2022 HME Business Handbook: Revenue Cycle Management
How Outsourcing Has Dominated the HME Billing Market
- By Joey Graham
- Jun 01, 2022
The HME industry in the
midst of a staffing crisis.
No secret there. If your revenue
cycle management feels out of
control, you’re not alone.
Fortunately, there are simple
ways to overcome this. In this
article, I’ll lay out some of the
common issues HME businesses
are experiencing when it comes to
managing their front- and back-office staffing, billing processes,
and how you can improve your
efficiency, lower billing errors, and
dramatically decrease delays in
cash flow.
First, let’s break down the HME
workflow:
- Front Office — Everything
before your product or service
reaches the patient. Inbound
referrals, intake/registration,
records and documentation,
prior authorizations, scheduling,
etc. This is run by
customer service reps (CSRs).
- Back Office — Everything after
your product or service reaches
the patient. Order confirmation,
held revenue, billing, collections,
and cash posting. This is run
by billers, collectors and cash
posters.
- The HME revenue cycle work-flow — Every order from the
front office to the back office,
closing the resulting invoice with
cash received in the bank. Each
referral is tracked, processed, filled, billed, and collected.
PROBLEMS WITH TRADITIONAL HME
WORKFLOWS
Despite HME’s high-tech offerings, frontand
back-office processes are often
still living in the 20th Century. It’s not
uncommon to see paper-based systems
or outdated billing systems.
Traditional HME workflows are manual
and tedious, prone to human error: stuff
happens; people get sick; paper gets
lost; the order gets dropped.
THE ROLE OF TECHNOLOGY IN MODERN HME
WORKFLOW MANAGEMENT
No more paper! Let the accordion files
go. Intelligent work queues, electronic
medical record (EMR) or billing systems,
on-demand tools through a business
intelligence (BI) system are a must.
Modern HME revenue cycle teams are
generally centralized (both front- and
back-office) and structured by process,
payer, or product as appropriate for the
provider. Leverage decision support
systems (DSS) to guide employees
through the process. This reduces the
learning curve, quality errors, and wasted
time.
Offer patients a self-service model via
an online patient portal, create an app,
digitize order status, order new products/supplies, review/pay their bill, send
messages to your team, and update their
account information.
Automate, automate, automate. (Yes, I
said that three times!) Reduce the human
effort needed to manage your revenue
cycles. Optimal HME workflows leverage
people only as necessary, allowing
information systems to handle much of
the work.
Manage by exception, not by each
order or invoice. Automate in the
following areas: data entry, benefits
verification, prior authorization, order
confirmation, cash posting, A/R & denial
management, and re-supply.
THE ROLE OF TECHNOLOGY IN MODERN HME
WORKFLOW MANAGEMENT
Reality check: Unless you build one, there
is no “one-stop system” in HME workflow
management. Many providers use work-in-progress (WIP) states to manage the
front-office workflow; as well as a separate
RCM workflow system to manage
the invoices in the back-office workflow.
Cover these back-office areas: order
confirmation, unbilled and held revenue
(and stops), rejections, open deposits,
billed claims (i.e., open A/R), denials, and
follow-ups.
For your front-office WIPs — don’t go
overboard creating WIP states. Label
them in a way that makes them display
in a logical order for your team, eg: “1.0
New Intake, 2.0 benefits Veification,
3.0 Prior Authorization, 4.0 Scheduling,
5.0 Out for Fulfillment, 6.0 Ready for
Confirmation.”
Then create sub-reasons as parking
lots, so to speak, for issues. For example:
“1.1 Missing Information, 1.2 Qualification
Issue, 3.1 PAR Requested, 3.2 PAR
Denied,” etc.
POINTS TO REMEMBER
- Most missed opportunities in
Revenue Cycle Management
success are caused by human error
and poorly utilized tech.
- Automation of your process using
tools purpose-built for your service
are critical to eliminating those
errors.
- There is no “one size fits all” off-the-shelf system for HME, but there
are ways to make the existing tools
work well together.
LEARN MORE
For more information on how to
decrease turnaround time on your
revenue cycle, improve your back-office efficiency, and get back to
focusing on growing your business,
visit the resource center at Prochant.com or ask Joey Graham directly by emailing [email protected]
This article originally appeared in the May/Jun 2022 issue of HME Business.
About the Author
Joey Graham is an industry veteran with over 20 years of experience in home medical equipment / durable medical equipment (HME/DME) and pharmacy operations and revenue cycle management. In his current role as Chief Revenue Officer (CRO) for Prochant, he is focused on simplifying reimbursement and delivering greater profitability to clients by combining technology and industry-leading processes with a team of highly-skilled specialists.