Home Health, Palliative, and Hospice Revenue Cycle Management Services

“Never leave money on the table”. We all have heard this phrase at some point in our professional lives. Unfortunately, over the past few years, more and more agencies are doing just this. Now is the perfect time to reverse the trend, increase your revenue and reduce write-offs.

The Current Challenges of Home Care Revenue Cycle Management (RCM)?

Home care revenue cycle management begins when you enter the patient into your EHR/EMR all the way until you get paid for taking care of that patient. The challenge many agencies face with RCM is standardizing the processes between the referral to receiving the payment.

With the ever-changing guidelines and demands of home health, you need a revenue cycle management partner that has flexible service offerings, aligns with your business strategies, and helps your agency scale. Most vendors today are either owned by software companies or equity firms. With all their red tape and line of executives that have to approve the smallest of changes to any agreement, nothing seems to get accomplished, and agencies are the ones that suffer as the market changes.

So how does revenue cycle management work?

The better question to ask is how should revenue cycle management work? Whether you do your RCM in-house or outsource to a third party, the goal of RCM is to create predictable revenue. Predictable Revenue is a framework to create consistency month over month, systematically and provide business growth based on a formulaic process.

Revenue Cycle Management in Home Care has some key processes that must be mastered and managed on a consistent basis. Failure to do so will cause claims to reject, deny, reimburse incorrectly, cause delays in payment, or not pay at all. With costs increasing, inflation at an all time high, falling reimbursement , and increased compliance regulations, agencies continue to feel the pressure and find themselves working more in the agency vs on the agency. To start with, I strongly suggest you create a list of all the employees on your delivery care team. In other words, determine who is responsible for what and when from referral to payment. Developing this list is an important step to optimizing your revenue cycle management.

Intake – It all starts here. The key with intake is to create a sound process with checks and balances to ensure you are collecting the most accurate information on the patient and recording the correct reason the patient needs the care. Once the information is collected, you must verify eligibility, obtain authorizations and on-going authorizations and place these documents in the same place so anyone can find them if they need to. Most claims are denied due to eligibility and authorizations not being present. If you are currently struggling now, this is the first place to start researching and develop a root cause analysis.

Scheduling – schedule visits based on the authorizations and the tracking of missed visits, entering correct dates of service, and ensuring no duplicate services. This management of visits allows you to ensure accurate claim submission.

Billing – Claims that are ready to be billed need to be validated before being sent. Depending on the number of payors you have, agencies should use a clearinghouse to better manage the claims process for one location vs. multiple portals. Most clearinghouses can be set up for claims to fall into 1 of 3 buckets; rejected, denial, or claims monitoring. Claims monitoring allows your billing team to set up each payor based on the average time it takes the payor to pay and if payment has not been received, it will alert your billers that they need to follow up on this claim. Setting this up removes the guesswork and creates a systemic process saving your employees time to work on other areas that require their attention.

Collections -The most sought after step, getting paid. Post claims correctly and match payments to the visits. Post daily and manage your Daily Sales Outstanding by payor and business line. Managing and measuring your financial performance needs to be a top concern for everyone that you listed above on your delivery care team.

Additional things to check to maintain a clean and accurate accounts receivable are payor contracts, updated reimbursement rates in the EMR, and completing a month-end close to balance the bank account.

Conduct internal audits– If you outsource your revenue cycle management vendor, be sure they have processes in place for measuring performance. Do they have procedures for mitigating poor results? What happens if they underperform and don’t deliver? How does that affect your agency? Without defined performance metrics and goals, you could end up very unhappy with your results. Also, you could get stuck in a contract, paying for services that aren’t valuable for your agency.

Revenue Cycle Management is a team game. Although employees may play different positions, it takes everyone for the agency to win.

We’re home care revenue cycle experts.

Unlike other revenue cycle management vendors, at HealthRev Partners, we’ll work with you to customize a plan that optimizes results. Upon implementation, we’ll identify challenges, benchmarks, and key strategies for success. This ensures that we’re all on the same page and marching to a unified goal. Additionally, we’ll have regular meetings to review reports, discuss progress, and get updates from you on internal operations. This could include changes in staff, processes, EMR, and more. During these meetings, we’ll also address any concerns and initiate action plans.

When you choose HealthRev Partners, you’re partnering with a revenue cycle management vendor that is invested in your success. To learn more about our revenue cycle management services for home health, palliative, and hospice, or to get information on our no-obligation trial period, reach out to us today.

When it comes to your cash flow, don’t hand over your home health, palliative, and hospice coding and billing to just anyone. We’re made up of home care revenue cycle management veterans who are passionate about securing your success. Our experienced team knows what it takes to achieve accurate, high quality RCM that produces real results. We’re driven to make client satisfaction and success our top priority. Our sole focus is on maximizing your revenue…and it shows.

If you’re dissatisfied with your current RCM vendor, or if you’ve been thinking about outsourcing, now is a great time to talk with us. To earn your business, we offer a trial period with no long-term obligation. We promise that you won’t be disappointed.