Home Health Revenue Cycle Management
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Take a comprehensive look at how revenue cycle management affects home health and hospice agencies, as well as the performance metrics and best practices for improving agency effectiveness.
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Home Health Revenue Cycle Management
- 1. Session 502: Home Health Revenue Cycle Management Melinda A. Gaboury, CEO - Healthcare Provider Solutions, Inc. Craig Mandeville, CEO - Forcura Nick Seabrook, Managing Director - BlackTree Healthcare Consulting
- 2. Introduction • Revenue Cycle Overview • Revenue Cycle Obstacles • Specific Issues and Solutions • Performance Indicators • Q&A
- 3. Revenue Cycle Overview The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue."
- 4. Revenue Cycle Overview • Intake • Insurance Verification • Authorization • Scheduling • Documentation • OASIS Completion • Document Management • Supply/Drug/DME • Billing and Collections • Reporting
- 5. Revenue Cycle Overview How does the revenue cycle work?
- 6. Revenue Cycle Overview Questions to ask when evaluating revenue cycle functions: What? What is the task? Who? Who is responsible for completing? Where? Where is it completed? When? When does the task get completed? Why? Why is the task being completed? How? How does it get completed? How Many? How many people are needed?
- 8. 1. Staffing
- 9. 2. Structure
- 10. 3. Duplication
- 11. 4. Technology
- 12. 5. Communication
- 13. 6. Productivity
- 14. 8. Paper
- 15. 9. Management
- 16. Specific Issues and Solutions
- 17. Intake Issues • Low Conversion Percentage • Incomplete/Incorrect Documentation • Delayed Admissions • Low Productivity • Delays in admitting patients • Insurance verification Solutions • Current interoperability trends - shift to e-referrals, direct secure messaging • Intake and Marketing collaboration • Easy access to Referral Log • Welcome calls to validate demographics • Flex and extend Intake hours for coverage • Blended staffing model (clinical and clerical) • Track productivity
- 18. Insurance Verification Issues • Denials for incorrect insurance • Denials for no authorization • High patient pay A/R Solutions • Designated staff for insurance verification • Educate staff on which payors your agency accepts • Access payor portals • Determine patient co-pays and deductibles up front • Standardize documentation in EHR for verification • Increase verification frequency • Automate re-verification
- 19. Authorization Issues • Denials for lack of authorization • Backlog in authorization requests • Delays in start of care Solutions • Designated staff for authorization • Access payor portals • Standardize documentation in EHR for authorization • Proactively identify expiring authorizations - reports • Determine protocols by payor for auths/re-auths • Communicate with clinicians in advance of expiring authorizations • Track and trend authorization denials by clinician • Hold clinicians accountable for visits made without authorization
- 20. Scheduling Issues • High number of missed visits • High SOC to evaluation lag time • High staff overtime • Self scheduling Solutions • Systematic approach to utilizing EHR for scheduling • Assign patients by Team or Geography • Approve frequency of visits • Utilize “Pending” report to prioritize SOC • Schedule SOC visit within 24-48 hours • Centralize Scheduling
- 21. Documentation Issues • Targeted Probe & Educate • Review Choice Demonstration • ZPIC/UPIC/RA Solutions • QA • F2F/Signed Plan of Care/Orders • Pre-Bill Reviews • Full Clinical Review before submitting ADR
- 22. OASIS Completion Issues • High # of days to RAP • Low case mix Solutions • Finance and Clinical Collaboration • Accountability for clinician response time to QA • QA staff have both coding and OASIS certification • Publish case mix weight by clinician • Monthly scorecard review
- 23. Documentation Management Issues • High number of unsigned orders/F2F • Increased unbilled A/R Solutions • Obtain as much information at intake as possible • Establish follow-up protocols i. Fax order ii. Place phone call 7 days after initial submission iii. Place second call 14 days after initial submission iv. Place third call 21 days after initial submission v. Utilize liaisons to help retrieve after 28 days • Follow-up by physician rather than patient • Establish incentives for teams • Determine reporting for follow-up • Utilize electronic physician signature portal
- 24. Supply/Drug/DME Management Issues • High supply/drug/DME costs • Timely access of needed supplies, drugs, DME for patients Solutions • Know your cost per patient per day • Drop ship supplies • Review formulary on regular basis • Engage Pharmacy Benefit Management company • Engage DME Benefit Management company
- 25. Billing and Collections • Issues • High Accounts Receivable • Low collectability • Inconsistent cash flow • Solutions • Bill daily • Go electronic (billing, cash posting) • Collaborate with clinical on any pre-bill errors • Follow-up monthly on all outstanding A/R aged over 60 days • Bill in monthly increments for non-episodic payors • Trend denials by reason for more insight into revenue cycle issues • Set productivity and cash goals for staff
- 26. Reporting • Issues • Not enough reporting • Too much reporting • Not looking at the right data • Time consuming reporting process • Solutions • Develop dashboards • Determine source of information • If not able to get information from EHR invest in ancillary software • Present data differently for appropriate audience • High level for executive team • Drill down for management team • Accrue, Analyze, Act
- 28. Productivity Benchmarks • Intake • Clinical Staff – 8-10 referrals/day • Clerical Staff – 15-20 referrals/day • Authorization • 150 non-Medicare patient census/FTE • Insurance Verification • 50 referrals per day/FTE • Document Management • 30 physician calls/day
- 29. Productivity Benchmarks • Scheduling • Staff entering own schedule - 1 staff to 400 patients • Staff not entering schedules – 1 staff to 200 patients • Coding/OASIS QA • 10-12 reviews/day • Billing/Collections • Medicare – manage between $20-25M in revenue • Non-Medicare – 30 phone calls/day • 600 accounts aged over 60 days
- 30. Revenue Cycle Key Performance Indicators • Referral/Intake • Referrals • Admissions • Conversion Percentage • Insurance Verification • Payor Mix • Authorizations • Payor Mix
- 31. Revenue Cycle Key Performance Indicators • Scheduling • Missed Visits • Average Days to Admission • OASIS Completion • Days to RAP • Case Mix • Error Percentage
- 32. Revenue Cycle Key Performance Indicators • Document Management • Average turnaround time • Outstanding orders by age • 0-7, 8-14, 15-30, 31-60, 60+ • Orders sent/month • Orders received/month • Days to final claim
- 33. Revenue Cycle Key Performance Indicators • Supply/Drug/DME Management • Supply, Drug, DME cost/day • Billing and Collections • A/R Balance • Days Sales Outstanding (DSO) • Unbilled A/R • A/R over 90 days • Write-offs • Revenue vs. Billed vs. Paid
- 34. How can you improve these metrics? Process • Define workflows to drive efficiency • Identify bottlenecks • Where are things getting stuck? People • Promote inter-departmental collaboration • Blended staffing model • Training and education Technology • Leverage reporting platforms • Build out custom workflows • Go paperless • Utilize mobile tools
- 35. Q&A Craig Mandeville CEO & Founder Forcura cmandeville@forcura.com 800.378.0596 Melinda Gaboury BBA, COS-C CEO & Co-Founder Healthcare Provider Solutions, Inc. mgaboury@healthcareprovidersolutions.com 615.399.7499 Nick Seabrook Managing Director BlackTree Healthcare Consulting nickseabrook@blacktreehealthcare.com 610.536.6005 ext 702