HME businesses face increasing numbers of pre- and post-payment audits, which can be very stressful and costly events. Without a sound strategy for maintaining accurate and retrievable documentation, an audit request can disrupt operations and put your organization at financial risk.
When an audit strikes, the response must be swift and precise. The best approach to an audit letter is a quick response with proof that all documentation complies with requirements.
Five steps HME providers can take to give a speedy response and make sure all claims are audit-ready include:
1. Give Customer Service Representatives tools to improve intake:
- Knowledgeable customer service representatives at the front end are essential to collecting the right information at the start of service, but staff turnover and constantly changing requirements make it difficult to keep CSRs up-to-date on payer requirements.
- Technology can fill the knowledge gap if it does more than just park the data in a form prompting CSRs to collect specific documentation, which enables correction of the claim before it is filed.
2. Document to payer-specific rules:
- Improve efficiency by helping CSRs collect payer-specific requirements through established validation rules.
- While Medicare rules may call for a document to support specific Healthcare Common Procedure Coding System (HCPCS) codes, other payers may have a looser set of rules for that procedural code, which don’t require the same level of documentation saving time for the CSR.
3. Enable quick response to the audit letter:
- Staff should be able to quickly access the documentation when responding to an audit letter, which is not always easy in the case of long-term service.
- Establishing a link between billing records and the sales order documentation eliminates the risk of error when pulling documentation and ensures the information can be gathered efficiently.
- In addition, advanced HME systems allow users to collect, submit and track documentation electronically in response to CMS audits.
4. Automate document review within the workflow:
- There are times a critically needed product must be delivered before documentation is complete.
- This increases the need for a careful documentation review before submission of the claim to ensure progress notes support medical need and meet requirements.
- HME providers can easily determine whether or not to delay confirmation of a claim until the file is complete and the claim is substantiated by automating the review process throughout the workflow, utilizing optical character recognition technology and installing checkpoints that alert staff to missing or inaccurate information.
5. Capture data on all patient-care related interactions:
- Setting up a process to capture all telephone calls to patients, verbal orders from physicians or communication with other providers is critical, but difficult with the number of people involved in each case.
- Technology that documents actions by time, date and personnel involved provides additional support as an HME provider demonstrates compliance with billing requirements.
There’s no sure way to guarantee you won’t go through an audit; however, by ensuring the good HME business technology is in place you can take on most any audit challenge. With proactive compliance and timely response submission, audits can be resolved and claims are paid faster leading to improved cash flow.
Don’t wait for an audit Make every claim audit-proof from the start and For more information email us at support@wonderws.com
]]>Is it hard to gather and interpret raw data and reports for your business? You’re not alone.
What else can you do by effectively managing your data?
Here are some strategies to generate revenue and improve operations:
Identify Which of Your Products Are Winners
- Tracking historical data of sales and profit by product type allows you to know, with real-time regulatory changes, which products are driving profits to your bottom line.
- Fully integrated billing software tracks and measures the effects of changing reimbursements on your products without using spreadsheets and tools, or employing a costly consultant.
- You can identify a problem with a specific product line the minute it dips, and use your sales data to instantly calculate gross and net profit for all payors or selected payors giving you the opportunity to adjust your formula and sales strategy.
- Make it your business to the not only project but measure the actual profit by product.
Forecasting Sales that Improve Patient Health is a Recipe for Success
- Many HME businesses offer a combination of equipment sales and rentals for a wide array of products focused on patient care.
- Different revenue streams provide different profit margins that may even vary by provider, and what the insurance company is willing to cover.
- Forecasting strong and diverse revenue streams are as critical to the success of your business as the patient care itself.
- Revenue projections that break your income down into profit margin by the product are a recipe for success.
- Sales forecasting goes hand in hand with your cash flow management so you know what you have coming in now and are pursuing what you really need in the future.
- Match your forecasts against patient compliance and therapy reports to drive sales with products that have the greatest effect on the health of your patients.
Don’t Wait, Drive Your Receivables!
- With long billing cycles and denials, it is critical to automate your cash flow and intelligently forecast 30, 60, and 90 days out.
- Monitor trends like DSO, revenue billed versus collected, revenue held for pending documentation, new sales orders versus confirmed sales orders and more with a state-of-the-art dashboard.
- These strategies will help you effectively measure where your money is by payor and time frame, and actively collect your receivables.
Harness the Power of Information
Information is the best resource available in the healthcare industry. With the right tools, you can harness the power of information and find solutions to the difficult answers that help your business and needs of your patients. In case for optimal visibility, invest in a best-in-class software platform that offers both an executive dashboard and a business scorecard:
- Executive Dashboard: Provides trending data over an extended period of time whether it’s a few months or an entire year which enables you to adjust your strategic plan.
- Business Scorecard: Provides a snapshot of where the business stands at that moment in time and allows you to adjust your formula and sales strategy.
Leveraging intuitive dashboards and tracking your metrics against k=Key Performance Indicators (KPIs) helps you gain the visibility needed to make sound business decisions and identify workflow bottlenecks, in order to increase efficiency moving forward.
Real-time visibility into your operations provides a deeper insight into your business, helps increase efficiency and maximizes your ROI.
Schedule a free live demo http://localhost/main-site-update/live-demo/ to generate revenue and improve your operations.
]]>Many HME providers know technology can help their business. What you might be missing is finding new, fast evolving technologies that can boost your revenues, grow your business and improve your stream of referrals. The latest innovations do all this by focusing on improving business efficiency and expanding operations areas that many HMEs struggle with to achieve success.
Why do most HME providers strategic plans fail?
Most of those plans fail. Depending on which study you follow, the statistics range from a dismal 3% of companies whose executives say they are successful at executing their strategies to at best about one out of every three organizations that integrates its plans into its daily operations with high effectiveness.
Why are we so weak on strategic plan execution?
Do we treat our strategic planning like the gym membership that we all get at the beginning of each year to lose weight and get in better shape, only to quit by February?
The best time to begin a strategic planning process is between September and Mid-November. We have a great opportunity as it pertains to a strategic sales plan for our business.
What can be the most advanced technology do to help your business grow?
Here are three things you can do with the latest innovations.
1. Power of Information:
- Information is the best resource available in the healthcare industry. With the right tools, you can harness the power of information and find solutions to the difficult answers that help your business and needs of your patient.
- Executive Dashboard: Provides trending data over an extended period of time whether it’s a few months or an entire year which enables you to adjust your strategic plan.
- Business scorecard: Provides a snapshot of where the business stands at that moment in time, and allows you to adjust your formula and sales strategy.
- Leveraging intuitive dashboards and tracking your metrics against key performance indicators helps you gain the visibility needed to make sound business decisions and identify workflow bottlenecks, in order to increase efficiency moving forward.
2. Ready with Audit
- HME businesses face increasing numbers of pre and post payment audits, which can be very stressful and costly.
- Without a sound strategy and technology platform for maintaining accurate and retrievable documentation, an audit request can disrupt operations and put your organisation at financial risk.
- An advanced software solution should automatically find the correct documents and add them to each claim, as well as send audit responses using the latest esMD protocols.
- Beyond improving efficiency, the right technology can help providers maintain a strong cash flow by resolving audits quickly and accurately.
3. Build Stronger Relationships
- Referrals are the heart of any HME business. It is hard work to establish productive relationships with referral sources and keep them engaged with you long term.
- More and more referral sources are embracing the transmission of electronic referrals through their EHR system.
- In the near future, physicians may opt to only send referrals to providers who are equipped to accept e-Referrals, request e Signatures, and automatically share patient data and outcomes easily.
- HME providers that implement a strong technology platform will be most prepared to succeed in this new interconnected world.
The best run companies have the hardest time growing. Building a process for monitoring your external environment and developing strategies based on that analysis can help position your business for sustainable growth.
To help you through this process schedule a free demo now!
]]>Today’s growth oriented HME provider realises that they simply can’t do it all and still maintains focus on the essential functions of a patient-focused business. Letting go is hard, but smarter HME have reaped tremendous benefits from outsourcing the more administrative parts of their business operations.
The HME outsourcing areas of the operations such as:
- Billing and A/R management
- Intake
- Resupply
- Business analytics
Have the below keys for successful outsourcing:
- Learn how to use operational assessments to define business objectives and identify non-core business functions that are limiting your growth.
- See how to define outsourcing success in terms of operational gains, cost‐savings and
- Understand the requirements for a successful outsourcing partnership
What Processes Could You Outsource?
- Insurance Billing & Collections
- Patient Billing & Collections
- Resupply Patient Contact
What are the Reasons to Consider Outsourcing?
- Focus on your core competency of growing your business.
- Reduction in overhead of staff management, recruitment and on‐going training.
- Variable expense when compared to fixed expense from in‐house staffing.
- Improved processes through best practice utilization.
- Access to consistent informational reporting.
- Staff to accommodate variable demand.
- Billing expertise in new product categories.
- Flexibility in pricing with various fee structures to align fee structure to your business: Flat‐Fee Pricing, % of Collections, Hybrid.
Set a Proper Expectations
- What is a fair stabilisation period when outsourcing?
- What level of communication & reporting should I expect from an outsource vendor?
- Which type of improvement should I expect when outsourcing my Revenue Cycle Management
- What should I expect to gain from outsourcing patient contact, like resupply calls
- Should I be nervous to have an outsource vendor contacting my referral source?
How to Measure the Success of Outsourcing
⇒ Set clear and measurable targets
⇒ Monitor performance closely:
- Managing by the checkbook balance no longer works
- Ensure an open line of communication with your outsource partner
⇒ Develop reporting to clearly measure:
- Overall performance trend
- Exception identification & issue resolution
⇒ Meet regularly to review performance
Myths & Realities of Outsourcing
Lack of control over my billing department
- Hold billing partner accountable
- Set performance goals and monitor it regularly
Lack of visibility into what is happening to my AR
Depending on your platform and outsource partner, outsourced workflow should be completely transparent
They will only collect the low‐hanging fruit.
- Set expectations on informational reporting
- Compare against pre‐outsourcing performance
Key Business Benefits from Outsourcing
- Implement best practice billing processes
- Manage to your business key performance indicators
- Improve DSO and accounts receivable aging
- Improve collections to billing ratio
- Post payments and adjustments accurately
- Ensure compliance of filed claims through random monthly audits
- Minimize denials and write offs
Conclusions
Outsourcing can make sense from an overall business strategy. Do a cost of benefit analysis using the model discussed to consider options. Explore options in the marketplace and remember that cheaper is not always better.Doing all this can help ensure that the whole outsourcing process is satisfactory for you and profitable for your business.
Billing services are a great way to free up your time so you can see more patients while increasing overall revenue. Request a free demo to learn more about your HME Outsourcing.
]]>