Let’s face it: the administrative burdens in healthcare aren’t getting any easier. Documentation demands continue to rise to meet compliance measures, payer rules are ever-changing, and denial rates for claims just keep going up. In fact, a report by Change Healthcare estimates that the average hospital has $5 million in payments at risk of being denied each year. The good news is that 63% of those denials can be recovered. The bad? It costs about $118 in administrative costs for each claim to capture the money owed.
And the common cause for all these rejections in the first place is our industry’s continued use of manual processes. For instance, a big challenge for most providers is performing eligibility checks during patient intake but not rechecking before submitting the claim. Without using automation to recheck, there’s a heightened chance that the claim will be denied if coverage has changed during the lag time. This process breakdown in the revenue cycle might not even be detected for a month, but it can be felt for many months because of the resulting decreases in cash flow and increases in administrative expense and time.
But it doesn’t have to be this way with revenue cycle management (RCM) services offered in the HME industry. Providers using these types of services are finding 3 factors: scalability, expertise and analytics that significantly reduce the administrative burden on their staff and correct process breakdowns for efficient and profitable billing, collections and receivables.
Hear directly from Gary Sheehan in this video.
Cape Medical Supply is an example of an HME provider using this strategy to manage the administrative burden. The organization, operating in Massachusetts, Rhode Island, New Hampshire and Maine, turned to revenue cycle management services in 2015 after finding it harder to fill positions internally amid a lot of organizational growth. Instead of trying to staff those functions on a day-to-day basis, CEO Gary Sheehan decided their internal management’s time and talent would be better allocated to focus on growing the organization while their revenue cycle management experts would run the billing behind the scenes using established best practices.
Sheehan has reported that the ability to count on experts to keep up with ever-evolving best practices has been a key factor. In fact, that guidance and feedback on how to clean up and monitor the front end of their operation has resulted in substantial improvements to their bottom line. Instead of chasing documentation and errors and responding to audits, they now have a smooth billing and collections workflow that is allowing them to get paid quickly. And with the offsite billing experts that serve as an extension of their business, Sheehan and his management team can move forward to focus on priorities like the patient experience rather than worrying about staff turnover or the need to increase staff.
In addition to solving their staffing issues, revenue cycle management services have answered today’s pressure for additional visibility and reporting. Already a metrics-focused organization, Cape Medical appreciates the ability to measure processes on a day-to-day basis through advanced analytics, including dashboards and reports that provide one version of the truth in how they’re performing. Plus, their revenue cycle management analyst is able to translate and provide the right guidance based on extensive industry expertise. By doing it right the first time, Sheehan feels well-equipped to operate his business during these especially competitive and challenging times.