Uncertainties about court-challenged vaccine mandates from the Centers for Medicare and Medicaid Services (CMS) and OSHA, and how those issues will impact staffing.
As 2021 winds to a close, many of the same issues facing home health at the start of the year are looming for 2022 – new variants of the same old problems.
“At this time last year, we were focused on helping our clients avoid cash flow shortages expected with the implementation of new no-pay RAPs (Request for Anticipated Payment),” said SimiTree Healthcare Consulting Managing Principal Jess Stover.
“This year, we’re looking at a new Notice of Admission (NOA) which takes effect Jan. 1,” she said. “And we’re seeing agencies who need our help dealing with a new round of Targeted Probe and Educate (TPE) audits spurred by their billing errors and inconsistencies.
“The pandemic hasn’t gone away, TPE audits are back, and there’s a new round of Medicare billing requirements ahead,” Stover said.
“In many ways, it’s just rinse and repeat.”
For agencies burdened by staffing shortages and the threat of additional, vaccine-related personnel issues, the potential consequences of billing errors are intimidating.
“I don’t know anyone who has the extra time or staff to deal with TPE audits right now,” Stover said. “And many agencies have been struggling with cash flow all year long under no-pay RAPs. They’re really at the breaking point and need some help to get things back on track in the new year."
That’s why SimiTree’s fully trained billing and collections team deploys quickly, becoming a seamless extension of the client’s own office structure to provide the skill, speed and proficiency for expedited claims processing.
“Outsourcing billing and collections with us offers our clients confidence and peace of mind, knowing that our team is up to date on all regulatory challenges and trained to help them avoid billing errors. In most cases clients see immediate and positive changes that make a significant difference to cash flow,” Stover said.
Here are 3 other reasons to consider outsourcing with SimiTree in 2022:
1. Your billing errors could trigger a TPE.
The Targeted Probe and Educate (TPE) Program was suspended for much of the COVID-19 public health emergency – but CMS resumed the TPE program in September.
Agencies with frequent billing errors are at higher risk for TPE audits, which require targeted agencies to submit between 20 and 40 claims for review, along with all supporting medical documentation.
Providing the manpower and resources for TPE audits can be challenging and time-consuming for agencies already facing staff shortages.
SimiTree’s expert billing and collections staff is trained to easily identify missing or incomplete documentation and other errors that lead to audits or denials, tying up an agency’s resources and delaying payment.
2. NOA becomes effective Jan. 1.
Last year, when CMS instituted the no-pay RAP (Request for Anticipated Payment), the lack of upfront Medicare payments and a new 5-day submission window left agencies scrambling to deal with cash flow shortages and significant penalties for missing the deadline.
The rules are changing again in 2022, with new Notice of Admission (NOA) requirements taking effect Jan. 1, 2022.
Billing is becoming much more complex, burdening agencies with ongoing training requirements. Turnover and retention issues place organizations at continuing risk of non-compliance.
SimiTree’s expert billing and collections staff is up to date on all regulatory requirements, including new requirements for the NOA.
3. We identify your cash flow obstacles.
Understanding what’s causing the problem is the first step to correct it. SimiTree’s proprietary collections tool adds a layer of transparency in clear, concise reports that provide a window to operational issues impacting timely billing and hindering payment.
“We quantify issues in the upstream revenue cycle and report to clients on the trends we identify,” Stover said. “Why are claims not processing? What information is missing? How often does this happen? Where in the process is the bottleneck occurring?”
SimiTree’s proprietary tracking tool keeps clients updated on account status, action taken, reasons for non-payment on claims and potential problem areas.
Start 2022 with greater confidence
As your organization heads in 2022, don’t let the same problems and issues stand between you and reimbursement from commercial payers, Medicare and Medicaid. SimiTree provides the billing and collections, coding and OASIS or full revenue cycle outsourcing your organization needs for success in the new year.
Reach out to us today to learn more about how SimiTree can help you start 2022 with fewer billing and collections worries. Call 800-949-0388 or use the contact form below.