Page 20 - HME Business, May 2018

Revenue Cycle Management Hits Home
adds. “Today’s margins are extremely stringent ... This means that HME providers must have highly- trained employees using highly sophisticated workflow software to maximize tight margins.”
Money on the Table
Clearly, maximizing money per-claim and per- patient is the name of the game, but, at present, providers aren’t effective RCM organizations. In fact, they’re leaving a lot of money on the table, according to Joey Graham, vice president of Prochant, a consulting firm that specializes exclu- sively in helping HME provider business with RCM.
“It’s an industry wrought with landmines that providers stumble upon all the time,” Graham says. “Providers a lot of times end up not prop- erly managing their revenue cycle and having really smart work lists and work queues for their collections teams and other teams to work on, things just fall through the cracks in the sense
of past timely filing denials or past-appeal-limit denials, which are two things that every DME owner, it’s at the top of their hate list. We can’t stand these things. They don’t like write-offs, for one thing, because that’s bad debt, but it’s past timely filing, that’s the most preventable denial there is. It’s salt in the wound.”
Providers need to be focusing on connecting the filing limits to the insurance companies and take that information to build smart work queues for their collections teams, according to Graham. However, he says most providers instead have their staff specialize by payer and focus on high- to low-dollar balance. It makes sense — but only to a point.
“When you don’t take timely filing into that picture, stuff falls through all the time,” he explains. “Maybe it’s a mid-dollar claim and it just gets far enough on the list, they don’t get to it for 30 days, by the time they touch the claim it’s past- timely because it was maybe UHC with a 45-day filing limit.”
Staff Challenges
So what is causing providers — businesses that are desperate to capture any and all revenue — to leave money on the table? As mentioned
earlier, running an HME business is not the same as running a hospital, and thusly there are RCM challenges and obstacles that are unique to the
homecare industry. One of them is staff bandwidth. “I think one of the biggest challenges is most
providers just don’t have the means to staff appro- priately to manage the revenue cycle,” Prochant’s Graham says. “We’re talking about high-volume, low-dollar claims. When you compare that to pretty much any other aspect of the medical industry, you see much higher dollar claims.
“Whereas in DME, especially like a nebulizer provider or provider doing a lot of walkers and wheelchairs, you’re talking about $10, $20, $30 claims times several thousand, tens of thou- sands,” he continues. “\[Providers\] don’t have the staff and the wherewithal to touch all those claims and touch all that AR and keep it clean. Then it ends up piling up, making a mess essen- tially, in their billing system.”
And when providers can put those kinds of the staff resources in place, it doesn’t come cheap. “Another aspect of the staff side is the whole
management of a billing department and managing all these people, people needing paid time off, maternity leave, all these other things come up, people get sick, people quit,” Graham says. “As a provider, you want to be able to focus on your patient base. That’s really what our core focus is, is to enable providers or empower providers to focus on outstanding patient care. They are not in this business to manage a whole back office with 20, 30 billers and all the person- alities and water cooler talk and other stuff that ends up happening in that scenario.”
Technology Tools
In the same way software revolutionized billing and claims management for HME businesses, those systems are adding RCM tools. The goals are to help management monitor and manage revenues in a much more proactive fashion.
“Really, in my opinion, software needs to have more visibility, as to why things are not getting paid,” Universal’s Golen says. “And of course present them in a way to the end users, that they’re not relying upon reports, or digging into, trying to find out what to do. You should be told by the system what to do.”
But what’s the right approach for software?
A key problem that Bailey says many providers encounter comes down to process. While large healthcare organizations might have developed RCM procedures that have become refined to the point that they are commonplace, RCM is new in HME. Much needs to be down in terms of outlining process.
“The obstacles we see most are the lack of clear workflow processes,” he says. “Without systems in place, it’s hard to find the leaks and fix them.”
Bailey notes that this is another excellent
opportunity for providers to put in software that can help them manage their RCM.
“It allows businesses to set structure in place for all of their employees and monitor results over time,” he says. “An ERP allows you to program workflow rules into the system. This means fewer choices for employees, and fewer choices lead to fewer mistakes. Our software walks employees through every step from intake through delivery and ensures they gather every piece of informa- tion and documentation they need before deliv- ering an item. This means fewer trips back and forth to the warehouse, less time spent waiting for paperwork (everything on our system is electronic), fewer reimbursement resubmissions, fewer non-reimbursable expenses, and other situations that result in lost money for the HME provider due to employee mistakes.”
Focusing on the beginning of the process is critical, according to Golen, because it prevents so many of the sorts of clams problems that turn into extremely costly time sinks if left to fester. Moreover, it gives staff time to focus on the real problems.
“If you think about it, your goal is to have a fully qualified order and a clean claim, that basically a no-touch claim that gets paid at a high percentage on the first pass,” he says. “So, for most of your business, say 85, 90 percent of it, the front-end creates the proper order. The billing doesn’t even have to touch or see or look at; no billing edits. Once the system decides that it can go, it goes.
“So then you’re managing exceptions,” Golen continues. “The software finds things that it pres- ents to you that it knows are problems. ... Those are the things that your team needs to get to.”
Managing Those Tools
Putting healthcare IT into place is critical, but at the same time, providers need to make sure that they are staying on top of their technology. Once you invest in a system, it’s critical to make sure that it continues to pay off over time. Providers must have staffers who manage their software on a regular basis. The last thing they want to do is take a “one and done” approach.
“A lot of providers, they’ll set up their new EMR ... They set it up once, they do kind of a so-so job of it, and then they never touch it again,” Graham says. “Nobody ever goes back and looks under the hood. ‘What were some of those settings that we set at the beginning? How is the system changing over time?’
“Any of these EMRs, about quarterly, they’re releasing new features,” he continues. “If you’re not staying on top of that and you don’t have somebody who’s responsible for reading those release notes and understanding the new capabilities that have been built into the system, you’re leaving so much on the table. These software providers have done an amazing job over the last few years of adding automation in
“If you think
of RCM as a ‘billing’ function instead of
a ‘business’ function, you’re missing out.”
— Wayne Bailey,
Bonafide Management Systems
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