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Revenue Cycle: Solving Your Core Home Care & Hospice Challenges


At one point or another, every home care and hospice organization will benefit from a review of its revenue cycle to identify and address any common concerns that may threaten financial performance and viability. According to Ron Barrera, Director, Simione Healthcare Consultants, opportunities exist at each stage of the revenue cycle to generate faster, more accurate payments for the services provided.

“Revenue Cycle Management (RCM) begins with the patient’s entry into the care system – from insurance verification and eligibility of benefits, to documentation of the face-to-face encounter and MD orders, to the admission visit and start of care – followed by the charge entry, billing, follow-up and denial management.  These activities all occur before an organization is paid,” Barrera says.  “With so many steps and requirements along that process, it’s no wonder that many home health and hospice agencies experience setbacks that increase Days Sales Outstanding (DSO), decrease cash flow, delay coding and billing activities, and/or result in payment delays or denials.  Several important exercises will help to address these issues to improve cash flow, support staff and improve overall performance,” he explains.

Initially, Barrera suggests that improving cash flow beyond an accelerated billing and collections effort requires that home care and hospice agencies pay their bills on time, negotiate longer payment terms with vendors, and understand their receivables.  From that point, agencies need to examine their revenue cycle framework.

Admissions, Face-to-Face and MD Orders

During the intake and admission process, accuracy of information by intake staff is paramount, including the correct spelling of names, social security or Medicare (HIC) number, and payer assignment.  For eligibility, the payer and benefits must be verified, and authorization obtained and entered correctly into the system, with specific documentation on contract terms to identify patients with payment ability.  Verification of this information by the clinician at the start of care admission visit is critical to ensuring accurate information from the start of the revenue cycle.

With face-to-face and MD orders, the process must be clear with responsibilities identified and monitoring in place to document the appropriate information. Additional documentation factors include OASIS assessment to reflect the patient’s status, coding accuracy, information that supports the need for services, the right disciplines for the right services and number of visits, and clinical notes that support the Plan of Care.

Charge Entry, Follow-up and Denial Management

Charge entry is another important aspect of the Revenue Cycle, inclusive of missed visits, billable vs. non-billable activities, batch processing, correct charges recorded for each payer, and medical supply charges.

During billing, the goal is to process claims effectively and efficiently, taking into consideration manual vs. electronic processes, days to Request for Anticipated Payment (RAP) and final claim, frequency of billing, the availability of key billing information to staff, any backlogs in billing, and potential risks for inappropriate billing. 

The follow-up process also serves a key role for ensuring quality checks on whether expected payments are received, the speed of response to rejections, analysis of the reasons for rejections, and proper workflow for resolution.

Denial management requires a process to identify, manage and track denials for payment, which needs to be assigned to the appropriate staff who can determine the reasons for rejection to improve the revenue cycle process. 

When evaluating receivables, Barrera suggests determining how much cash is collected by payer, verifying that contractual allowances are recorded correctly and analyzed by type, and considering credit balances, secondary payers, and balancing cash receipts to daily deposits.

 It’s time to get MAD about Revenue Cycle Management! The keys to being a MAD success are Measurement, Accountability and Discipline.

Measurement is the first key ingredient for success, and the old adage, “If you can’t measure it, you can’t manage it!” rings true for RCM.  An important factor is ensuring that what is measured is accurate and meaningful, and that it fosters distributed accountability. Agencies should also measure early and often, automating the measurement process as much as possible,” Barrera says.

In order to improve cash flow, some measurements to consider include:

  • Credit balances
  • Cash collections
  • Claims on hold
  • Number of outstanding orders
  • Unlocked OASIS
  • Rejections by reason
  • Denials by type

Accountability is the second key to effective RCM, and its starts with a home care or hospice agency taking important steps regarding roles and goals.  “Home care and hospice leaders need to ensure that the ‘right people’ are in the right roles, and that departments have established projects and goals for performance that are aligned with the agency’s revenue cycle strategic goals.  Every metric should be tied to an accountable leader within the organization,” Barrera says, “and all staff should be accountable to at least one metric.” 

Discipline with RCM is the third and final key to ensuring basic operational processes are functioning effectively. “Once you identify a process champion, organize your team to evaluate work flows (both paper and electronic), and document them so that you can determine if there are unnecessary or redundant steps to eliminate, or any other opportunities for improvement,” adds Barrera.

Several other considerations may help home care and hospice organizations make other improvements in the revenue cycle. These include:

  • Analyzing accounts receivable by payer with teams assigned to follow claims from start to finish
  • Screening for Medicaid, working with states to streamline and optimize the Medicaid application process
  • Capturing patient information through integration with hospital or physician systems to obtain pertinent data
  • Cutting costs by having staff work from home
  • Establishing a culture recognizing the importance of the revenue cycle that includes a highly visible recognition program focused on RCM achievements

Developing Benchmarks

Barrera recommends the following key performance indicators for managing and improving Revenue Cycle:

  • Accounts Receivable aging distribution by payer
  • DSO by payer
  • Aging 91-180 days by payer
  • Aging over 180 days by payer
  • Number of days to RAP
  • Number of days to final claim
  • Write-off as a percent of revenue
  • Cash collections net to 90

 Also ask yourself, “Where have we been, and where do we want to be?’”

  • Use trending info rather than data from one point in time
  • Track a minimum of 6 to 12 months
  • Analyze ups and downs to identify opportunities for improvement
  • Develop or use benchmarks that will give you a clear, real-time comparison of your performance with other home care and hospice organizations

RESOURCES TO HELP YOU

Revenue Cycle Management Consulting

Simione Healthcare Consultants specializes in Revenue Cycle Management (RCM), recognizing that excellence in accounts receivable operations is one of the critical success factors for home care and hospice organizations. We have assembled a team to help you build processes that reflect best practice and the use of key indicators to monitor your progress.  Our team will provide expert analysis of your organization's billing and collection processes, and help you implement improvements to accelerate cash flow and decrease Days Sales Outstanding.  If you require additional AR support, we can provide AR recovery services, denial and appeal process management, interim management of your billing and coding, including outsourcing, and specialized training to help you reach a new level of organizational performance.  Visit Simione.com or call 844.215.8820 to learn more.

Real-Time Benchmarking Promotes Better Decisions

The Simione Financial Monitor provides the industry’s only real-time national benchmarking tool to compare agency performance across the nation. In 2013, home health and hospice agencies using the Simione Financial Monitor for the full year achieved on average an increase of 2 percentage points in gross margin.  For more information visit simionefinancialmonitor.com or call 844-215-8826.

Is Outsourcing the Answer for Billing & Coding Efficiency?

Is your cash flow sluggish due to an increased DSO, issues with commercial insurance collections, or a periodic coding backlog?  With services for billing, coding and OASIS quality review, Premier Returns is designed to reduce the administrative burden and optimize the revenue cycle to improve financial performance for home health and hospice agencies. By reviewing the cost benefit of outsourced billing and/or coding, agencies will find a suitable alternative that also minimizes concern regarding recruitment, retention and training investments to stay current with billing and coding requirements. For more information, visit premeirreturns.com or call 888-345-3947.