Rx for cash shortages

Collaboration and tracking are key aspects for improved billing, fewer delays and denials

How often is your home health agency’s billing team meeting with clinicians and other team members?

Anything less than weekly – even when claims processing appears to be moving forward without noticeable glitches – could place your agency at risk of costly delays and claim denials adding up to significant revenue losses, according to Kimberly Chapman, Senior Manager in financial consulting and revenue cycle management at Simione Healthcare Consultants.

Collaboration among all departments – intake, clinicians, coders and billers -- is integral to success under both the Patient-Driven Groupings Model (PDGM) and Medicare’s new 5-day timeframe for Request for Anticipated Payment (RAPs), Chapman said.

“The billing department really needs to be integrated, operating in tandem with all other departments in a regular and ongoing collaborative effort,” Chapman said. “Integration has a significant impact on the amount of reimbursement and heads off potential revenue cycle disruption.”

Changes in the focus of care for the second 30-day billing period are common and illustrate one important way in which PDGM has increased the need for billers to communicate more frequently with clinicians and coders. The new payment model also heightens the need for effective orders management and expedited documentation collection for certification of eligibility. Non-Medicare payers also have authorization requirements necessitating collaboration, Chapman said.

Inter-departmental communication needs further increased on Jan. 1, when Medicare began requiring agencies to submit the RAP within 5 days of the start of care or face financial penalties for each day it is late.

“Right now, agencies are undergoing a major adjustment to accommodate the new RAP timeframe, figuring out how to expedite their processes and avoid those penalties,” Chapman said. “Eventually, home health will iron out all the wrinkles in much the same way hospice agencies had to work it out when Medicare began requiring the Notice of Election (NOE).

But the new agenda brings a crucial need to stay on track with regulatory changes and maintain frequent communication to support efficient operations, according to Chapman.

"Billers are still going to need all those important clinical pieces for the final claim. Going forward, billing is always going to be a collaborative effort,” Chapman said.

The need for tracking

Effective tracking, including pre-bill auditing, is another essential aspect to avoid delays and denials that lead to revenue shortfalls, according to Chapman. To shore up its revenue cycle, an agency must be able to quickly identify missing pieces of documentation, any trends which need corrective action and more.

“This is why we stress to agencies that EMR optimization is so important,” Chapman said. “Most EMRs come with plenty of bells and whistles, but we find that not every team member at every agency knows what those bells and whistles are or how to use them effectively. Full staff training in the EMR really needs to be a priority, because understanding how to use the EMR to its fullest is a crucial piece of being able to track authorization, orders, days to RAP submission in home health or NOE in hospice – all of it.”

A fresh approach

How does an outsourced billing company such as Simione Healthcare Consultants fit into an agency’s fully integrated operations?

“We really do become part of the team,” Chapman said. “And that happens easily because our billers are all experienced, bringing to the table a level of comprehension that enables them to fit into an organization’s structure and function effectively as part of the team.”

Simione’s billers have daily communication and weekly meetings with agencies, Chapman said. They spot compliance and billing issues, identify trends which need corrective action, and work closely with clinicians and coders to get it right.

“We treat it like it’s our own money and try to collect every single penny,” Chapman said. “And not just from Medicare, but from all payers. Our billers have years of experience billing for various organizations at all levels, and they have extensive expertise in working with different EMRs. They’re able to come in, fit in, and begin making a real difference right away.”

30 days to stronger cash flow

With a 50-year history of home health and hospice experience, and an impressive slate of industry leaders among its consultants, Simione is able to back up its outsourced billing services with help in any other area in which an agency is struggling.

“We’re not just an outsourced billing company,” Chapman said. “Problems are often interrelated, so if a home health or hospice organization needs help in another area, we have the resources and the expertise to resolve it quickly -- whether it’s with a one-time session providing OASIS training to clinicians, or a contract for ongoing services such as cost reporting or coding.”

Many clients prefer to package their billing and coding services, realizing that the combination is the surest means for maximizing reimbursement amounts and filing claims in a timely and efficient manner. Simione offers bundled packages for cost savings, Chapman said.

And the results? Generally, it takes 30-45 days for Simione’s outsourced coding and billing clients to see a positive impact, and fewer process delays contributing to cash shortfalls. Would you like a free quote?

If you would like more information about outsourced services – or to obtain a free quote – we’d love to hear from you. Call 800.949.0388. More information is also available at https://www.simione.com/outsourcing