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Trends in North Carolina Medicaid

Based on the latest data from the state of North Carolina, we can look at trends for Medicaid in skilled nursing in the state. Overall, average case-mix is up significantly, continuing a long term climbing trend. Keep in mind that in North Carolina, if the mean case-mix is increasing while your facility case-mix stays constant, your pay can go down. In other words, if the case-mix at your building is flat, your pay could be going down.


As you probably know, there are two main drivers for case-mix under the 34 grouper: therapy and ADL scores. We'll take a look at both.


After a couple of flat quarters, the percentage of residents in therapy has risen by one percentage point. This would certainly drive the case-mix index up.


ADL Scores

Over this same time period, average ADL scores declined slightly. In North Carolina average ADL scores tend not to move much. 


If you'd like to get a custom analysis of your Medicaid or a market analysis, contact us today!

2 Reasons You Should be More Concerned about Casemix than RCS-1 if You're In Tennessee

2 Reasons You Should be More Concerned about Casemix than RCS-1 if You're In Tennessee

Tennessee is in a unique position right now. Everyone is trying to figure out how RCS-1 will change Medicare Part A. However at the same time Tennessee is also preparing to transition to case-mix for Medicaid.

RCS-1 can tend to look more important because a lot more people are talking about it but here are two reasons why you should focus more of your energy on understanding casemix.

  1. Case-mix will likely have a larger impact on your reimbursement than RCS-1. Which do you have more of: Medicare Part A or Medicaid residents? For a facility with 10 Med A residents and 60 Medicaid residents, a $1 change in daily reimbursement is 6 times more impactful for Medicaid than Medicare Part A. Small changes to Medicaid can make a big difference and the majority of the changes you can make simply involve better documentation of work you already do.
  2. You have far more control over your case-mix than your Med A with RCS-1. With RCS-1 you will have 4 RUGs per patient with RCS-1. (Check out our RCS calculator for more information.)  Two of those RUGs, PT/OT and Speech, are largely out of your control. Those two RUG make up around half of the  overall payment for RCS.

Between your facility payer mix and the nature of RCS-1, you can see that a good understanding of case-mix is going to be important. There is good news however:

  • The 48 grouper is an excellent choice. With the 48 grouper you'll use the same ADL scoring system that you use for Part A. (Until RCS-1 at least.) Also, the therapy RUGs make sense. Imagine using a Medicaid grouper with an UH RUG. Don't laugh, some states do. I've worked with a wide variety of Medicaid groupers. Based on my experience I would pick the 48 grouper above the others. (with a few minor tweaks)
  • You aren't the first state to transition to case-mix or start using the 48 grouper. In fact you are in good company. The 48 grouper is quickly overtaking the 34 grouper as the most used. That means there are good resources out there to help you educate yourself. (Try our our MDS Calculator for example.) 

While we don't know rates yet and won't for a while, Broad River can analyze your Medicaid population and give you a "first look" at how things might shake out. We can also assist you in setting up programs that make sure your documentation is absolutely air-tight while at the same time delivering the highest quality care AND make sure you get fully reimbursed for your work. We have many years of case-mix experience. Put our experience to work for you. Call us today and let's talk it over! 1-800-596-7234