Effectively address staffing challenges in Revenue Cycle Management for Home Care agencies. Secure your agency's financial future with proven solutions.

This article looks deeply at how each functional area can contribute to optimal reimbursement and accelerate cash flow for Home Care agencies.

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.

Home Health Care Agencies will continue to face staffing shortages for the foreseeable future. Home Care Agencies cannot hire their way out of the problem and must learn to do more with less and get the most out of their limited human resources.

Home care agencies must make prudent investments in Home Care Software Platform 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 another problem that the entire industry is facing. Low wage rates combined with multiple responsibilities for care coordination and communication, not to mention the exhausting travel times, are some of the issues leading to staff burnout. At CareVoyant, we strategically focus on improving operational efficiency, making it a central theme of our development efforts. We empower home care agencies with software features that will help them do more with less across care coordination, scheduling, and revenue cycle management functions. This article examines how each functional area can contribute to operational efficiency, optimal reimbursement, and improved cash flow.

Intake

The ability to gather timely and correct information – patient, insurance, coverage, and benefits – during intake is essential to insurance reimbursements. The Revenue Cycle starts with referral management and intake processes. Home Care Software should provide you with the ability to collect all the information necessary for billing the claims so that you can reduce claim denials and improve cash flow. Some of the essential features in your Home Care 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 scheduled 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 the need for proper authorization for the services provided. Home care agencies can proactively reduce denials by integrating Authorization Management functionality with Intake, Scheduling, Clinical, and Billing. The following are some of the critical features your Home Healthcare Software platform should have:

Integrated and effective authorization management is vital 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 authorization or care plans, agencies can stay within the limits of 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 amounts.
Prevent staff from scheduling services beyond the authorization period and frequency.

Scheduling

We highlight some key features Home Care Software should have for effective scheduling and revenue cycle management.

Effective scheduling is essential to reduce nonbillable claims and claims 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.
The ability to capture time from the Point of Care documentation and create charges will eliminate time spent verifying the visits and reduce data entry errors.
Create charges directly from schedules to reduce data entry time and errors.

Revenue Cycle (Billing and Collections)

For agencies to be financially viable, timely billing and collections are essential. Home Care agencies must look for functionalities in Home Care Software that ease 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 rates 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 ensuring specific authorizations are 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 Home Care Software that leverages 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, and Outpatient Therapy.

Read other articles in the series:

About CareVoyant:

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.

CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.

For more information, please visit CareVoyant.com or call us at 1-888-463-6797.