Page 38 - HME Business, October 2019

RX 1: REVENUE CYCLE MANAGEMENT
Not surprisingly, full-service billing services recommend outsourcing when your business is healthy, not just when you’re feeling pain. There’s a strong argument for that: much like law, billing takes specialized expertise that may be difficult to find, train, support or retain on a small DME staff.
Think of Revenue Cycle Management (RCM) as the balm you rub into your business’ joints every day to keep it moving. You contract with
a service that will manage just about every aspect of your billing and payments. It’s a continuous treatment that keeps your business healthy by monitoring and managing critical indicators.
“To ensure cash flow and ongoing profitability, DME providers must have consistent, high levels of reimbursement. This only happens when
the billing team is submitting claims in a timely manner, following up on every claim, minimizing claim denials, and never forgetting about a claim, Tohill says. “This is where we excel. Our service, coupled with our software, makes it possible for DME providers to maximize their reimbursement revenue.”
A company that takes over your RCM will want to be involved in billing from the get-go. Early in your relationship they might have to do some cleanup on past-dues, but the goal is always to keep claims squeaky clean and current. That will probably mean changing a few of the front-end processes. The sooner that starts, the faster you’ll see improvements.
RX 2: THIRD-PARTY ACCOUNTS RECEIVABLE
If you’re comfortable with the day-to-day operation of your business but
need someone else to chase down unpaid or denied claims, there are services that specialize in A/R from third-party payers. Their services are like having an in-house claims manager to manage Medicare and insurance billing and follow up on denials and documentation.
“We outsource DME processes. There’s about 30 different processes, they run the gamut from working the A/R, working denials, posting the cash, processing new orders, working the front-end denials,” says Graham.
Prochant, which specializes in third-party billing, also extends advice to front office processes like intake, eligibility and prior authorization. Sorting out what ails your business is likely to expose some office process dysfunc- tion that’s gumming up the works downstream. Working with a billing provider can force you to establish or formalize processes that may seem like a mystery today.
The general theory of RCM is doing everything right from the begin- ning. One common problem for DMEs is tasks that get set aside for the mythical light afternoon, creating an endless pile of overdue receivables and denied claims.
“There is a new thing we are seeing lately with one insurer we’re working with: They switch up the denial. They are denying for a completely invalid reason. Once you figure out how to fix that denial, they start creating
a new denial. Nobody knows what that denial is, even at the insurance company...They’re just trying to delay you getting paid. They won’t offer you any further advice,” Minnich explains. “If you are a small mom-and- pop DME and your biller has 20 jobs she has to do in a day, if she calls and gets that she’ll say, ‘I’ll get back to that later.’ When does she get back to
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