Complete Revenue Solutions http://www.completerevenue.com Medical Billing Service, Revenue Cycle Management Thu, 05 Apr 2018 18:44:36 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.5 http://www.completerevenue.com/wp-content/uploads/2016/01/cropped-LOGO-32x32.jpg Complete Revenue Solutions http://www.completerevenue.com 32 32 Revenue Cycle Management’s Importance in Home Health Care http://www.completerevenue.com/revenue-cycle-management-home-health-care/ http://www.completerevenue.com/revenue-cycle-management-home-health-care/#respond Mon, 26 Feb 2018 18:03:49 +0000 http://www.completerevenue.com/?p=402 Offering quality home health care requires dedication, attention to detail and passion. It also demands a steady revenue stream that can accommodate the requirements of market competition, staff training and growth, and expansion of services. Revenue Cycle Management that is dependable, detailed, consistent, and stable is the only way to ensure a steady revenue stream.

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Offering quality home health care requires dedication, attention to detail and passion. It also demands a steady revenue stream that can accommodate the requirements of market competition, staff training and growth, and expansion of services. Revenue Cycle Management that is dependable, detailed, consistent, and stable is the only way to ensure a steady revenue stream.

revenue cycle management

Dependable Revenue Cycles Allow Agencies to Compete Effectively

The fastest growing segment of the population, seniors age 65 and older, also comprises the largest segment of home health care patients. As the need for home health services expands with the increased longevity of seniors, the competition to provide those services is also increasing.

Between 2000 and 2014 the number of home health care agencies rose from 7,099 to 12,400, a growth rate of 175%. That number continues to rise.

Dependable revenue cycles are essential to competing in the expanding home health care marketplace. By eliminating cash flow concerns, providers can focus on the core function of the agency, providing the best possible home health care. 

Reliable Revenue Cycles are the Pulse of Your Agency’s Health

Just as quality home health care requires professional management of providers’ health services, the business health of an agency depends on expert revenue cycle management. Financial pressures can weaken an agency, making it less competitive, threatening its survival.

Reliable revenue cycles are the pulse of your agency’s financial health. Stable cash inflow allows your agency to not only compete and survive in the marketplace but to thrive and grow.

Revenue Cycle Management Allows You to Focus on Healthcare

Wading through the billing and claims filing process can be tedious for any health care provider. While billing is an undeniably essential part of a home health care agency, it requires different skills sets than providing health care to your patients.

Professional revenue cycle management offers significant benefits to a home health care agency, including:

  • Expertise in revenue recovery
  • Timely, accurate and simplified billing and claims submission process
  • Compliance with payers’ claims requirements
  • Reduction in delayed and denied payments
  • Automatic follow-up for problem claims
  • A stable revenue stream into the agency
  • Reports on the revenue flow and financial status of the agency

The revenue cycle management experts focus on the financial health of your agency while you focus on providing health care.

Attention to Detail and Consistency

Without timely, accurate billing your home health agency cannot survive. Delayed or denied payments directly affect your health agency’s ability to function and provide quality services. Attention to detail, consistency, and follow-up are essential in a successful revenue cycle management program.

At CRS, we are passionate about the details. Our focus is on accurate, timely home health care billing and claims resolution. That focus has given us a 96% claims paid rate on the first attempt and made us an industry leader in revenue cycle management.

This attention to detail and consistent follow-up maintains a healthy flow of revenue into your agency. Our dedicated experts ensure that:

  • Requests for Anticipated Payment (RAP) claims are filed within twenty-four hours of agency completion and approval of the Outcome and Assessment Information Set (OASIS)
  • End of Episode (EOE) Claims are submitted within twenty-four hours of completed documentation, far exceeding the industry standard of fourteen days
  • Problem claims are followed up daily until resolved

Stable Revenue Ensures Your Agency Survives and Thrives

Operating a home health agency without a revenue cycle management program is like hoping a patient improves without any treatment or care. You are merely relying on chance to determine the economic survival of your business. Chance is not a business plan.

A robust revenue cycle management program in the hands of dedicated experts focuses on your agency’s health while providers focus on patient health care. Stable revenue streams ensure that cash flows remain high and accounts receivable are reduced. The result, your agency survives and thrives.

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4 Steps for Effective Home Care Billing http://www.completerevenue.com/4-steps-effective-home-care-billing/ http://www.completerevenue.com/4-steps-effective-home-care-billing/#respond Tue, 20 Jun 2017 07:18:46 +0000 http://www.completerevenue.com/?p=369 4 Steps for Effective Home Care Billing Home care billing is the key to any successful home health care company. Without excellent home health billing processes, your agency is likely to experience poor cash flow, increased denials, and increased stress levels. Complete Revenue Solutions has compiled a four-step process to help you improve your billing [...]

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Home Care Billing

4 Steps for Effective Home Care Billing

Home care billing is the key to any successful home health care company. Without excellent home health billing processes, your agency is likely to experience poor cash flow, increased denials, and increased stress levels. Complete Revenue Solutions has compiled a four-step process to help you improve your billing process. First, home care billing starts with the intake process and making sure you have proper patient information and insurance eligibility. Second, home health care billing requires timely submission and pre-claim review. Third, a good home health billing process requires attention to detail and consistent follow-up. Finally, accurate and consistent reporting is imperative to a successful home health care billing strategy.

  1. Home Care Billing starts before the care starts

The only way to set up your billing partner up for great success in the billing, is to have a very comprehensive patient intake process. The keys to this process are patient demographic information gathering, insurance eligibility confirmation, and obtaining prior authorization. A few necessary pieces of demographic information you will need are: correct spelling of the patient’s full name, date of birth, address, and social security number. The next step is verifying proper insurance eligibility for the patient, this process should be completed prior to starting care and at least once per month after care has begun. Finally, the most imperative pre-billing process is the prior authorization process. This process can become very difficult and time consuming, check out our post to help you create a successful prior authorization process. The keys to this process are requesting prior authorization in a timely manner and executing a detailed prior authorization follow-up schedule. Once you have this step completed, the next step is timely submission and pre-claim review to increase the success of your billing process.

  1. Home Health Care Billing: Submitting Timely and Correct claims

Many payers require different types of claims, submission intervals, timely filing requirements, and coding guidelines. Here at CRS we generally separate payers into a few different categories and submit claims as listed below, all of these timelines and schedules are customized to the individual agency.

  • Weekly Home Care Billing Process:

    • Claims for the prior week (Sunday-Saturday) will be billed on Wednesday & Thursday each week
    • Main Goal is to have all visits for entire week on 1 claim
  • Episodic Home Health Billing Process:

    • Episodic Billing will be completed on a daily basis
    • If a RAP/Final Claim remains un-billable for more than 5-10 days from the first billable date, notify the agency immediately.
  • Monthly Home Health Care Billing Process:

    • Claims for the prior month will be created and submitted on the 2nd Wednesday of each month.
    • Main Goal: Have entire month of services on 1 claim

Prior to submitting any claims, all home health care billing experts know you need to check the claim for any errors. Common errors include incorrect subscriber ID, incorrect patient date of birth, misspelled patient name, and no prior authorization. These errors are all avoidable and if not caught prior to billing can lead to increased denials and slowed cash flow.

  1. Attention to detail & Consistent follow-up

Complete Revenue Solutions believes that the most important factor in home health billing success is directly tied to our ability to collect denied claims and keep accounts receivable balances low. Our process is outlined step by step to make sure no claim is missed:

  • All payments will be posted to the correct claims the day following the receipt of the payment
  • Pending claims are to be followed up on by Wednesday of each week and have a status update each week
  • All claims beyond 30 days are to be followed-up on, daily
  1. Home Care Billing Reporting

Oversight of the billing process is the key to accountability and complete transparency. These reports will give you real time insight into the financial health of your agency.

    • Weekly Billing Report
    • Episodic Billing Report
    • Monthly Billing Report
    • Private Pay Report
    • Accounts Receivable Aging
    • Denials- A report of denials will be sent for each payment, the report will include Patient Name, Date of Service Denied, Date Denied, Denial Reason, Action Required. Additionally, a comprehensive report of all denials that remain unresolved.

Home Care Billing is the driver behind the day to day cash flow of an agency and is an imperative process for a home health care agency to be successful. This guide gave you a good overview of how to improve your home health billing process. First, it is important that you have a comprehensive intake process, submit timely and error free claims, pay great attention to detail and follow-up, and finally, utilize detailed reporting to oversee the process.

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For More information about Home Health Billing, visit the CMS Claims Processing Manual

 

 

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4 Steps to a Successful Prior Authorization Process http://www.completerevenue.com/4-steps-prior-authorization-process/ http://www.completerevenue.com/4-steps-prior-authorization-process/#respond Tue, 13 Jun 2017 08:53:11 +0000 http://www.completerevenue.com/?p=351 4 Steps to a Successful Prior Authorization Process Prior Authorizations are often overlooked when it comes to improving a home health agency’s revenue cycle management, however, this step in the cycle is often one of the most difficult to manage and one of the biggest challenges for home health care providers. Luckily, using the outline [...]

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Prior Authorization Process4 Steps to a Successful Prior Authorization Process

Prior Authorizations are often overlooked when it comes to improving a home health agency’s revenue cycle management, however, this step in the cycle is often one of the most difficult to manage and one of the biggest challenges for home health care providers. Luckily, using the outline in this article, you will be able to not only improve your prior authorization process but also increase your cash flow. This article will give you a step by step guide to prior authorization management, starting with initial authorization request, timeliness of requests, follow-up schedule, and how to handle the situation when the insurance company is not responding to your request. The first step in this process is obviously sending your initial authorization request.

1. Initial Request: Initiate the Prior Authorization Process

Here is the situation: you just received a new referral (hooray!), your intake department gathers all the information and you have verified the patient has active insurance that you can accept. Most agencies schedule the start of care and the case is under way, however, if you don’t contact the insurance company for authorization to see the patient for the initial evaluation, your agency could face a long uphill battle to get paid for the services you provide. The first step in correcting this is to immediately once a referral has been accepted, contact the insurance and send over the necessary clinical documentation to support medical necessity and obtain an initial authorization for the start of care visit. Many insurance companies have adopted a policy that home health care agencies get automatic approval for anywhere from 1 to 3 visits to start that patients care, regardless, it is important to contact that payer and initiate the care. So now that you have the initial authorization approval, you’ve started the patients care, next step in the prior authorization process is requesting ongoing authorization for the care you plan to provide.

2. Requesting Authorization: Continue the Prior Authorization Process

The most important part of this prior authorization process is making sure your clinicians are completing their documentation quickly, accurately, and thoroughly. Once the initial start of care and plan of care documentation is completed by the clinician, the authorizations department must send that clinical information along with a prior authorization request form to the insurance company (via fax, online, etc.) to obtain authorization for all the planned visits outlined in the plan of care. It is very important that this request is sent prior to the requested dates of service, many payers will not approve any retroactive authorizations or have a very limited time frame for retro authorization requests. This will be a process that you have to complete on an ongoing basis (usually every 30-60 days depending on the insurance company). Once you have obtained your first authorization for ongoing visits, it is important to submit subsequent requests no less than 3 days prior to the end of the current authorization for any more future visits the patient requires. You’re probably sitting there saying “I sent my request for ongoing visits but have not gotten a response from the insurance company, what do I do?”, unfortunately this is very common and that is why it is very important to maintain constant oversight over all prior authorization requests that are outstanding.

3. The fortune is in the follow-up

Home health care agencies are often times put into the position where the end of the previous authorization has come and gone, yet they are still waiting on the approval or denial of their request for ongoing authorization. The best way to combat this is to be proactive and maintain a very detailed log of communications and utilize some sort of alert or calendar to know when you sent the request the first time and follow a very strict follow-up schedule. At Complete Revenue Solutions, here is the follow-up schedule that we follow:

• A follow-up fax and phone call will be made to the insurance company if the requested Authorization has not been returned to us within 5 business days.
• At 7 business days after the request has been first sent, another phone call will be made to the insurance company to request status and at that time a phone call will be made to the patient to inform them of potential disruption in services if the insurance doesn’t approve the requested visits within 3 days, and encourage the patient to contact the insurance company directly.
• On the 10th business day after the initial request has been sent a letter will be written and faxed and certified mailed to the insurance company, along with the patient and doctor, notifying them that if the request is not returned to us within 1-2 business days we will be discontinuing the patient’s services. Additionally, a phone call will be made to each party and notified of the contents of the letters.
• If by the 13th business day there has been no auth returned to us, the patient will be placed on hold and the insurance, patient, and doctor will be notified that the patient will not be receiving services until an authorization has been established.

There is no such thing as a perfect system, but in our experience this prior authorization process has worked very well for us. Typically, we never reach the 13-day mark, usually with the patient’s involvement insurance companies work much quicker. Obviously, we leave all patient communication and care decisions up to the home health agency, this is simply a suggestion. Possibly the most important part of this process is the reporting aspect, without reporting and oversight this process cannot succeed.

4. Keeping your eye on the prize with Reporting

Reporting and oversight are extremely important aspects to any good business process, I may even argue that it is even more important for the prior authorization process than almost any other. Many electronic health record software vendors have some sort of built in authorization tracking that can be very easy to use and pull reports from. I strongly encourage you to review all prior authorization process reports at least weekly. Here at CRS we utilize a reporting model that looks as follows:

• A report listing of all requested authorizations that are open, pending, or denied will be sent every week on Friday by 4:00 pm. The report will include: Patient Name, Insurance, Dates of Service Requested, Date Sent, Follow-up Actions, Status
• Additionally, a report of all upcoming ending authorizations will be sent, broken down by payer. Listing: Patient Name, Insurance, Ending Date of Current Auth, Date New Request sent (or projected to be sent), Status/Reason for it not being sent.

The process of obtaining and maintaining prior authorizations is vital to the success of any home health care agency. This prior authorization process impacts almost every aspect of the revenue cycle and operations of your business. This article should give you the knowledge and outline to maintain a very effective prior authorization process, beginning with your initial authorization request, submitting ongoing requests in a timely manner, following up on outstanding authorization requests, and finally how to handle when an authorization request is not being responded to by the insurance company. Complete Revenue Solutions provides home health care billing services as well as other related services such as Authorization Management, go to www.completerevenue.com to learn more, also check out this blog post Home Care: New Challenges, Same Struggle

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Home Care: New Challenges, Same Struggle http://www.completerevenue.com/home-care-management/ http://www.completerevenue.com/home-care-management/#respond Thu, 29 Oct 2015 13:05:02 +0000 http://www.completerevenue.com/?p=151 With the implementation of ICD-10, home care providers are faced with another challenge to overcome in the seemingly never ending process to get reimbursed. While this challenge has recently developed, providers have been dealing with a multitude of challenges that has impacted their reimbursement almost on a bi-annual basis recently. In addition to the implementation [...]

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home care management

With the implementation of ICD-10, home care providers are faced with another challenge to overcome in the seemingly never ending process to get reimbursed. While this challenge has recently developed, providers have been dealing with a multitude of challenges that has impacted their reimbursement almost on a bi-annual basis recently. In addition to the implementation of a greatly more difficult set of codes, insurance companies and Medicare Fiscal Intermediaries have made it even more difficult for Home Health agencies to get reimbursed for their services by their lack of readiness for the ICD-10 implementation date of October 1, 2015. Palmetto GBA recently denying all claims with a through date on or after October 1, 2015, they had this to say about the issue:

Palmetto GBA is researching home health (HH) final claims (type of bill 32X) with a THROUGH date on or after the October 1, 2015, that are incorrectly returning to the provider (RTP) with reason code 31276. The reason code narrative states “Outpatient claim contains an ICD-10 indicator of 9 and an ICD-10 diagnosis is present”.

Medicare Learning Network Articles SE1408 and SE1410 state that “Medicare requires the use of ICD-10 codes on HH claims and Requests for Anticipated Payment (RAPs)” with a THROUGH date on or after the October 1, 2015.”

Another challenge facing providers today is the continued implementation of the Affordable Care Act (ACA), with the addition of dual-eligible plans through Managed Care payers and Medicaid expansion pushing patients onto Managed Care plans. As a result, agencies are struggling more than ever to get reimbursed for the work they are doing. In Ohio, managed care companies like Molina take several weeks to respond to authorization requests from providers, leaving providers bound to physician orders to provide services that they are unsure will be covered by the insurance company. If an agency is lucky enough to get an authorization, these companies are inept when it comes time to process the claims you have submitted. Claims may process 30+ days before providers receive a response, and often times will receive a denial stating “Claim lacks sufficient information for processing”. Now the agency will have to resubmit the same claim and wait another 30+ days before the claim may get paid to them.

Obviously all of these challenges can frustrate an agency, but the most frustrating challenge facing agencies now is the ACA’s mandatory 14% decrease in reimbursement. Industry experts, physicians, hospital CEO’s, and even some lawmakers have said the Home Care is going to become a bigger and bigger part of the healthcare cycle; however, with the slimming margins and increasing difficulty to get paid, it is becoming more difficult for seniors to find the care they need. CMS has recently reported in their proposed rule for 2016, that home care will experience an additional reimbursement cut totaling $350 million. How much more can your agency take before it is time to close the doors?

While all of these difficult challenges can cast a wide shadow over the potential of home care, there are steps you can take to guarantee the continued success of your agency:

  1. Know the Numbers

Now more than ever, it is vital to the health of your company to always have a clear financial picture of your agency. While it may not be necessary for you to have up to the minute numbers produced by your accountant, it is necessary to review the financial status of your company on a daily basis. Continuing to review complete accounting records and reports on a monthly basis will help, but if you don’t have a report given to you each morning with real time data, the future of your company may be in jeopardy. The key numbers to look at each day may vary depending on the agency; however, the basic numbers you should have in front of you every day should always be there: cash on hand, open accounts receivable and accounts payable, weekly billing summary, and year-to-date revenue. This “Daily Snapshot” report will set you up to always be in control of your business.

  1. Documentation remains the driver

Documentation has increasingly become more scrutinized and more imperative to an agency’s success and that concept isn’t going anywhere. The current saying among clinicians, “If it wasn’t documented, it didn’t happen”, is undeniably true in more ways than just care provided to the patient. Stressing the importance of timely, accurate documentation to your clinicians has never been more important than in today’s home health landscape. If the documentation isn’t completed and completed correctly, that visit never happened in the eyes of the insurance company and will be quickly reflected in your bank accounts balance. This is why I suggest adding a “visits incomplete” report to your daily snapshot report, it is no longer just the clinicians responsibility to complete their documentation; sometimes they need a little extra motivation and encouragement.

  1. Margins are the Key

There was a time not too long ago where home health was a highly sought after industry by potential investors and entrepreneurs due to its highly attractive profit margins. If you don’t already know, let me be the first to tell you: those times have come and gone. Medicare has always been the profit driver for home health agencies, however with the already in place ACA mandated 14% cut and the proposed additional $350 million cut, margins on this payer are quickly diminishing. The two margins you want to always have your eye on are Gross Margin (revenue minus costs of services provided) and Profit Margin (revenue minus all business expenses). Industry benchmarks for each margin have been set at 44% and 5% respectively, but if you maintain your current expenses without adapting, your margins will quickly fall below 30% and (10%). Reviewing an agency’s margins on a monthly basis is a must, and I recommend going a step further and reviewing your margins each week. It is imperative to make adjustments to expenses to maintain your company’s profitability.

  1. Cash is King and Receivables are the Kings Jester

Being a profitable agency on paper is great when looking to impress banks or potential business partners, however if that isn’t translating into cash in the bank those numbers aren’t worth the paper they are printed on. The revenue cycle management team of an agency has quickly become either a significant strength or detrimental weakness, and if your team isn’t up to par, it is time to make a change. Payers are looking for every way possible to hold onto their wealth for as long as possible, furthermore, if your team isn’t doing everything within their power to get the agency paid, it won’t be long before you are deciding whether to pay the rent or pay your employees. Having a weekly financial team meeting where you review the current receivable aging for each payer is a necessity. At any given moment your team needs to be able to tell you the current AR balance and status of any claims that are unpaid. In addition, training your staff on the concept “the squeaky wheel gets the grease” is the only way to insure payment. If a claim is pending, staff needs to be on the phone, sending emails, sending letters, or doing anything and everything to remain present in front of the payers until the claim is paid.

While home health care continues to grow, the number of providers will continue to decrease and the only way to make sure your agency isn’t responsible for this decrease is to educate your staff and always have a clear perspective on the finances. New challenges will always arise, but your ability to stay ahead of these obstacles and not allow the same struggles to continue is to take control. Now might be the perfect time for your agency to consider utilizing a medical billing service.

If you have any questions or would like more information on how your agency can face these challenges and prosper, leave a comment or send me an email at casmith@completerevenue.com

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