2022 HME Business Handbook: Revenue Cycle Management

How Outsourcing Has Dominated the HME Billing Market

Revenue Cycle ManagementThe HME industry in the midst of a staffing crisis. No secret there. If your revenue cycle management feels out of control, you’re not alone.

Fortunately, there are simple ways to overcome this. In this article, I’ll lay out some of the common issues HME businesses are experiencing when it comes to managing their front- and back-office staffing, billing processes, and how you can improve your efficiency, lower billing errors, and dramatically decrease delays in cash flow.

First, let’s break down the HME workflow:

  • Front Office — Everything before your product or service reaches the patient. Inbound referrals, intake/registration, records and documentation, prior authorizations, scheduling, etc. This is run by customer service reps (CSRs).
  • Back Office — Everything after your product or service reaches the patient. Order confirmation, held revenue, billing, collections, and cash posting. This is run by billers, collectors and cash posters.
  • The HME revenue cycle work-flow — Every order from the front office to the back office, closing the resulting invoice with cash received in the bank. Each referral is tracked, processed, filled, billed, and collected.

PROBLEMS WITH TRADITIONAL HME WORKFLOWS

Despite HME’s high-tech offerings, frontand back-office processes are often still living in the 20th Century. It’s not uncommon to see paper-based systems or outdated billing systems.

Traditional HME workflows are manual and tedious, prone to human error: stuff happens; people get sick; paper gets lost; the order gets dropped.

THE ROLE OF TECHNOLOGY IN MODERN HME WORKFLOW MANAGEMENT

No more paper! Let the accordion files go. Intelligent work queues, electronic medical record (EMR) or billing systems, on-demand tools through a business intelligence (BI) system are a must.

Modern HME revenue cycle teams are generally centralized (both front- and back-office) and structured by process, payer, or product as appropriate for the provider. Leverage decision support systems (DSS) to guide employees through the process. This reduces the learning curve, quality errors, and wasted time.

Offer patients a self-service model via an online patient portal, create an app, digitize order status, order new products/supplies, review/pay their bill, send messages to your team, and update their account information.

Automate, automate, automate. (Yes, I said that three times!) Reduce the human effort needed to manage your revenue cycles. Optimal HME workflows leverage people only as necessary, allowing information systems to handle much of the work.

Manage by exception, not by each order or invoice. Automate in the following areas: data entry, benefits verification, prior authorization, order confirmation, cash posting, A/R & denial management, and re-supply.

THE ROLE OF TECHNOLOGY IN MODERN HME WORKFLOW MANAGEMENT

Reality check: Unless you build one, there is no “one-stop system” in HME workflow management. Many providers use work-in-progress (WIP) states to manage the front-office workflow; as well as a separate RCM workflow system to manage the invoices in the back-office workflow. Cover these back-office areas: order confirmation, unbilled and held revenue (and stops), rejections, open deposits, billed claims (i.e., open A/R), denials, and follow-ups.

For your front-office WIPs — don’t go overboard creating WIP states. Label them in a way that makes them display in a logical order for your team, eg: “1.0 New Intake, 2.0 benefits Veification, 3.0 Prior Authorization, 4.0 Scheduling, 5.0 Out for Fulfillment, 6.0 Ready for Confirmation.”

Then create sub-reasons as parking lots, so to speak, for issues. For example: “1.1 Missing Information, 1.2 Qualification Issue, 3.1 PAR Requested, 3.2 PAR Denied,” etc.

POINTS TO REMEMBER

  • Most missed opportunities in Revenue Cycle Management success are caused by human error and poorly utilized tech.
  • Automation of your process using tools purpose-built for your service are critical to eliminating those errors.
  • There is no “one size fits all” off-the-shelf system for HME, but there are ways to make the existing tools work well together.

LEARN MORE

For more information on how to decrease turnaround time on your revenue cycle, improve your back-office efficiency, and get back to focusing on growing your business, visit the resource center at Prochant.com or ask Joey Graham directly by emailing joeyg@prochant.com

This article originally appeared in the May/Jun 2022 issue of HME Business.

About the Author

Joey Graham is an industry veteran with over 20 years of experience in home medical equipment / durable medical equipment (HME/DME) and pharmacy operations and revenue cycle management. In his current role as Chief Revenue Officer (CRO) for Prochant, he is focused on simplifying reimbursement and delivering greater profitability to clients by combining technology and industry-leading processes with a team of highly-skilled specialists.

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