Page 18 - HME Business, May 2018

Revenue Cycle Management Hits Home
and claims management and increase opera- tional efficiencies, and that has helped providers cut costs and boost margins.
However, starting a couple of years back, HME software makers have worked with provider busi- nesses to start defining how RCM should work in the HME industry to help providers to completely rebuild their revenue performance — not just refine their billing. Just like in a hospital, RCM needs to be an umbrella practice in the HME organization.
“Most HME providers think of RCM in terms
of billing, but my argument is that this falsely indicates that billing is an island that can manage and increase collections all by themselves,”
says Wayne Bailey, director of client services for HME software company Bonafide Management Systems. “This is just not true. RCM must involve intake (CSRS checking eligibility, same or similar, Part A denials, physician PLECOS), delivery (correct product, correct HCPCS, correct compli- ance, correct training), invoicing, sending claims, posting, sending secondaries, and working denials. My point is that if you think of RCM as a “billing” function instead of a “business” func- tion, you’re missing out.”
Why the Change?
In the past, RCM has been a non-issue and a non-entity in the world of home medical equip- ment. That was back when reimbursement was generous, and providers didn’t have to pay nearly as much attention to cash flow and overhead structure as they do now. Today, it’s a whole new ballgame, and providers need a new strategy, according to Bailey.
“It was easy to not worry about RCM when
the industry enjoyed margins in the 50 percent range,” Bailey says. “With high margins, HME providers didn’t need to use sophisticated management tools. ... When the industry was flush, claims were sent, and DME providers hoped they would get paid. Billers were not tightly managed or monitored, and very few tech- nical systems were in place to enable an enter- prise view of billing efforts and results.”
All that has changed now, thanks to competi- tive bidding. Now providers need to implement new business practices if they want to survive
and thrive despite reimbursement cuts, audits, and other funding pressures that not only tighten margins but increase the cost of business through more extensive documentation procedures, etc.
One thing is for certain: traditional HME management approaches won’t suffice.
“Management lacks visibility to what to do, so it’s left to the operators and staff members to do a lot of manual work, and try to extract informa- tion then, to figure out what they’re going to work on next,” says David S. Golen, Vice President
of Business Development for HME software
company Universal Software Solutions. “And a lot of is manual work, calling insurance companies, following up on claims.
The goal with RCM is to automate this. To create a structure using both technology and well-defined workflows — to bring some order to the chaos.
“The people who are working on \[revenues and claims\], know what needs to be touched, why, be able to sort them in different orders to get to the highest dollar, the ones that are getting closest to timing out — all the things that would cause you to want to work on something faster than the next thing,” Golen says. “But again, that needs to be done in a very visible manner on your screen, not relying upon you digging to find it.”
“HME providers don’t have control over the maximum reimbursement rates, but they do have control over their billing workflow and systems,” Bailey explains. “They are able to manage their busi- nesses using the latest tools and software so that they can maximize the reimbursement on every single item and make the tight margins work for them.”
“Today’s HME providers need advanced RCM in order to survive on today’s tight margins,” Baily
18 HMEBusiness | May 2018 | hme-business.com
Management Solutions | Technology | Products
“The obstacles we see most are the lack of clear workflow processes. Without systems in place, it’s hard to find the leaks and fix them.”
— David Golen, Universal Software Solutions
Tricky Territory:
Collecting Patient Payments
One aspect of RCM that has been a “work in progress” for providers is collecting co-pays and ongoing payments. The issue concerns
how the culture of how HME provider businesses work with patients has changed. Back when DMEPOS reimbursement was much more profitable, and providers could stand to be a little more flexible with patients. However, in an era of tough Medicare cuts, that culture needs to change. Providers need to start collecting co-pays up front. How can they make that culture change?
“You know, it’s one of those things where you just have to rip off the Band-Aid,” says Joey Graham, vice president of Prochant, a consulting firm that specializes exclusively in helping HME provider business with RCM. “It’s about how you present it to the patient. Your existing patient base who’s used to you never charging them, they’re going
to be your trouble. Your new patients, they’re used to it, they expect it, and it’s not questioned at all. ... the reality is patients expect that nowadays. ... You have to set the tone up front: this is not free.”
Here staff can start working with patients to manage their expec- tations and let them know that co-pays are going to be collected up-front. And this is an effort the entire organization should support.
Similarly, the provider should put procedures in place to help patients who cannot pay the full amount, but perhaps can pay a portion of the co-pay, and then arrange a payment program for those patients.
“Strong patient private pay collections practices are critical,” Graham explains. “Everybody’s been talking about it for years now, but of course collecting that money up front, there’s no substitute for it. What I tell providers over and over again is your only point of leverage with your patient is your product or your service. That’s it. The moment you give it to them, you just lost all your leverage. Do you walk into Walmart and think that you’re going to walk out without paying? You can’t say, ‘send me a bill.’
Graham notes that RCM-minded providers have re-tooled their eligibility processes so that they are determining the patient’s responsibility, and communicating it to the patient very clearly. Instead of asking “Would you like to pay now,” they ask “Is that going to be Visa, MasterCard, or American Express?”
And once staff gets the credit card, they need to ask to keep the number on file so that they can apply it to rentals or other charges.
“We need to get a card on file because traditionally in our industry patients only pay about 50 percent of the time,” Graham explains. “Believe it or not, if you have a balance — the patient responsibility — and you are only going to send them a bill, you have about a 50/50 chance of getting paid.”