All services are complimentary

• Quality Management
• Contracting
• Case Management Services
• Business Operations

Quality Management

Credentialing

Each facility is credentialed prior to becoming an affiliated provider in the MNS network and prior to the execution of a Network Agreement. MNS is sub-contracted by several major insurance companies to conduct these credentialing surveys. The credentialing process involves the following:

1. Review of the Request for Information (RFI)
2. On-site assessment by a MNS credentialing specialist utilizing the MNS Credentialing Tool
3. The MNS Credentialing Committee then reviews the collected facility data. The committee will make a decision concerning a facility's participation in the MNS network by combining standards set forth by OBRA (Medicare), JCAHO, and NCQA. The facility will be informed by a MNS representative of the committee's decision; if the facility is accepted into the MNS network a MNS representative will inservice the facility's staff regarding MNS services and processing of insurance patients.

Re-Credentialing

Re-credentialing will occur at a minimum of every three years. The re-credentialing survey consists of:

• Onsite assessment by a MNS representative
• Review of facility file for current Licensure and Compliance to HCFA and Contracted Payor quality standards

The MNS representative will provide feedback to the facility management using the Summary of Survey Results concerning areas of strength, concern, and opportunities for improvement.

The MNS Credentialing Committee makes the final decision concerning a facility's initial or continued participation in the MNS network. The facility will be informed by MNS regarding their status of application and re-credentialing process.

State Survey Review

The MNS membership agreement requires that the affiliated provider forward their most recent state survey and CMS recertification letter to the MNS Provider Affairs department upon receipt from the Ohio Department of Health.

The agreement also requires that each affiliated provider notify MNS Provider Affairs of any complaint surveys that may occur and must forward a copy of the results of such survey.

Payor Credentialing Worksheet:

MNS will maintain and submit a worksheet whose contents are directed by the payor's Quality staff. We welcome an on-site audit of our credentialing files.

Satisfaction Surveys

Summaries of patient and affiliated provider satisfaction results are provided to Payor representatives as requested.

1. Affiliated Provider (Facility)

Periodically an affiliated provider will be asked to complete a satisfaction survey of the services that are provided to them by MNS. Survey results are reviewed by MNS staff and recorded in our monthly QA minutes to support our Improving Organizational Performance Plan (IOP).

2. Patient

MNS sends customer satisfaction surveys to a significant sample of patients upon discharge. Any patient satisfaction survey returned will be copied and forwarded to the affiliated provider's administrator for review.

3. Ongoing Evaluation

The affiliated provider is monitored concurrently with any skilled patient admission. MNS case management service representatives monitor the care that is delivered as evidenced by the medical update reports received from the affiliated provider. When there is a concern/complaint about care either evident in documentation, patient/ family report, insurance case manager reports, or community report, such concern/complaint will be submitted to the Director of Quality & Education for review. The Director of Quality & Education, in conjunction with the Director of Case Management and Director of Provider Affairs, will review the issue and decide if it warrants further investigation.

Investigation may include but is not limited to:

1. Verbal review of case/ incident
2. Requested written review of incident and action for correction
3. Onsite review by an MNS representative

If an on-site investigation is warranted, the affiliated provider will receive a written notification suspending them from the network until the issue is resolved. All applicable payors will receive notification within 24 hours that the said provider is suspended. The Director of Quality & Education will conduct the on-site investigation within two business days of receipt of the complaint and based on the investigation will compose a written report to the Quality Committee for their review. The Quality Committee may reinstate the affiliated provider or may conclude that the provider should no longer be a member of the network. Written notification of the decision will be sent to the provider.

If the provider disagrees with the Quality Committee's decision, they may apply for an appeal by submitting a written request to MNS within 10 business days from the receipt of notification of termination/suspension detailing the areas of grievance or disagreement. MNS will contact the provider within 5 business days from receipt of the appeal and may request further documentation, on-site review and/or a meeting to discuss issues. All additional information will be presented to the Quality Committee within 10 business days of investigation and will be presented in a confidential format therefore there will be no identifying information of the report. A determination will be made by the Quality Committee and it is final. Written notification will be sent to provider within 5 business days following the appeal hearing.

Affiliated Provider Profiles

In order to maintain a current database of your facility's information, MNS will fax to the Administrators attention a request to update the "Facility Profile" every quarter. Please cross out the old information, write in the new and return with any recent survey reports.

Special Reports

As a network affiliated provider, you may be requested to participate in special surveys relating to skilled patient placement and care. All information from an affiliated provider's participation is held in confidence by MNS as agreed upon in the MNS Membership Agreement.

Special Surveys

Some of the insurance contracts available to the affiliated provider through the MNS network allow the insurance company to request to perform an onsite survey for credentialing or medical record review purposes. An insurance company and/or MNS representative will notify the affiliated provider to make arrangements for an insurance on site visit by representatives of the insurance company.

Contracting

Affiliated Provider Selection

MNS's contracting goal is to provide county access for each insurance payer as needed. In urban areas MNS enrolls affiliated providers based upon payer market demand. In rural areas we enter the market only if beneficiaries are residing in the market. This demand is dynamic as payers initiate or withdraw member products based on past successes or expected market performance.

From time to time MNS is directed to enroll specific affiliated providers by individual payers. This results in "select networks" within the greater MNS network. At every opportunity we offer the entire network to our payer contracting community.

MNS is independent and does not own, operate, or manage facilities. We serve for profit, not for profit, privately owned as well as corporately owned facilities. In order to operate in some states, MNS has instituted application and membership fees. If your state operates with such a fee then the policy regarding such follows the "Agreement for Membership Services".

Facilities at a minimum must pass our critical criteria as described in the MNS Quality Programs to be considered for membership in the MNS network. Occasionally an insurance contract may require a facility to meet a standard higher than MNS's credentialing criteria (i.e. JCAHO, CARF, etc).

Master Contract

Every affiliated provider executes a master contract with MNS. This contract delineates the responsibilities of both MNS and the provider.

These responsibilities include but are not limited to:

• Submission and payment of invoices
• Selection of payor contracts
• Participation in quality programs
• Signature sheet agreeing to rates and definitions for levels of care
• Designation of payment

Case Management Services

MNS employs a professional team of nurse and LSW case managers and administrative assistants. The case management services team is centrally located at the MNS office in Dublin, Ohio. Case management services are available 24 hours a day, 7 days a week. The Case Management Services department is staffed in the office during regular business hours of 9:00 am to 5:00 pm EST Monday to Friday and via an on call system after business hours weekdays, weekends and holidays.

In order to serve all our clients more efficiently we have organized patient files that we assist in care management using the first initial of the patients' last name. Our Administrative Assistant will assist with patients that insurance companies require direct report to their own care coordination departments from the affiliated provider. When calling in to access the network, for a patient placement, question, update or discharge info via 1-800-949-2159 please listen to the prompts and follow accordingly. By allocating patients in this manner we arrange for you to work consistently with a case management representative during the patient's stay.

The Case Management Services process includes the following main components:

1. Network and affiliated provider access process
2. Obtaining initial information required for admission and preauthorization of affiliated provider skilled admission
3. Obtaining required evaluation information for additional authorization of skilled stay and supporting level of care
4. Patient update for continued skilled authorization
5. Change in condition & incident reporting that may affect the skilled stay
6. Discharge summary
7. Referral for Part B or outpatient services
8. Medicare exhaust chart and bill submission

The Case Management process includes the following main components:

1. Admission process:

A referral may come from one of five sources, they are: Insurer, Hospital, Nursing Home Provider, Physicians Office or Family. MNS Case Management Service Representatives will work with any of the above referral sources in order to keep a patient within the contracted, credentialed network, and properly placed as far as the level of ability of the chosen provider. MNS will not steer patients but rather allow the patient to choose their preferred provider as long as the provider can deliver the care required.

2. Obtaining initial information required for admission:

MNS Case Management Service Representatives work with skilled providers as well as the insurer, therefore a mature understanding of the documentation needed on both sides has been developed. Skilled providers are highly regulated and have a government mandated/defined set of requirements for admission. Insurers utilize prescribed utilization programs and insurer based software, all requiring pertinent information in order to make decisions. MNS representatives work diligently to ensure that initial and on-going communications are clear and optimal and in addition check the patient's current insurance benefits for coverage.

3. Obtaining required evaluation information:

Once admitted the PCP and, when applicable, therapist evaluate and prescribe the patients routine for care. This information is communicated efficiently to the insurer in order to determine the appropriate utilization plan and reimbursement level. The insurer's identification of the patients need for services is always primary in determining a level of care. MNS Case Management Service Representatives only assist and recommend levels of care, as well as offer creative solutions when the need arises.

4. Patient update:

Driven entirely by the insurers guidelines, MNS Case Management Services Representatives will report as frequently and as in depth as the insurer requests. MNS representatives may offer recommendations to the insurer if the patient could benefit from a change in services.

5. Change in condition & incident reporting:

MNS Case Management Service Representatives document and communicate all changes in the patient's condition and if an incident has occurred. When an incident occurs patient information is gathered that can assist the insurer in determining a decision regarding the care or the provider.

6. Discharge summary:

MNS Case Management Service Representatives begin emphasizing discharge planning at the time of admission in order to assist the patient/family and provider with a smooth transition to the patient's next destination.

Business Operations

MNS will bill each payor at the beginning of each week for those patients whose covered stay ended during the prior week, or for all patients at the end of the month. MNS currently bills electronically and is in the process of setting up EFT with each payor.