Author: Harper Dion
Posted Date: May 23, 2023
Cost management in the post-acute space is one of the defining characteristics of success for a smaller agency. Misallocation of funds, under-availability of employees, and failure to keep up with changing regulations are all common occurrences that lead to detrimental loss of money and productivity. As the industry is still in the midst of a nationwide employment shortage, many departments are receiving minimal consideration as back-office processes are often an afterthought. The few available employees are already spread thin, what little time is available is not enough to manage the required heavy lift for a fully optimized and compliant revenue cycle. Proper management of the revenue cycle, especially in smaller home health agencies, is of utmost importance when ensuring continual growth and success. This commonly under optimized area is the cause of many reoccurring struggles, agencies that consider outsourcing this department can reallocate and reinforce other areas of operations. This decision ultimately gives agencies a competitive edge as their most important processes receive deeper consideration and full third-party support.
What is Home Health RCM?
Revenue Cycle Management (RCM) in post-acute care is a complex process. From end-to-end, RCM consists of identifying, managing, and collecting patient service revenue.1 The procedure begins at insurance verification, requiring direct contact with patients to workshop claims submission and denial management. Following that extensive documentational process, payment and reporting must occur to ensure agency compliance and maximization of revenue.2 RCM management is a heavy lift, dealing with the multifaceted process proves complex, especially for smaller home health agencies. To properly execute the RCM process, agencies must coordinate care among different healthcare providers, maintain accurate and detailed records of all services, and comply with various regulations and requirements, such as HIPAA and Medicare. Staff training and development is also critical to ensure that staff members have the skills and knowledge necessary to provide high-quality care and manage the revenue cycle effectively. Successful management of these tasks requires countless back-office hours devoting meticulous attention to detail. Agencies that lack time and resources will often fall short on these tasks, resulting in wasted money and staggered productivity. To curb this issue, and ultimately overhaul productivity and profit, outsourcing of RCM processes provides a transformative solution to maximize positive outcomes.
Benefits of outsourcing Home Health RCM
Outsourcing RCM in a home health context is incredibly beneficial for smaller agencies. Although beginning this process proves to be a significant up-front investment, overall, this decision increases ROI and adds many benefits to RCM processes.
Cost Savings: Outsourcing vendors have a team of experts who focus solely on the complexities of the revenue cycle, staying up to date with the latest changes in regulations and billing codes, and supplying advanced technology to automate tasks. Outsourcing RCM overall increases revenue by reducing denials and improving collections, while mitigating the risk of non-compliance with regulations and billing errors.
Access to Expertise: Vendors employ experts who are well-versed in the latest regulations and coding requirements, as well as the specific nuances of home health billing. By partnering with a vendor, healthcare providers ensure that their home health RCM is managed by experts who have the specialized knowledge and skills necessary to optimize revenue and compliance.
Reinforced Compliance: Third-party vendors have established processes and procedures to manage compliance risks, including audits and reviews of claims and billing practices. These vendors provide training and support to healthcare providers. This training empowers providers to stay compliant, educating staff on regulatory requirements, providing guidance on billing practices, and helping healthcare providers prevent compliance violations. In addition to this training, outsourcing vendors assume responsibility for compliance, reducing the risk to healthcare providers, ultimately delivering an added layer of protection against penalties and fines.
Improved Cash Flow: RCM outsourcing vendors have specialized expertise in managing the billing and collections process, using advanced technology and analytics to correct errors and improve efficiency. By outsourcing RCM, healthcare providers can focus on patient care while vendors assume responsibility for managing the revenue cycle. This results in faster processing of claims, reduced payment delays, and improved collections. Outsourcing vendors can also provide customized reporting and analytics to help healthcare providers identify areas of improvement to optimize their revenue cycle and improve cash flow.
The MHA Difference
Outsourcing home health revenue cycle management (RCM) provides several benefits to healthcare providers. By partnering with a specialized vendor, healthcare providers benefit from the vendor's expertise in home health billing and coding, advanced technology and software, and established processes and procedures. This results in improved accuracy, efficiency, and compliance, leading to reduced denials and improved collections. Outsourcing also reallocates resources and staff time that is used to focus on patient care, while reducing administrative burden and risk. Additionally, outsourcing vendors provide customized reporting and analytics to help healthcare providers optimize their RCM and improve cash flow. Overall, outsourcing home health RCM empowers post-acute providers to improve revenue, compliance, and patient care.
MHA is here to help your agency overhaul RCM efforts. Our team provides a baseline through a rapid assessment, looking at every stage of your cycle and identifying places where money is lost. From there we expose weaknesses and prescribe solutions. If outsourcing is needed, we will bridge the gap and connect your agency with one of our transformative partners. Our solutions close the gaps in your RCM, freeing up your time and reallocating agency efforts to more productive areas. If you’re interested in learning more about our RCM solutions or would like to get connected to a transformative outsourcing partner, visit www.maxwellhca.com, or contact us at [email protected].
1. "What is Healthcare Revenue Cycle Management?" RevCycle Intelligence, 29 Mar. 2018, https://revcycleintelligence.com/features/what-is-healthcare-revenue-cycle-management.
2. Howard, Angie. "What is Revenue Cycle Management? 4 Key RCM Steps." Medical Advantage, 4 Mar. 2021, www.medicaladvantage.com/blog/what-is-revenue-cycle-management-4-key-rcm-steps/.