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Secrets of Success in Revenue Cycle Management

Author: Sam Smith

The revenue cycle is the backbone of any business. The success of your home health business depends on how you manage your revenue cycle. The Healthcare Provider is managing a business, therefore the management of the revenue cycle and its timing and process are of critical importance. With the shifting trends in healthcare, industry leaders are changing the way they look at and manage their home health, Medicare, Medicaid and other revenue streams in their revenue cycles.

The most important aspect of revenue cycle management is that there IS “top-line” revenue. Some key questions come to mind.

  • Can referral sources utilize your reporting to determine the optimal path of future referral streams?
  • Is your business fulfilling a demand for healthcare in your community?
  • Does your clinical service meet a known need in your market?
  • Does the quality of your revenue generating services cause repeat patients or a steady stream of referred patients to your agency?
  • Does your data reporting support your quality of services reputation?

In order to build interest in revenue cycle management (RCM), this article assumes that you are serving the community and you have a healthy “top-revenue, line driven” home health and home care business, generating enough revenues to fund the ongoing salaries and benefits your business needs to move forward.

Five trends that will reshape RCM in general and home healthcare:

Patients obtain their health plans through either personal means, from the government or through an employee sponsored coverage. Accommodating higher deductibles is becoming more common, and rarely the exception. This trend may unfortunately begin to impact Medicare beneficiaries, depending on the new Administration and Congress. The increased financial responsibility may seem burdensome to patients, but ultimately, it is up to the providers to ensure the responsibilities are fulfilled. The priority of “right on time” insurance verification and upfront collection are bound to increase. The focus should be to hire staff that is able to obtain precise insurance information, or Medicare/Medicaid benefit verification and at same time, collect any necessary out-of-pocket costs up front.

In most healthcare RCM, front-end collections are linked strongly to customer service. To achieve maximum upfront collections, necessary investment in resources is paramount. Call centers and trained healthcare RCM staff should be utilized. Moreover, to make a patient-centric revenue cycle, the focus should be on the patient experience. The patients of home health agencies should be educated and encouraged to meet their financial obligations to have a healthy revenue cycle. The processes and protocols of general insurance collection for healthcare are necessary when considering how prompt collection procedures are to be instituted for home healthcare.

RCM techniques, in order to be optimized, must include the well-oiled process of determining and managing the patient experience. For Medicare Certified Home Health, this means your HHCAHPS provider must be integrated seamlessly with your RCM functions. Value Based Purchasing (VBP) standards are certain to endure through any changes that are to be brought forth by the new Administration, and will most likely need to be incorporated into home health RCM once the demonstration process has been completed. The CAHPS process will be an underlying valuable process to be observed as RCM protocols are procedures are fully established.

An efficient staff can make even the most ancient of software work to their favor, whereas, an inefficient staff cannot achieve much with state-of-the-art, efficient software. This means, people make the software work and not the other way around.

It is true that technology that is specifically designed to increase revenue cycle will have a positive impact, but it cannot be utilized to its fullest extent unless the staff is competent. The ideal business has a stable relationship between software and human resources and one compliments the other.

With decisions made under the past Obama Administration, Medicare and Medicaid are on the path to value-based payment (VBP). This appears to be impacting the managed care insurance community. With the rapid changes throughout the system, healthcare payments are undergoing a paradigm shift. Value and compensation are moving closer together, bridging the gap between business and medicine. The providers must offer quality care and must demonstrate it. The penalties for not participating in this trend are continuing to increase.

Unless the providers accept the value equation, there will be everlasting impact on cash flow and the inherent damage to their revenue cycle. Value not only changes how care is compensated, but how it is delivered. Providing care to a large scale of population will create a complex problem to tackle. The companies, people in healthcare billing and reimbursement systems who tackle those problems effectively with natural and effective processes, will naturally emerge as the market leaders.

Payers and providers have long governed the revenue cycle. However, with the recent regulatory and technology changes, these two are beginning to merge together and the line between them is getting thinner with the passage of time. Hospital providers are now launching their own health plans and insurance payers are readily investing in provider networks.

The creation of these new entities increase the demand for large-scale, integrated revenue cycle management tools. There is a growing need for a tool that can handle the complete revenue cycle from management to billing. Using RCM tools will enable home health operators to streamline their processes more rapidly than operators without these efficient tools.

Outsourcing is an idea that is not at all new and has been going on for years now. With the increase in talent, those using outsourcing will continue to rise, with the costs of outsourcing continually declining. Moreover, with the increased regulations, the pressure and cost of maintaining an effective revenue cycle is bound to increase.

While the healthcare scenario is dramatically changing, the basic elements of revenue cycle shall remain the same. The importance of cost effectiveness is ever increasing and outsourcing of coding and billing will save many dollars.

Whichever option you choose, every agency’s ultimate goal should be to build a robust Revenue Cycle Management process that maximizes patient care reimbursements, improves cash flow for the agency and minimizes the time it takes to get paid.


* First ran in the Home Care Association of Florida Winter/Spring 2017 The Florida Home Care Connection publication.


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