for your critical access hospital, and they can be very beneficial for patients and their families as well. In this article, we'll go over the common challenges hospitals face with a swing bed program and Medicare Advantage plans and how to combat them.

Prior Authorization

In 2022, the United States Department of Health and Human Services' Office of Inspector General filed a report saying that 15 of the largest Medicare Advantage Organizations, or MAOs, have denied or delayed access to care and payment requests from providers that actually met their own billing rules and typical Medicare coverage. This can be really challenged for hospitals with a swing bed program, since Medicare patients are often the majority of swing bed patients. This creates extra work for providers to process appeals and can result in a delay in timely care or continuity of care. As a hospital with a swing bed program, it is key to educate providers on this issue and help them understand the true impact of what this means. Another helpful way to combat this issue is by conducting post-discharge interviews to help catch any issues or hang ups that may have happened with any particular patient.

Continued Stay

Another common challenge many swing bed programs may face is with length of stay, with Medicare Advantage patients often receiving a shorter length of stay than they really need. Appeal rates with this particular issue can vary widely from as low as 1% to 40.5%. When patients receive a shorter stay than they need, it can often result in increased preventable hospitalization, which can cause issues for your facility. To combat this issue, it's essential to document clearly and specifically why a licensed provider is needed or not needed to facilitate care or services.

Compensation

Once care has been provided, it's extremely important that your hospital receives compensation accordingly, but sadly, this is another common issue with Medicare Advantage patients and swing beds. Just because authorization has been granted doesn't always guarantee payment, and the fee schedule is often less than traditional Medicare and can also be delayed. Of course, this can cause issues of financial hardship for swing beds and can trigger RAC (Recovery Audit Contractor) audits. To prevent this issue, it's key for your hospital and swing bed program to establish contracts with clear parameters and examine those contracts well and often.

Additionally, a crucial part of having a successful swing bed program is in therapy services and making sure those are run as efficiently and effectively as possible. BenCura works with acute care and critical access hospitals to provide quality contract rehabilitative services at a lower cost than traditional in-house models. This can really aid your swing bed program and help it to be successful. BenCura also works with partnering hospitals specifically on enhancing swing bed programs, so if you have additional questions or concerns, we can help with that! To learn more about what BenCura can offer your hospital, visit https://bencura.com/hospitals/.

BenCura Rehabilitation Services is a premier contract rehabilitation service committed to providing quality care to patients. BenCura partners with acute care and critical access hospitals and skilled nursing facilities to provide high quality physical, speech, and occupational therapy at a lower cost than traditional in-house models. For more information about BenCura Rehabilitation Services and our partnership with hospitals and long-term care facilities, please visit: https://bencura.com/.

CONTACT:

855-423-6287
info@bencura.com

SOURCE: BenCura Rehabilitation Services