Wisconsin Care Coordinators Expose LTC Gap 2 Law Makers

The role of care coordinator exists to improve the over all quality of the health care systems measure of  care assurance.   Law makers enact regulation to maintain health and safety across the community being represented.  Inherent in the stability of long term care provision is the understanding of how change within the traditional template creates revenue cycle inefficiencies being calculated as a percentage of the cost of delivering a standard unit of service.

The traditional LTC personal supportive care template:

DHS and Office of Commissioner of Insurance assigned to over sight

3rd party contracts to distribute funds on behalf of beneficiaries

CMO or Insurance plan conducts independent assessment and authorizes service

Local providers performs personal supportive care for eligible individual


The CMO or insurance plan contracts with the local service provider by defining the unit reimbursement value.  For example every hour of service is equivalent to 20 dollars.  The CMO or insurance plan performs an independent assessment from which the hours of service are defined.  For example this person will receive 3.5 hours of reimbursable service per day.   So contractually the unit reimbursement value and the authorized units have been established prior to service delivery.

The local personal supportive care provider delivers service.  The local provider formulates a claim from the employees submitted time card and electronically communicates with the 3rd party fund distributor.  The 3rd party fund distributor ascertains units of service submitted for reimbursement match the previously authorized units.  The 3rd party fund distributor assigns the direct electronic payment to the local providers bank account. 

This is a very simple process with a recurring revenue component that has experienced the efficiencies advancement of technology can contribute.  Yet care coordinators have noticed a disturbing trend.  Any change in the participants of the current traditional LTC personal supportive care template can be communicated as a percentage of the cost of the delivery of the standard unit of service.

Any change with the CMO/Insurance plan, 3rd party distributor, or local provider brings revenue cycle inefficiencies.  Inefficiencies can be seen as changes experienced as increased labor investment and loss with collection/cash flow problems.  The unfavorable assault on the process will be felt by all involved, we no longer operate in an isolated closed system. 

Care coordinators believe personal supportive care providers have little or no competition in Wisconsin today due to the way unregulated inefficiencies in revenue reimbursement cycle adversely impact the percentage of the cost of a standard unit of service delivery.  Care coordinators suggest regulations designed to manage sustainability with revenue cycle reimbursement is an essential piece of the federal mandates requiring lower profit margins. 

For lower profit margins to be placed upon CMO/Insurance plans, 3rd party fund distributors, and local personal supportive care providers a seamless simplified revenue reimbursement cycle needs to be regulated.  Regulation needs to support revenue reimbursement cycle efficiencies.

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