Revenue Cycle Management for Home Care Agencies - Addressing Staffing Challenges - Part 1

Overview

The number of Americans in the age group of 64 years and older will reach 80 million by 2040. In the next 40 years, this number is likely to double. The number of adults in the age group of 85 years and older will also increase exponentially. America is aging. We anticipate that the need for personal care services and what are now called Home and Community-based services will grow manifold in the next 20 years, as most Americans will like to age at home.

COVID-19 has exacerbated the labor shortage for home care agencies as 100s of personal care, and qualified nursing staff members have shifted to other more lucrative options or changed cities. The massive shifts in labor dynamics mean that home care agencies cannot hire their way out of the problem and must learn to get the most out of their limited resources.

Home care agencies must make prudent investments in software that allow them to:

Leverage technology and intelligent automation to automate repetitive and time-consuming tasks

Expand the bandwidth of the existing resources to do more

Promote management by exception to enable agencies to focus on issue resolution

Provide a more rewarding experience for employees and reduce employee burnout and turnover

Burnout of caregivers is a problem that the entire industry is facing. Low wage rates combined with multiple responsibilities for care coordination and communication and, not to mention, the exhausting travel times are some of the issues leading to staff burnout. At CareVoyant, we have a strategic focus on improving operational efficiency and have made it a central theme of our development efforts. We empower home care agencies with features that will help them do more with less across care coordination, scheduling, and revenue cycle management functions. This article looks deeply at how each functional area can contribute to optimal reimbursement and accelerate cash flow.

Intake home care software - Revenue cycle

Intake

The ability to gather the correct information – patient, insurance, coverage, and benefits – during intake is essential to insurance reimbursements. The Revenue Cycle starts with referral management and intake processes. Your home care agency operations management platform should provide you with the ability to collect all the information necessary for billing the claims so that you can reduce claim denials and accelerate cash flow. Some of the essential features in your software platform are:

Configurable validation framework to identify missing information and provide alerts/warnings

Scheduled exception reports with missing and mismatched information to help intake staff correct the details

Seamless and instance eligibility verification during intake

Batch and schedule eligibility verification to capture eligibility changes and alert staff with exceptions.

Ability to verify NPI (National Provider Identifier) and PECOS (Medicare Provider Enrollment, Chain, and Ownership System) information for referring physicians during intake

Authorization, Plan of Care Revenue cycle

Authorization/Plan of Care Management

One of the main reasons for claim denials is not having proper authorization for the services provided. Home care agencies can proactively reduce denials by integrating Authorization Management functionality with Scheduling, Clinical, and Billing. Some of the points to note:

Integrated and effective authorization management is key to improving revenue cycle management

Proactively monitor expiring authorizations and initiate the reauthorization process to eliminate the possibility of providing services without authorization.

By creating schedules from the authorization or care plans, agencies can stay within authorized services.

Monitor and manage frequency compliance with the authorized plan of care through scheduled reports

Monitor and manage authorized hours and delivered hours for the authorization period

Monitor and manage authorized hours and dollar amount

Prevent staff from scheduling services beyond the authorization period and frequency

Scheduling

We highlight below some aspects that emphasize the importance of effective scheduling for an optimal revenue cycle.

Effective scheduling is essential to reduce nonbillable claims and claim denials

Create schedules from authorization to help schedulers avoid scheduling outside authorized hours or visits

Configurable validations to capture potential billing errors - mismatched plan and service, schedule beyond authorization date, and duplicate services

Automatically split schedules at midnight, preventing denials by submitting claims with correct dates

Ability to capture time from the point of care documentation and create charges – This will eliminate time spent on verifying the visits and reduce data entry errors

Create charges directly from schedules to reduce data entry time and errors.

Financial System, Revenue cycle

Revenue Cycle (Billing and Collections)

For agencies to be financially viable, timely billing and collections are essential. Home Care agencies must look for functionality that eases the burden of responsibility on their revenue cycle staff. We highlight below areas critical to creating a thriving revenue cycle:

Accelerating Cash Flow realization. Improved clean claims rate and first-pass resolution can help agencies realize cash faster and avoid rework due to denied claims.

Improving Front-End Rejections. A flexible and configurable built-in claim scrubber allows the agency to configure claim validation on payer-specific business rules and improve clean claim submissions.

Validating Authorization. Looking back and making specific authorizations in place will reduce claim rejections.

Addressing Clinical and Medical Necessity Denials. Validate clinical documentation is completed and signed before sending claims to reduce potential survey issues.

Payer Specific Claim Submission Requirements

Adjust claim formats (paper or electronic) to meet payer requirements to reduce manual interventions and errors before sending claims.

Send invoices to payers, like community waiver programs, who do not accept standard claim formats (1500 – UB04)

Patient Statements and Collections. Send statements to patients for private pay or co-insurance

Collections. Proactively send claims and invoices to the collections queue based on configurable criteria to avoid a pile-up of aged receivables

Reports

We list below some of the ways your reporting infrastructure can improve revenue cycle management effectiveness:

Exception and financial management reports will help home care agencies with efficient revenue cycle management.

Intake exception reports listing missing intake information needed for claims

Report that will list admissions and authorizations without any schedules

List of schedules for which charges have not been created for various reasons

List of charges for which the agency has sent claims to the payer

Pre-claim validation reports based on the claim scrubber

Aging report with user-definable aging buckets

Days Sales Outstanding Report by payer, business line, or location

Late claims reports to ensure submission of claims within the time limit for payers

The average number of Request for Anticipated Payment (RAP) and Final claim days for Medicare agencies

Trending reports comparing data over date ranges

Conclusion

CareVoyant understands that leveraging technology and automation to get more out of Revenue Cycle Management staff is critical for home health care agencies to meet the staffing challenge. CareVoyant's integrated functions and standard interfaces with partners will improve the operational efficiency of the revenue cycle management process and the bottom line of home care agencies providing one or more home base services - Private Duty Nursing, Non-Medical Personal Care, HCBS, Home Health, Pediatric Home Care.