This article is sponsored by HEALTHCAREfirst. In this interview, Home Health Care News sits down with Ronda Howard, Vice President, Revenue Cycle and CAHPS, HEALTHCAREfirst, to talk about working through the challenges affecting a home-based care agency’s bottom line. She discusses sequential billing issues, and also explains the top notice of elections (NOE) errors and how to overcome them.
Home Health Care News: What career experiences do you most draw from in your role today?
Ronda Howard: Throughout most of my career, I’ve worked in finance, specifically on the insurance or business side. However, I draw from all my experiences, which include acute care and ambulatory surgery. Despite the varying settings, the underlying principles of billing, cash flow and denials are consistent across the industry. While there may be slight differences in the details, the similarities are vast and encompassing.
What are some of the key bottom-line challenges affecting agencies today, and how are operators working through them?
One of the major challenges faced by the industry today is staffing. Since COVID, there has been a significant shift in the staffing landscape. Finding qualified personnel is becoming more and more difficult and retaining them has become even harder. Agencies are now competing with hospitals for the same staff, and hospitals can offer more resources and better pay. To overcome this challenge, agencies are becoming increasingly creative in their efforts to attract and retain staff, offering flexible hours, benefits, and other appealing incentives.
The same goes for the business side. Finding qualified and experienced office staff is also a significant challenge for many agencies. To attract and retain employees, agencies are revamping their perks and benefits with things like flexible hours and remote work options. However, for smaller agencies where staff often wear many hats, such as handling billing and intake, providing flexibility can be more challenging. This has led to a lot of discussion on how to make the workplace more appealing for business office staff.
What are some best practices for solving many of today’s accounts receivable and revenue cycle management issues?
Improving accounts receivable performance is crucial to ensuring steady cash flow. One of the most important best practices is to keep unbilled claims to less than 10% of your monthly revenue. Unbilled claims mean no cash coming in the door and the payor doesn’t have it either. Therefore, it’s essential that agencies promptly resolve pre-bill edits and other issues that can delay claims processing, such as incomplete plans of care or assigned orders. Quick resolution of such issues helps in timely billing and getting in the queue with a payor for claim processing and payment.
When it comes to billed claims, it’s important to keep in mind that Medicare is usually the largest payor for home-based care agencies, and they typically process and pay a clean claim in about 14 days. So, when you’re looking at your accounts receivable and analyzing how long it’s taking for payors to pay, anything exceeding the 90-day mark should raise some red flags. This usually indicates that there’s an issue with the claim and it’s important to investigate why it’s not being paid.
To ensure timely cash flow, it’s important to proactively address any issues with claims that could delay payment. This means monitoring aging claims and identifying and resolving issues before they exceed the 90-day mark. This is important because issues that delay payment on one claim are likely to repeat on others. As a best practice, a balance over 90 days should be less than 20% of total aging, but if your agency primarily deals with Medicare, the standard should be less than 10% due to Medicare’s quicker and cleaner billing process.
How are operators navigating sequential billing issues in the home-based care industry today?
For a smooth billing process, it’s essential to know the agencies in your area. Sequential billing issues can arise if your own agency tries to bill out of order. It’s also possible that another agency has billed something out of sequence. However, this is usually an internal agency issue. Some software programs provide notifications to let you know if you’re trying to bill for a later month before billing for an earlier month. If your software doesn’t provide such notifications, it’s crucial to stay on top of your billing to avoid any issues.
Step one is resolving unbilled services for your oldest patients first. You want to make sure that any previous billing issues are resolved before moving on to billing the rest of your patients in sequential order. Any Medicare claims unpaid after 30 days indicate some sort of claims issue. Private payors and Managed Care payors take longer to pay for any unpaid claims aged out 60 days, and they need to be reviewed to determine the reason the claim is not yet paid. Sequential billing issues usually occur when claims are billed out of sequence This can lead to a backlog that needs to be released in a specific order so they are processed correctly. By addressing these issues in a timely manner, you can streamline your billing process and ensure that you’re getting paid.
Discuss the top notice of elections or NOE errors in terms of what to look for and how to address them.
One of the common errors we see is that the NOE is not t submitted in a timely manner. This could happen due to a hold-up in the admission process or incorrect patient status updates in the system during transfer or discharge. As a result, identifying the need for the NOE and processing it timely becomes difficult. The root cause of this issue is usually communication breakdown within the agency.
There needs to be a clear chain of responsibility for the NOE process, including who is responsible for releasing, filling out and tracking the forms. Timing is also critical, and if an issue isn’t resolved by a certain point, there needs to be accountability and a plan for addressing it. Communication within the agency is key to ensuring that everyone is on the same page and that the process runs smoothly.
I cannot assume that someone else on the team will take care of the task, leading to delays and penalties after five days. This often results in confusion over responsibilities and difficulty in finding a resolution, leaving team members pressed for time.
Talk about the issues we’re seeing across the home-based care industry and how to solve them.
The home-based care market is experiencing a rise in Medicare Advantage Plans, which have distinct billing procedures that differ from traditional Medicare billing, despite their apparent similarities. One major challenge with these plans is that they require authorizations, which is not something that agencies typically encounter with traditional Medicare. This is a significant shift for agencies and requires adapting to new processes.
The requirements for managed Medicare billing can be complex, and it’s critical for agencies to understand them before entering this arena. Missing authorization can be very costly since some payors do not allow retro authorization. While some payors may require a Notice of Election (NOE), others do not. It’s essential for agencies to have a clear understanding of what is covered under their contract and what isn’t, as well as to comply with timely filing requirements. Unlike traditional Medicare, which allows a year for timely filing, managed care has different requirements.
Managed care plans often have shorter timely filing windows, sometimes as short as 60 days, while others have 90 or 180 days. The eligibility process can also be challenging, as patients may not know which managed care plan they are enrolled in or may believe they are still under traditional Medicare. This makes it difficult to determine the patient’s eligibility and to verify whether the agency is contracted with their plan. For home-based care, this verification process must occur upfront. All this added work and knowledge requirements can put a strain on the agency staff and increase processing time.
Finish this sentence: “In the home-based care industry, 2023 will be the year of…”
… Continually evaluating reimbursement models and staffing shortages.
Editor’s Note: This interview has been edited for length and clarity.
The experts at HEALTHCAREfirst help providers accelerate reimbursement, maximize cash flow, reduce risk of denials, and go beyond compliance for CAHPS surveys. Click here to connect with us today.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].