Nursing Home Aging Reports are Sickening!” 
As a Billing and Collections consultant, I am sickened by the millions of dollars appearing on aging reports at nursing homes — often 3 Million to 4 Million Dollars. Why does this ail me? Because the emotional attachment which some owners grow towards these receivables actually hinders their ability to accept the reality that the insurance money is not going to be collected by “their own staff.” Their emotions block their ability to accept the reality that eventually, and inevitably, the money will be lost forever.  

The fact is that if a receivable has been on the aging report for over 6 months, it is often due to improper billing – which starts at admissions and is further exacerbated at billing. Unequivocally, billing systems must also be accurately updated with correct billing types, rates, rate codes and specific requirements for each insurance product to assure correct billing and payment – and since this is not being done, eventually the claim must be written off.

Most billing clerks are not privy to the contractual agreement that the facility has with the insurance company, so how can they know how to bill properly?  A facility’s cash flow is greatly impacted by rejected claims which have been denied due to reasons which could have been easily avoided had the original claim been submitted correctly. The money left on the table could be given to charity. This is what ails me. 

We all know that smart phones can transform just about everything in our lives! A simple telephone call can transform into a formal three-way video conference at the push of a button, and we can be “called” at any time no matter how far away we are from the office. But what about “smart eating”? Do we have to wait for a major health issue to arise as a wakeup call for us to put away all the fatty animal products we consume in our diets?

At Vegan Power Pizza we have answered the call of smart people everywhere who have asked for more healthful plant-based foods. We believe that lives can be transformed by the foods we eat. Smart food choices help provide the energy needed to enjoy life and all it has to offer. In addition, eating smart can reduce your risk for diseases such as heart disease, stroke, diabetes, certain types of cancer and osteoporosis. We have intentionally created a food choice that is made of natural ingredients and is always gluten free. No need to travel “long distance” to find plant- based products anymore! You can find Vegan Power Pizza right in your local grocery store.

The etymology of the idiom “wait for the other shoe to drop” comes from the experience that tenement apartment dwellers lived through during the 19th century. Since the bedrooms were located directly above each other, it was common to hear a neighbor removing their shoes in the apartment above. As one shoe made a sound hitting the floor, the neighbor below waited expectantly “for the other shoe to drop.” Similarly, MLTC organizations often wait expectantly for the “other member to drop” as hundreds of members fall off their roster each month. 

While not as noisy as a shoe dropping, membership roster drops create a deafening explosion to profitability if not prevented early enough. And, in a way, it begins with “the apartment above” because the financial losses for MLTC’S often begin with data issues occurring when the Medicaid renewal paperwork gets delivered to the  member’s apartment instead of to the actual current residence—the rehab center! This commonly occurs at expiration of Medicaid coverage (which precipitates mailing of the renewal packet.) Until the plan submits the necessary “5-year lookback” documentation, and Medicaid processes the upgrade, Medicaid is unaware of the resident’s current  address. 

This has caused many plans to fall behind or simply not pursue their membership to complete the upgrades. Hundreds of members are therefore dropping off rosters and leaving MLTC’s vulnerable in the event of Medicaid audits since updates are required  under their provider agreement with the Department of Health. MLTC’S should be pro-active and outsource this financial service instead of waiting for the other shoe to drop! 

Cauliflower is part of the category of vegetables called “Brassicaceae” or “Cruciferous.” Curiously, the name comes from the Latin “Cruciferae” — meaning “cross bearing” because the four petals resemble a cross. It is interesting to learn the genesis of plant naming. It originated with a Swedish botanist named Carolus Linnaeus, who developed a binomial (two name) system of classification for plant type and species in the mid-1700’s. Mr. Linnaeus used Latin and Greek names for the groups because these were the international languages of science at the time.

Today, we find some of the Latin names hard to pronounce. Some frozen pizzas’ ingredients are hard to pronounce too!  However, Vegan Power Pizza’s ingredients are never hard to pronounce because they are natural products that we are already familiar with. And, just like plants, Vegan Power Pizza has two category names as well: they are healthful and delicious! Our plant-based pizza crust is made with cauliflower, Violife 100% Vegan Mozzarella Cheese, and other natural ingredients which are always easy to pronounce and delicious to taste.

“The Sandwich Generation: Where’s the Beef” 
Many of us remember the TV commercial which featured a feisty, disgruntled elderly woman being served a small hamburger sandwiched between two huge pieces of bread. The infamous tagline we will never forget, is what she barked at the server: “Where’s the beef?”  For working parents who are sandwiched between taking care of young children, as well as their elderly parents, there is a lot  to beef off about! 

The stress begins with the early morning frenzy to prepare breakfast, get everyone groomed (as well as yourself) then hurried into the car and buckled up to be dropped off at several  different  locations… before eventually  getting yourself squeezed into rush hour traffic to finally arrive to your paying job! Then, before you know it, it’s five o’clock and you are doing the same routine in reverse on the same day, only to know that tomorrow brings the same drudgery yet again!  — That is, if you are “lucky.” 

The luck comes in the form of “cooperation” from the children and your parent. It means that no one is grumpy; no one is throwing a temper tantrum; no one is refusing to put the properly coordinated clothing on that you laid out for them; and no one is having last minute bathroom issues. Otherwise? The morning routine has just passed the drudgery stage and morphed into misery! 

They say that misery loves company, so you might be glad to know that you are one in 10 to 16 million Americans who are in the “Sandwich Generation.” You probably waited until your mid-thirties to start your family, and now you find that you are sandwiched between the expense and time of taking care of your children, while you are also  in the role of primary caregiver to your aging parents. In addition to activities of daily living needs, many aging adults also have medication requirements which can be quite complicated.   That is why it is always good to build a relationship with a pharmacy  that offers  personalized  service. With an independently owned pharmacy, you will not have the same “beef” as you do with big chain stores. 

As countries continue to move away from high-polluting fossil fuels towards sustainable low-carbon alternatives for energy production, it is interesting to consider how much “energy” is used by food processing plants to transform natural agricultural products into “mystery” food. Most convenience foods are highly processed and can play havoc on the human body when the end “product” is consumed. The result of a diet heavily laden with overly processed foods is an overly sluggish, low energy sense of being. The long-term effects of eating a diet low in nutritional value are proven to create a shorter lifespan, and one filled with disease.

For people who prefer to live a healthier lifestyle and enjoy the best that life has to offer, we created Vegan Power to be the most healthful, trusted plant-based cauliflower pizza crust in the world!  It is no mystery: eating natural foods is naturally better for you. The energy we provide to you from our “power plants” will be sustainable throughout your entire lifetime!

Our pre – k students at Apple Tree Academy celebrated the 100th Day of School by dressing up like they were 100 years old. While most of our students will not even be in their teens by 2030, the U.S. Administration of Aging reports that by the year 2030, one in five Americans will be aged 65 or older.

Studies have shown that exposing children to seniors throughout their life can do wonders for young and old alike. Young children and seniors can enjoy activities like arts and crafts, nature walks, baking or making puzzles together. When children spend time with their elders, they learn a lot about respecting diversity – which is an added bonus! 

As children get to know older people personally, they will understand the dignity of every life and will also cultivate honor and respect for the elderly. As parents develop this attitude in their children at a young age, the parents also stand a better chance of receiving respect from their children toward themselves as they get older. It’s a win-win for all involved in the socialization of children with seniors.

In addition, the more adults your kids are around and interacting with, the better they can handle the transition to adulthood later. Apple Tree Academy loves celebrating milestones, and we look forward to reaching many more with our school family for years to come!

Medication in older adults can sometimes be complicated. Caregivers need to be aware that some medications have the potential to harm seniors. Although medication is important to manage serious health conditions, if not managed properly serious harm can result to the patient instead of improving their quality of life.  In fact, some medication can actually worsen clinical symptoms! Many of the problems stem from the fact that aging bodies process chemicals differently than younger ones. 

Caregivers need to be mindful that certain commonly dispensed drugs can cause issues with balance and thinking.  Anticholinergics, for instance, which are used for bladder control, sleep disorders, depression, and other conditions, is a class of drugs which can produce these side effects. Many seniors will become more confused, suffer memory loss, or have an increase in falling episodes when taking these medications.   
We often see the effects that certain drugs have on older adults when their blood pressure prescription lowers their blood pressure too  far! The result is dizziness, and this sometimes results in an increase in falling episodes because of the lightheadedness.  An older adult’s ability to think and concentrate is also greatly impacted when their blood pressure drops too far down. 

When it comes to medicating seniors, there is also the concern of drug interactions when they are taking multiple medications, supplements, and vitamins.   Since physicians seldom follow up to ascertain whether a patient’s symptoms have improved after prescribing a new medication, they have no way of knowing if adjustments are needed to properly treat the symptoms if reactions happen. Compound this situation with the possibility that the senior patient’s general health may suddenly and rapidly deteriorate, and it can become very complicated to manage. 

This is why it is very important to use the services of a pharmacy that provides personalized service. A  pharmacist  who is familiar with the senior will be much more cognizant about the patient and can properly advise you to prevent medication issues that could possibly arise. 

At Apple Tree Academy, we played hopscotch on bubble wrap in honor of Bubble Wrap Appreciation Day. Some people were wondering how this “holiday” ever got started. So, we discovered that a radio station announcer once inadvertently unwrapped microphones on the air, and listeners loved it! The rest is (bubble) history as the saying goes…

It was our joy to watch the children express utter delight with the popping of every bubble. We cannot decide which gave them more fun — the popping noises or jumping forward to reach every square. Why not come in for a tour to see all the fun we have with the children? It’s only a Hop, Skip, and a Jump away! 

We are all familiar with the axiom “charity begins at home.” But few people realize that most nursing home operators are so concerned with being charitable to their staff, that they leave millions on the table for the insurance companies to keep their staffs employed!  As a billing and collections consultant, I often tell nursing home managers to “keep your staff if you want to be charitable, but just let us get your money for you!” 

In some cases, the office staff are relatives or close friends of the family that owns the facility.  So, if the facility outsources to the professionals, and collects an extra 3 to 4 million dollars annually, they could then actually start a non-profit and use their existing staff for other positions. Charity begins at home, but it can also begin at a nursing home. 

At Apple Tree Academy, we lovingly refer to the tremendous developmental leaps that a child’s personality and intelligence undergo between the first and second year of life as “The Terrific Twos” while many parents and less experienced childcare centers, however, know it by a different name altogether. 
Parents can make great strides towards coping with the puzzling behavior of their toddler’s “new” personality, by purposely making a paradigm shift in their own thinking. As your child is discovering the fascinating world around them, you can begin “putting the pieces together” for you and your family by changing the narrative. It is no longer “terrible” that the toddler is trying to be self-sufficient, because after all, it is terrific that someday they will be independent adults who grew through the loving care of their terrific (not terrible) parents! 

A toddler does not have control over their own thoughts, emotions, and actions because their world is often puzzling to them. It will take years for them to understand and mature. Thankfully, their parents can learn to make a paradigm shift in a matter of days so that the pieces will fall into place. 

“Seeing the Forest Through the Trees.”
There are many health benefits that can be achieved by increasing plant- based foods in one’s diet while reducing the amount of meat one consumes. According to The American Heart Association, eating less meat will help reduce the risk for heart disease, stroke, type 2 diabetes, and high blood pressure, to name just a few. We are all searching for the nutritional keys to wellbeing, and the answer is sometimes right in front of us – in our grocery freezer – But it’s “hard to see the forest through the trees” when we are barraged with so many choices at the supermarket. How is one to know which products are the healthiest?

At Vegan Power Pizza, we believe the answer lies in the forest! (Well, not literally of course, but metaphorically speaking). It is interesting to note that there are plants in the forest which produce wonderfully natural foods and flavorings. For instance, edible leaves, nuts, seeds, tubers, mushrooms, gum and sap are all found in forests, and all provide us with protein, energy, vitamins and essential minerals. Many berries such as blueberries, blackberries, lingonberries and elderberries are also found growing naturally in forests.

Natural is always key when it comes to choosing a healthy vegan pizza. People who wish to maintain a healthy lifestyle will clearly see from our ingredients list that all VEGAN Power Pizzas are completely plant-based and always natural. We do not ever add hormones, antibiotics or food additives to our products. Our food is made from healthy plants (which although are not always grown in the forest) can easily be “seen” in the frozen pizza isle at your favorite supermarket.

MLTC Growing Pains or Growing Gains?”
The financial issues facing Managed Long Term Care companies are important to consider when evaluating the sustainability of growing plans in an ever-changing healthcare market. Due to the myriad Medicaid rules and regulations, “growing pains” for growing plans, are becoming more common these days. We find that although MLTC’s are excelling with respect to the quality of care they are providing to enrollees, unfortunately they fall short in achieving maximum financial benefits for their businesses. 

MLTC financial losses initially stem from the Medicaid mandate for MLTC’s to provide Homecare services, Adult Day Care services and Skilled Nursing Home coverage to members.  Thirty days after admission to a SNF, the plan is required to upgrade members’ coverage from Community Based Medicaid to nursing home coverage, regardless of their short or long-term needs.  However, many MLTC’s do not have adequate personnel needed to contact increasing volumes of members and/or their responsible party, in order to explain the need to convert their Medicaid coverage and to obtain the necessary documents. 

It is helpful to provide the responsible party with a comprehensive checklist of documentation that is required so that they can begin the process of retrieving the paperwork. Items such as bank statements, social security cards, and Medicare identification cards must be obtained for Medicaid review of the application. The bank statements must reflect a five-year history, and thus it is typically necessary to special-order the statements from the banking institution.

This is not an easy process for seniors or their caregivers. And, it is not any easier for MLTC personnel to obtain. Once the banking information is obtained, a Medicaid applicant must document the larger deposits and withdrawals. Undocumented deposits, excess resources or lack of complete documentation, will likely lead to an outright rejection of the upgrade. Withdrawals or transfers of funds that are deemed “illegal transfers” based on Medicaid guidelines will generate a period of ineligibility. 

In addition, the applicant must also produce proper identification which can include birth certificates or other proof of citizenship and proof of residence.  Again, a birth certificate is not always readily available for a ninety-year-old person and must be special ordered. This is a time consuming and arduous process and is further complicated when a member is lacking capacity or is forgetful. Family members often do not have access or knowledge of the information either, which adds to the difficulty. Applicants or the responsible party find themselves in a Catch-22 when it comes to producing proper identification for Medicaid because they need  proper identification to obtain  proper identification. 

One way for Managed Long Term Care plans to achieve higher growth rates financially while keeping up with growth objectives, is to turn over the financial side of the business to Medicaid professionals. In this manner, the MLTC resources are best spent on hiring employees needed to provide medical care  to members, so that growing pains can be turned into  growing gains.  

Most small businesses would consider it a lottery win to increase receivables by millions of dollars annually! Yet, for psychological reasons, many nursing homes would rather lose millions of dollars instead of outsourcing to professionals. When it comes to outstanding receivables, the aging reports do not lie and owners are writing off millions of dollars in insurance receivables because “we always did it that way, and it is hard to change.” Yet, in-house staffs are usually unable to properly navigate the complex insurance paths in today’s payment system labyrinth. 

As billing and collections consultants, we typically find 3 to 4 million dollars on the aging reports which could easily have been collected had billing been handled correctly.  When nursing homes outsource the financial side of their business, it is like winning the lottery! 

During Chinese New Year season, we decorated our dramatic play area as a Chinese restaurant to teach children how to navigate the proper protocols when dining in a public place and to appreciate a culture that may be different from their own. According to Chinese tradition, there are certain “taboos” that one should refrain from during this holiday. The first one: “Do not say negative words.” All words with negative overtones are forbidden! 

 It has been a wonderful experience for the children on several fronts in terms of learning appropriate behavioral conduct. However, we also used the opportunity to reinforce proper ways for them to express their thoughts and feelings in a positive way. While learning about using manners in “a restaurant” we also reminded the children to demonstrate kindness and respect for others by using polite words and phrases. They learned to wait their turn online, to say please and thank you when being served, and to say positive things about the meal. (Refraining from saying negative words would be a good idea for all of us — and not just during this season!) 

Nursing Homes don’t just break my heart because of the plight of vulnerable seniors who find themselves needing care: they break my heart because soon they might not be available to help seniors who need care! 

I am astounded at some of the responses I get from nursing home Administrators and Owners when we offer to help them collect millions of dollars due them from insurance companies. They say things like “Oh, we hired our new controller because he is ‘trainable’ or “I don’t want to make our biller feel bad by taking the receivable from her after she has spent so much time working on it.”  Meanwhile, the aging reports for nursing homes typically run in the 3 million to 4 million range for uncollected funds. If they are going to get emotional about it, why not feel bad for all the jobs lost and seniors who will no longer be cared for if they go out of business? This breaks my heart.