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Neighbors of Dunn County staff brief supervisors on nursing-home payer sources; committee accepts vouchers
Summary
At a Dunn County standing committee meeting, Neighbors of Dunn County staffer Carmen reviewed the facility’s main payer sources — Medicaid, Medicare Part A, Medicare Advantage, private pay and VA — and explained eligibility rules and billing nuances. The committee voted to accept vouchers and financial statements.
Neighbors of Dunn County Standing Committee members heard a primer on the primary payer sources for Neighbors of Dunn County (NDC) and approved the facility’s vouchers and financial statements during their meeting.
Carmen, a Neighbors of Dunn County staff member, told supervisors that “Medicaid is our primary payer source” and that “on any given point, we about have 70% of our residents that are on Medicaid.” She explained Medicaid’s mixed federal-state funding, that Medicaid requires both medical and financial eligibility, and that eligibility can be determined either before admission or after a resident is already at the facility.
The discussion laid out how each payer behaves: Medicare Part A covers most short-term rehabilitation stays and is federally funded; its maximum coverage is 100 days per qualifying hospital stay and payments decline the longer a resident remains on a Part A spell. “Medicare Part A’s payer system is extremely detailed and cumbersome,” Carmen said. She told supervisors that Medicare reimburses on an all-inclusive basis tied to Minimum Data Set assessments and that therapy is the primary qualifier for Part A coverage.
Carmen described Medicare Advantage plans as operating similarly to Medicare Part A but requiring facility contracts and frequent utilization reviews by insurers. She said appeals to denials are sometimes necessary and noted NDC has pursued Administrative Law Judge reviews to secure coverage. “We typically do win appeals when we submit them,” she said, while warning the insurer review process can be continuous.
On private pay, Carmen said the facility sets a room-and-board daily rate that typically increases each Jan. 1 and that private-pay residents may be charged separately for items such as medications or oxygen. She said many private-pay residents later transition to Medicaid as their financial status changes.
Carmen also summarized Veterans Affairs coverage: NDC is the only facility in Dunn County with a VA contract and VA eligibility is determined by the Department of Veterans Affairs, often based on service connection. She described VA billing nuances such as preapproved numbers of physician visits and common coverage for hospice services among qualifying veterans.
Supervisors asked procedural and eligibility questions. One supervisor asked about the Medicaid “look-back” for divestments; Carmen explained Medicaid can “do a look back to see if any money that has been spent down within the past seven years.” She said facilities often avoid admitting residents on “Medicaid pending” status because divestment findings can leave the facility unpaid. Carmen added that if a resident’s private-pay funds are exhausted because of divestment, the facility could pursue an involuntary discharge for nonpayment but must first ensure the resident has a safe placement.
Carmen also summarized ancillary items and local operations: CNA training classes with a maximum class size of eight are held at the facility, referrals remain high (the packet showed 96 referrals during the month, 16 admissions and an end-of-month census of 115), and NDC is working to replace a retired pharmacist and to fill finance positions after staff retirement and transfers.
After the payer-source briefing and accompanying packet review, the committee moved to routine business. Supervisor Lyon moved to approve the meeting minutes; Supervisor Story seconded the motion and the minutes were approved. Later, Supervisor Wolf moved and Supervisor Law for seconded a motion to accept the vouchers and financial statements; the committee voted in favor and the motion passed.
The committee set its next meeting for May 22 at 9 a.m.
The meeting included standard operational updates — maintenance (new food-service golf cart bid of $19,965; bench replacements), human-resources numbers (five direct-hire interviews, three positions offered, one accepted, three resignations in March) and first-quarter 2025 financials showing year-to-date positive results without depreciation. Committee members had no further questions and the meeting adjourned.
