The Patient-Driven Groupings Model (PDGM) is being touted as the biggest change confronting home health providers in years. As agencies analyze their historical data to project the Medicare reimbursement impact they will realize once the new structure takes effect in 2020, some are anticipating a boost to business, while others are projecting a decline.
Either way, the reduction in episode length will mean more claims to be processed and more resources needed to help agencies navigate changes to cash flow and workflow within their organizations — all of which have a bottom-line impact.
Some companies are relying on technology to help with these challenges.
At first seeking a billing solution two years ago after many years of outsourced billing, Quincy, Massachusetts-based Presidential Home Health Care has found the shift to technology platform eSolutions to be a major source of saved time and resources, even prior to discussions of PDGM.
“What was important to us was process improvement while ensuring compliance with our Medicare billing processes,” says Mark Said, president and CEO of the company, which provides home care and home health services to six counties across the greater Boston area. “We needed our processes to be less manual and more analytical in reviewing claims data in real time, and making sure if there were any issues, we were addressing them without any delay.”
The company was spending thousands of dollars on its external billing provider and was having to manage the labor-intensive process of processing claims, statements and confirmations.
“The process was not only very labor-intensive, but the communication and reporting had significant delays,” Said says. “Sometimes we would not learn about an issue until 10 days later.”
A workflow and cash flow management solution
Presidential Home Health Care ultimately implemented eSolutions to help resolve its workflow issues and to optimize the billing process. It quickly saw the number of hours spent on claims fall significantly. In addition, the company experienced a significant increase in analysis and reporting, giving insight into its operations and efficiencies.
“It’s definitely day and night,” Said says. “I have saved days’ worth of work.”
The agency receives daily reports indicating what was submitted the previous day and whether it was accepted or rejected. It also indicates any claims that require actions and allows direct entry into the Centers for Medicare & Medicaid Services (CMS) system, rather than a third-party.
Because the platform processes claims in real time during CMS hours of operations, it can additionally save time for small business owners, like Said, who may work on claims after hours or on weekends.
“You don’t have to worry about a company being closed for a holiday,” he says. “You can enter it and on the next business day the claim will be the first one to get processed. It’s about timing and efficiency and will help you get things done more quickly.”
Preparing for PDGM
Because PDGM focuses strongly on documentation and accuracy of claims — and because it is reducing episode-billing time frames from 60 days to 30 days in length — timely and accurate claims information becomes even more critical under the new payment model.
“With PDGM, it’s crucial rather than doing cash claims every two weeks, to do claims on a daily basis,” Said says. “With the platform, you will be able to know if there’s anything wrong with your claims, where your claims are, which are in paid status, and which one has a problem.”
Given the changes and the attention to claims that PDGM requires, agencies are preparing to do more with less, while still maintaining their care quality.
“The workload will increase,” Said says. “How we coordinate care will change, starting with the marketing director to office manager, intake, clinical director, billing and quality assurance company. We need to be mindful about whether the patient is coming from an institutional source, or the community, as that impacts reimbursement. Because the payment will be submitted every 30 days, the clock is ticking. It’s going to be very intense.”
But allowing some of the processing to technology can help agencies keep their attention on what matters most, he says.
“You can’t put a price on the trust that our patients put on us,” Said says. “It’s an honor to rise to the occasion and continue to earn their respect and to have the opportunity to help.”
For more than two decades eSolutions has worked to strengthen providers’ revenue health so they can focus on what really matters – their patients’ health and well-being. We accomplish this by delivering the best RCM tools for physicians and providers in hospital, home health, hospice, health center, skilled nursing/long-term care and durable medical equipment markets. Learn more.