Medicaid pending cases are a big liability for nursing homes. Don Chapin, president of National Eligibility Solutions, states that nursing homes need access to real-time information on incoming residents to understand how they can get paid and ensure long-term financial viability. Currently, most nursing homes wait until private payment runs out before applying for Medicaid, but applying earlier could significantly reduce bad debts and increase profits. National Eligibility Solutions provides consulting services to help nursing homes obtain necessary information to streamline the Medicaid application process.

1. Interview with: Don Chapin, CELA,
President, National Eligibility
Solutions
Many long-term care (LTC) facilities
are now turning down Medicaid pending
cases, but when 80 percent of the
population is middle class and could fall
into that group, it does not make
business sense to do so, says Don
Chapin, CELA, President, National
Eligibility Solutions (NES). Nursing
homes have to maintain their payments
without interruption, and without relying
on the families of residents or the
government, he adds.
A healthcare consulting firm, NES is a
solution provider at the marcus evans
Long-Term Care CXO Summit Fall
2013, in Palm Beach, Florida, July
25-26.
What are the challenges on the
financial side of the LTC business?
The government is lowering Medicare
and Medicaid reimbursement for LTC
services while regulations are becoming
far more complex. Facilities get paid
when residents are insured, can afford
private pay or are on Medicaid, but for
80 percent of residents who are middle
class, they cannot determine how they
will get paid for their services.
If the resident does not have savings or
LTC insurance, which only about eight
percent of people do, Medicare and
Medicaid are the only options left. For
LTC, Medicare is limited to 20 days if
there is a rehab, with a maximum of 80
additional days. These Medicare days
are accessible if the patient is admitted
to the hospital for three billing periods
and on an inpatient status. However,
nobody will have this information until
the patient gets to the nursing home.
How could facilities ensure they get
paid for services?
They need access to real time
information to understand how they can
get paid for the newly entered resident.
How many weeks of private pay can
they afford? Are they insured? How
were they admitted to the hospital? Is
Medicaid available once private pay is
exhausted? If the family gave the house
away to a church or university
endowment, it will be penalized from
Medicaid.
No matter the length of stay or level of
wealth of residents, nursing homes
must make sure they will get paid. NES
is able to provide the knowledge base
facilities need, with state-by-state
information on the rules and
regulations, and help with what
questions admissions officers need to
ask.
Does this require a culture change?
How would this guarantee the long-
term viability of the business?
The current culture in nursing homes is
to wait and wait until the family reports
that there is no money left and
someone gives them a Medicaid
application.
When the nursing home does that, it is
essentially delegating its cash flow, the
lifeblood of its business, to a family who
knows nothing about the system and is
afraid of the Medicaid officer. The
application is likely to be delayed and
even denied several times before they
get it right. In the meantime, the
nursing home has a bad debt of three to
four months because of that.
They must apply for Medicaid in the first
weeks of residency, which requires a
culture change in the nursing home.
They care about residents’ dentures and
hearing aids, but not about payment
issues. It is not in the mentality of care
workers to ask tough questions, but
they should.
Medicaid pending cases are a big
liability for nursing homes. Addressing
the issue would have a very positive
financial impact, increasing the
profitability of the facility.
Medicaid
pending
cases
are a big
liability
for
nursing
homes
Increasing the Profitability of LTC Facilities

2. marcus evans Summits deliver
peer-to-peer information on
strategic matters, professional
t r e n d s a n d b r e a k t h r o u g h
innovations.
Please note that the Summit is a
closed business event and the
number of participants strictly
limited.
About the Long-Term Care CXO Summit Fall 2013
This unique forum will take place at The Ritz-Carlton, Palm Beach, Florida, July
25-26, 2013. Offering much more than any conference, exhibition or trade show,
this exclusive meeting will bring together esteemed industry thought leaders and
solution providers to a highly focused and interactive networking event.
www.longtermcaresummit.com
Contact
Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits
Division
Tel: + 357 22 849 313
Email: press@marcusevanscy.com
For more information please send an email to info@marcusevanscy.com
All rights reserved. The above content may be republished or reproduced. Kindly
inform us by sending an email to press@marcusevanscy.com
About National Eligibility Solutions
National Eligibility Solutions, LLC (NES) is a national health care consulting firm assisting the long term care industry by helping
each nursing home facility make sure they will be paid for each resident. NES operates in all 50 states. We educate and empower
local BOM’s to be more effective. We handle case referrals for Medicaid eligibility which raises census and reduces Medicaid Pending
cases.
www.TrustNES.com
About marcus evans Summits
marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss
strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to
individually tailor their schedules of keynote presentations, case studies, roundtables and one-on-one business meetings.
For more information, please visit: www.marcusevans.com
Upcoming Events
National Healthcare CFO Summit - www.nhcfosummit.com
National Healthcare CNO Summit - www.nhcnosummit.com
National Healthcare CXO Summit - www.nhcxosummit.com
To view the web version of this interview, please click here: www.longtermcaresummit.com/DonChapin