Page 14 - HME Business, September/October 2022

Business Solutions
“The original drivers for outsourcing are still there, but now, with the resource shortage, no one can find qualified candidates. It’s hard to get and hard to keep your billing employees. ”
— John Stalnaker, ACU-Serve
And that last point — simply not getting desired results — was becoming an increasingly important driver for outsourcing revenue cycle management.
“To get that DSO where it needs to be or to get that A/R balance where it needs to be, that makes sense to bring in a partner with that expertise,” explains Joey Graham, chief revenue officer for billing service and RCM company Prochant LLC (prochant.com). “... That drove providers to outsource.”
Covid-19 Enters the Chat
Then, in March 2020, Covid-19 hit in earnest. Pandemic lockdowns began,
the HHS public declared a public health emergency, and a variety of unforeseen economic issues began hitting the United States in general and the HME industry in particular. And the biggest Covid-related factor to impact HME providers when it comes to their billing is staffing. In a hotly competitive job market, it’s tough for HME providers to keep a billing team together.
“The original drivers for outsourcing are still there, but now, with the resource shortage, no one can find qualified candi- dates,” Stalnaker says. “It’s hard to get and hard to keep your billing employees because they leave so easily now.”
“The cost of staff, the lack of avail- ability of staff, plus the whole change in the mindset of the workforce have driven providers to say, ‘While I have never done it before, maybe I should consider working with an outsourcing company,’” Graham explains.
Additionally, work-at-home arrange- ments are not all they’re cracked up to be when it comes to billing. There’s a lot of institutional knowledge that needs to be shared with newer employees, and when it’s gone, it’s gone for a very, very long time in some cases.
“Everybody got sent home, but now people are looking to put the office back together,” Graham says. “However, a lot of people are quitting their jobs because they
don’t want to go back to the office, and they want to continue working remotely. So that’s further driven that, that staffing pain.”
And even if there is available staff, work- at-home isn’t a technological, organiza- tional, or logistical slam-dunk to imple- ment when it comes to billing. Stalnaker notes that his company, ACU-Serve,
spent considerable time undertaking a work-from-home strategy so that it could sharpen its billing services.
“Two years before the Covid-19 pandemic, we decided to go with more than 90 percent work-at-home model,” he recalls. “We had already vetted the way we were going to structure that at-home office to where we could apply our technology to manage things the way we wanted.
“Providers were not ready for that,” he said. “Don’t forget that many providers were having issues managing the billing staff that was sitting in their building. Then they sent them home and added a whole other layer of complications.”
Investing in Work-at-Home
And why did ACU-Serve go with a work- at-home strategy? Because well before the pandemic, it was tough to attract the kind of top-tier billing talent and knowledge that any outsourcer needs to work out of one location, according to Amie Barone, executive vice president of operations for ACU-Serve. So, the billing company spread out across the country to attract the right talent and now has 230 employees across 37 different states.
“That strategy allowed us to go after talent, no matter where it is located,” she says.
And work-at-home is an investment
in not only talent but technology and resources, Barone adds. For instance, ACU-Serve work-at-home team members operate on secure, thin-client devices. Flexibility can’t come without security.
“We have many tools in place to monitor our team, where they all work off of HIPAA-compliant workstations,” she explains. “They can’t print, they can’t save. Everything is through our Amazon Workspace.”
If a billing company did that more than two years ago to ensure it had a solid billing team, the average HME provider might find itself late to the party trying to run an entirely in-house billing team in the post-lockdown job market.
Not an ‘Either-Or’ Option
And the expression “entirely in-house”
is an important distinction. Outsourcing doesn’t have to be an either-or option. A provider doesn’t have to outsource all or none of its billing. It can take a blended approach — and in many cases, that might be the wisest approach.
That has somewhat been the strategy
for Lehan Drugs Inc. (lehandrugs.com), which is headquartered in DeKalb, Ill., with several locations in the state. Founded in 1946, the multi-generational family-
run company has seen several stages in its evolution as a multi-line HME provider business with pharmacy services as well. One of those stages has been the option
to outsource its billing, and that was not
a “head-first” dive into the deep end,
says Jim Lehan, owner and CFO of HME provider and pharmacy Lehan Drugs Inc. (lehandrugs.com) in DeKalb, Ill.
The company saw significant growth after getting some respiratory contracts during Round Two of competitive bidding and seeing some success in the mother- and-baby space after the passage of the Affordable Care Act.
“Over the course of about 10 years, we were averaging 20 percent to 25 percent
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“The cost of staff, the lack of availability of staff, plus the whole change in the mindset of the workforce have driven providers to say, ‘Maybe I should consider working with an outsourcing company.’”
— Joey Graham, Prochant LLC