The WHY of hospice is what brings so many passionate and altruistic people to devote themselves to caring for the dying. However, Revenue Cycle Management (RCM) is a critical business feature for hospice agencies that cannot be overlooked. Whether you outsource your billing or handle it in house there are key components that will impact your ability to maintain financial stability, profitability, and grow your agency.
Hospice agencies often struggle to get timely and accurate reimbursement. RCM issues such as clean & fast turnaround claims, ADRs (Additional Development Requests) and denials, reconciliation, and in some states, managing pass through rates and more. RCM management through a comprehensive revenue cycle workflow with best practices is essential to a healthy hospice agency to allow you to do what you do best, provide awesome health care to terminal patients and their families.
Tips to Better Hospice RCM
1. Get Intake Right
Verifying patient eligibility & benefits period is the first step in the RCM process.
Although patients need a terminal diagnosis of 6 months, after the two initial 90-day benefit periods patients can remain on hospice for 60-day benefits periods indefinitely. The hospice benefits do not cap out.
However, you do need to ensure that your benefit period is accurate to avoid claim rejections. Example of common pitfalls with eligibility are:
- Patient transfers in from another agency
- Patient had a previous benefit period, revoked hospice and is now coming back on
- Your claim is being submitted before a previous agency discharge their claim
- Claims submitted with incorrect service dates or overlap with service dates from another healthcare provider such as a hospital or skilled nursing facility
Your hospice EMR must make intake simple, fast, accurate, & accessible virtually anywhere for clinical & financial reasons. But capturing this information in intake with an EMR that tracks admission type, date, & cert date to calculate the proper benefits period is the solid ground you need to start an effective RCM process.
Check out how Hospice Tools simplifies intake & captures all the data you need.
2. Key Metrics
Key Metric #1 – Notice of Elections
NOE submission is vital to the financial health of your agency. It’s crucial that you monitor NOE submissions and acceptance to ensure that they fall within Medicare’s five-day timely filing guideline. If your NOE is filed late you will not be reimbursed for the time period before the NOE filing. Even worse, if you do bill for the days before the NOE filing your claim will be submitted with incorrect service dates which will require re-submission and significantly delay reimbursement.
Key Metric # 2 – Days in AR.
This metric actually needs to be parsed into separate categories by Payer. Private Insurance and especially Medicaid can be especially difficult and have lengthy reimbursement times but as Medicare comprises the vast majority of claims we will stick to the Medicare claims general outlook. The rule of thumb for Medicare claims reimbursement is under 45 days vs over 45 days. Obviously, the less time under 45 days to receive reimbursement the better but over 45 days is a warning sign that something is going wrong and your process must be reviewed.
If Medicaid is your payer source and you are in a pass-through state, a state where your hospice agency collects the nursing facilities room & board rate for hospice patients residing in their facility, tracking days in AR and ensuring your process is timely, efficient, and effective, is critical to keeping the lights on. The nursing facility will want their money in a timely fashion regardless of your billing issues.
Further, timely payments to nursing facilities is not only a cash flow issue, it will affect your agency in other ways such as referrals, contracts, and more.
Key Metric # 3 – RTP & Rejections
Forget about timely payments, Return to Provider (RTP) & rejections must be tracked to ensure that you receive payment at all!
Some of the most common pitfalls that cause RTP & rejections are:
- Overlapping hospice election periods
- Duplicate claims
- Untimely filing of NOE
- Lack of proper clinical documentation to support terminal prognosis
- Face-to-Face requirements
- Improper Plan of Care documentation
- Missing ADR documentation
Your EMR & billing software/service should capture all this data to avoid these missteps and provide insight at each stage of the RCM process.
3. Accurate & Efficient Documentation
Hospice RCM isn’t just about billing. Accurate & Efficient Documentation is key to ensuring timely & complete reimbursement. Your documentation must be complete and accurate with personalized and coordinated Care.
Effective RCM all flows from capturing the right patient data. Patient data starts with intake as described above but goes throughout the lifecycle of the patient. Your agency needs to capture the right insurance information, facility information, clinical documentation, as well as other records such as medications and DME. Having an EMR that allows this documentation to be entered quickly, accurately, and efficiently is a key aspect to having a solid RCM process. Without this foundation it is near impossible to have an efficient and effective RCM process.
Once your documentation process is accurate & efficient then you can begin a monitoring process to ensure your RCM process is accurate & efficient.
Check out how Hospice Tools simplifies clinical documentation and delivers smart care plans so your documentation is always accurate, efficient, and compliant.
How Hospice Tools Maximizes Hospice RCM
Hospice Tools is the powerfully simple EMR built from the ground up for hospice & palliative agencies. From intake through billing Hospice Tools simplifies hospice management. Our clinical experts have designed professional workflows that are user friendly ensuring accurate and streamlined charting. Our billing experts handle any payer while monitoring and providing insight into every step of the RCM process to ensure your reimbursements are timely & complete.
Hospice Tools is the powerfully simple EMR built from the ground-up for hospice & palliative agencies.
Get smooth operations, simple chart management, revenue management services and much more!