Hospice Billing: In-house vs. Outsourced

While hospice rating are measured based solely off CHAPS surveys of your agencies level of care, scheduling of your team, bereavement program and ‘front-end’ hospice operations, if your agency isn’t getting paid completely and timely, your care and agency ratings will suffer.

We all know more than one example of when an agency was rocked by a billing fiasco.

Hospice RCM is a methodical and involved process that requires numerous steps to be working in concert before dollar one gets paid to the hospice provider. Deciding whether to use an outsource service or in-house billing can have a dramatic effect on the health and viability of your agency.

4 Key Tips to Hospice Billing

1. The right billing team: In-house vs. Outsourced

Hospice billing requires great attention to detail, from intake through the whole patient lifecycle. Issues such as insurance verification, eligibility checks, ADRs, SIA payments, coding and more require that your team have a strong and wide-ranging knowledge base.

If you are thinking about bringing billing in-house, some tips to consider:

• Hire people who have worked in hospice billing or at least in other healthcare billing teams
• Make sure you have overlap within your team. Without overlap, if a person leaves or falls ill, your RCM can fall apart virtually overnight!
• Cost: Outsourced hospice billing runs – on average, from 2 – 5%.

This range depends on size, division of responsibilities, support levels for tech and billing, payer types, and more.

In-house billing tools cost on average .5 – 2% again, depending on a range of factors such as support, robustness of tools, etc.

• Will your team cost more or less than 1-3% of gross collected on top of the licensing fee?
• Will your team achieve 98%+ payment efficiency?
• How long will it take to have your team up and running to that level?
• Opportunity cost: can the resources to have an in-house billing team be better directed elsewhere?

One often overlooked cost: will you need expensive consultants for additional and ongoing billing training & review?

2. The Right Software

• Getting and staying organized is key to having an optimized RCM. Easy to use and understand, Patient data, visits, insurance, and other vital info should flow directly from the EMR and the right tools will keep the variety of claims and stages organized for maximized RCM
• Make sure SIA payments are captured
• ICD-10 codes should be automatic with claim validation built in
• Tracks payer rates and appeals and follow ups
• Handles NOEs, NOTRs easily with tie into CMS/DDE screen
• Medicaid room & board pass-through AR/AP
• Handles Telehealth and rolls into appropriate claims
• Does your hospice offer or plan to offer palliative care? Make sure your billing is built for that and includes the CPT palliative library.

3. Persistence & Time

Regardless of whether you go in-house or outsourced, rejections and claim denials happen – especially when it comes to Medicaid and Managed Care billing. These delays and effort and are part of the cost of hospice billing.

Your billing team needs a plan and the tools to keep tabs and follow up on these difficult claims. While the right software makes it easy to track these issues, the long delays that are commonplace with these types of payers can allow some issues to fall through the cracks. Reports for these items must include process info such as: all follow-ups, attachments, and days left to appeal.

Furthermore, the financial department must recognize and plan that those categories of payers may often delay payment for months which is a function of the type of payer and not just the biller’s abilities.

4. Cloud based RCM

Billing tools and relevant patient data should be cloud-based. Not only is cloud far more secure than installed solutions, they provide for faster updates, easier troubleshooting, and importantly, access from anywhere.

Hospice is 24/7 which means that billing needs almost as much access. Whether you’re at home, in the office, or travelling, team members and other related people need access to billing tools.

Conclusion

An In-house billing team can make a lot of sense for multi-state operators where managing it internally and the economy of scale justifies the financial and people power expense.

However, for mid-size and small hospice agencies, with resources stretched, and limited billing knowledge base and overlap, outsourcing makes the most sense.

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