Rethinking RCM in HME Operations

Amanda Wreede hears it all the time.

As the Senior Customer Success Manager at HME business management solution platform Brightree, Wreede meets with HME providers monthly and runs through their top revenue KPIs, such as held accounts receivable (AR) days, denial rate, net revenue and more. What she hears is a realization from providers of how all of these datapoints fit together around a common theme:

“Am I making money and am I being successful?”

“These meetings give us the opportunity to say, ‘There’s an area of opportunity here — how can we help?’” Wreede says. With the Brightree team, operators begin asking themselves important questions. “Is there something in the system that we’re not utilizing?” “Is there a report or number or figure or something that we should be looking at?”

“Those are benchmarks that everybody in the industry should be looking at, but those are ones that we really focus on at Brightree to make sure that you know you’re getting the most out of your investment with us,” Wreede says. “That’s the primary goal.”

Revenue cycle management (RCM) in HME has traditionally been a back-end function focused on fixing errors, resolving denials and chasing payments after issues arise. In today’s environment of tighter margins, rising patient responsibility and increasingly complex payer requirements, that reactive model is no longer sufficient.

Instead, leading providers are shifting RCM toward a front-end, intelligence-driven approach that emphasizes accuracy, automation and clear communication from the earliest points in the patient journey. By incorporating intelligent document automation into intake and qualification processes, organizations gain streamlined workflows that help reduce errors and minimize revenue leakage.

Available data from Brightree users suggests that intelligent document automation can deliver measurable improvements, including:

• Up to 98% document classification accuracy
• More than 95% data extraction accuracy
• Over 50% reduction in time required for patient and order creation

Here is a look at how today’s leading HME providers are rethinking RCM.

Understanding intelligent document automation: inside its two capabilities

Intelligent document automation focuses on capturing key data from static documents — such as faxes and scans — and using that information to drive efficiency and accuracy in downstream workflows. Brightree’s Intelligent Document Automation enables two primary value areas:

• Automated intake — Accelerates the creation of patient records and sales orders by structuring incoming information, reducing manual effort and improving data consistency.
• Automated qualification — Applies payer and product criteria to documentation to support faster, more consistent qualification decisions.

Together, these capabilities help reduce manual processing, improve data quality and streamline workflows, increasing operational efficiency and enabling earlier visibility into revenue cycle outcomes.

Historically, much of the revenue cycle relied on the knowledge of a handful of staff members, sometimes just one key person. Technology lets providers shift that knowledge to the platform itself.

“This is going to mean faster time to cash,” says Noel Tauzin, Head of Revenue Cycle Management at Brightree.

Automated workflows at intake and qualification can immediately validate incoming orders, confirm required data and ensure compliance with payer rules before the order progresses.

This early intervention ensures faster and more accurate information going to the patient, which also contributes to higher referral satisfaction.

The second service area — documentation and eligibility — was once among the most error-prone stages in RCM. Missing signatures, incomplete documentation and expired prior authorizations were common causes of denials. In a manual environment, these issues are often discovered too late.

Automation changes that dynamic. “Flagging of errors in real time — that’s key,” says Jennifer Leon, Head of Patient Collections for Brightree. Errors include missing or incomplete documentation and expired or lack of prior authorization. “If it flags them in real time, then in real time they can be fixed,” she says. “Otherwise it leads to more delays.”

By centralizing documentation and validating data at the point of entry, providers can resolve issues immediately rather than reworking them later.

Top operational benefits

Rethinking RCM at the front end of the process has significant operational implications, particularly in reducing inefficiencies that have long been accepted as unavoidable. One of the most notable improvements is the elimination of bottlenecks caused by manual review and rework.

“You don’t have those labor-heavy bottlenecks, so now you don’t have any of the need to rework it because from the beginning it all went through this intelligent, automated workflow,” Leon says.

This reduction in rework also improves staff efficiency and morale. As Tauzin notes, repeatedly revisiting the same order can be frustrating for employees.

“Those bottlenecks generally are because we’ve had to touch an order multiple times,” Tauzin says. “This is also very frustrating for the employee, who realizes they have to go back and look at a given order again.”

Real-time communication is also a critical advantage. When errors are identified immediately, providers can notify referral sources or patients without delay.

“If we can immediately identify those errors and notify the ordering provider, they’re going to react much more promptly,” Tauzin says.

Outcomes: driving RCM improvement

The shift toward a proactive, front-end approach to RCM delivers improvements across financial and operational metrics. One of the most significant outcomes is a reduction in claim denials. By ensuring that orders are complete and accurate before submission, providers achieve cleaner claims and reduce the need for costly rework.

“At the end of the day, reduced denial rates and less rework means that cash is in the bank faster,” Tauzin says.

With payer reimbursements continuing to decline, even small patient balances have become essential to financial sustainability. A provider might have previously been able to write off a $20 unpaid copay.

“They can’t do that anymore because their payer reimbursements have been squeezed to the death,” Leon says. “You can’t forget about that $20 anymore.”

Designed to work the way providers do, intelligent document automation is native to Brightree, which means when using these capabilities, teams can stay focused inside one workflow.

No extra tools. No switching screens. Just a streamlined experience.

“We’re not with you to make money — we’re with you so you make money,” Wreede says. “Our customers aren’t just customers. We are part of their team, meaning we are part of their success. That’s our role.”

This article is sponsored by Brightree, whose core platform supports the full lifecycle of HME/DME operations, enabling providers to run complex, revenue-critical workflows with greater consistency and confidence. Built on workflows already proven in real-world HME environments, the platform continues to evolve to help teams work smarter as operational demands change.

Brightree enables seamless data sharing across referral sources, manufacturers, patients and health care systems, supporting an interoperability-first approach. From intake through billing and resupply, teams can manage reimbursement, reduce variability and stay compliant through workflow-native automation that minimizes manual effort and reduces errors. The result is more predictable operations, stronger financial performance, and better experiences for both patients and staff. To learn more, visit www.brightree.com.