A comprehensive home health orders management guide 

After the release of the Home Health proposed rule, we are again seeing rates tighten, and it becomes even more critical to accelerate cash flow and mitigate held claims. 

From a financial perspective, failure to obtain signed orders on time will result in delays in billing and ultimately impact your cash flow. In this blog post, we share advice from our financial expert, Brian Harris, Vice President of Financial Consulting on everyday struggles with orders tracking and ways to streamline the process. Check out our previous article on orders tracking/management that focuses on compliance and cash flow.   

In the meantime, contact us today for a free orders tracking/management consultation. Click here for our orders tracking sell sheet.  

The Impact of Orders Management on Home Health Finances: The Cost of Delays  

The financial impact of delayed orders (e.g., lost revenue, increased AR days, penalties) 

Unsigned physician orders are typically the number one cause of held claims incurred by providers.  A provider’s goal should be to send final claims within seven (7) to ten (10) days of the end of the PDGM period, which gives them 37 to 40 days to obtain all necessary signed orders for their start of care claim.  Collection efforts on physician signatures should be front-loaded within this period to allow for escalation measures to occur before desired billing timeframes.  Failure to do so will impact the agency in a few ways: 

• Delayed cash flow, especially with traditional Medicare, which remits payment within a few weeks.  Providers dealing with cash flow challenges at large may struggle with regular expenditures such as payroll or accounts payable. 

• Additional resources focused on cleaning up aged unbilled activity could detract from the necessary focus on collections efforts on billed claims or other key revenue cycle functions. 

• Physicians may grow unwilling to sign orders if the provider allows them to age out too far, which could ultimately prevent billing altogether.  In these scenarios, providers will have to write off the balances for these claims as bad debt. 

How order delays affect patient care and satisfaction 

Home health, by design, is a form of health care that is physician-directed and, therefore, driven by the plan of care and subsequent supplemental orders.  Therefore, delays in physicians signing off on these orders create risks in the care plan and the quality of care being provided.  At a macro level, cash flow challenges prevent providers from investing in items that drive care quality, including retention/recruitment of direct caregivers and technology advancements. If you are looking for hospice billing tips, click here.  

The Role of Order Management in Accelerating Cash Flow  

As referenced above, unsigned orders are typically the leading cause of held claims.  Therefore, each additional day it takes to obtain signed orders beyond the desired billing timeframe represents and additional day to receive payment. 

How improved order management can contribute to a healthier bottom line 

Improved order management via streamlined processes, effective prioritization, and embracing technology will allow an agency to limit resources necessary for the function while meeting its cash flow goals.  As payment rates shrink, agencies must look for these opportunities to maintain healthy margins.  Consistent and reliable cash flow will allow providers to invest in initiatives to drive favorable referral relationships, secure a strong workforce, and adopt technological benefits. Get order management expertise with a free consultation.  

Common Challenges in Home Health Order Management 

1. Order Acquisition and Processing: Difficulties in obtaining signed orders  

• • Inefficient processes:  Orders management workflows must be structured to promote productivity and efficiency.  Establish dedicated submission cycles for new orders multiple times per week.  When reviewing outstanding orders, follow up on all orders for a physician simultaneously and leverage multi-physician locations to consolidate collections efforts where possible.  This will also help prevent the physician from getting annoyed with persistent follow-up attempts. 

• • Lack of resources: Too often, order tracking functions are assigned to multiple people as the third or fourth priority in their responsibilities.  This creates gaps in accountability, poor communication, and unrealistic productivity expectations.  Providers must ensure dedicated resources are assigned to these tasks, as failure to do so risks the billing and cash flow challenges referenced in this blog post. Providers could explore hiring interim revenue cycle staffing leaders to achieve uninterrupted cash flow in tough times and in the most common fluctuating times, like transitional phases, summertime, and leave of absence. e of absence. If this sounds like something you need, download our IRC staffing brochure here.

• • No escalation measures: Providers will likely have a few “problem physicians” for whom they experience signature delays despite structured follow-up. If standard follow-up efforts prove unfruitful, defined communication channels and escalation measures must be implemented. SimiTree recommends these escalation measures begin at day 30 to prevent significant billing delays. Read more about how to avoid the top billing issues.  

• • Lack of training: Staff members may not be properly trained in how to track outstanding orders or leverage their EMR to support them. This can lead to errors and delays.  Once dedicated resources are assigned, identify education opportunities to further support their efforts. 

• • Incorrect physician on orders: A common challenge encountered in orders management is physicians declining to sign orders indicating that another physician should oversee the care plan.  This often occurs with referral sources with several hospitalists or urban areas where physicians rotate between multiple facilities throughout the week. A provider’s intake department is crucial in this process, through confirmation of the physician signing start of care orders and identification of the patient’s primary care physician (PCP) that can be contacted for recertification orders. 
    
    
  • Low visibility on impacts of issues: There must be strong, two-way communication between the orders tracking and billing teams to ensure a collaborative effort towards clearing any orders issues impacting unbilled claims.  While orders tracking staff are ultimately responsible for getting documentation signed, the billing team should be proactive in communicating aging-held claims identified during the billing process.
    
  • Untimely checking in of signed orders: The last thing an agency wants is to hold claims for signed orders when the signature has been received.  A structured process must be in place to check on signed orders quickly once received.  Along with getting billing released, this will also support productivity orders tracking staff.  It can be equated to cash posting on the billing end.  Providers do not want their billers to waste time following up on claims that are already paid, and they do not want staff following up with physicians on orders that are already signed. 

2. Challenges in order entry and data accuracy. 

As with any process, data entry accuracy is a vital first step to ensuring success.  Physician signatures could be delayed if the physician believes there are issues with the content of the order.  Also, it must be remembered that the order cannot be initially submitted to the physician until the clinician completes it and clears quality reviews.  Suppose this process does not occur in a streamlined manner. In that case, it will take longer for the physician to initially receive and shorten the timeframe to procure the signed order before billing. 

3. Order Tracking and Follow-Up  

Depending on the size of the provider, agencies could be dealing with hundreds, if not thousands, of outstanding orders at a time.  The provider should first embrace available platforms embedded within their EMR or via a third-party vendor to maintain a tracking system of order status and follow-up prioritization.  If none of this technology is available, the organization may need to revert to using Excel spreadsheets, which could be difficult to obtain.   

In terms of follow-up prioritization, staff must understand the operations of their assigned physicians to maximize efficiency.  For example, if you know a physician is not in the office on Fridays, then workflows should not include a Friday follow-up call. 

4. Follow-up with physicians 

As with any form of follow-up, it is important to build strong relationships with physicians.  If the physician represents a key referral source, staff will likely be calling them at a minimum weekly, asking for signed orders.  If handled poorly, this could lead to frustration on the physician’s end, making them less willing to prioritize orders as they come through.   

**KEY TIP** One tip for this is to find the resource(s) at the physician’s facility who could serve as a primary communicator in place of the physician. This is especially effective in multi-physician facilities, where this approach could allow for one follow-up call instead of multiple. 

Leveraging Technology for Efficient Order Management 

The Role of EMRs and Physician Portals 

Let’s talk about how EMRs and portals can streamline order management. 

As referenced above, facilitating the order management process through paper or manual spreadsheets significantly slows down staff productivity and timelines for each task within the workflow. This can ultimately delay the receipt of signed orders. Look for opportunities to improve efficiency through your EMR, physician portals, or other third-party vendors. Effective EMRs or other order-tracking technology can allow for batch submission of orders, streamlined identification of problem areas, and adequate delineation of assignments to staff.   

If physician portals are utilized, communication will still be necessary to ensure the physician monitors the portal and responds timely. However, this should still be less burdensome than faxing/calling consistently.  Also, staff must be educated on all available technology to ensure it is utilized effectively. 

Benefits of electronic order exchange and integration 

Facilitating the orders management process through paper significantly slows down the timelines for each task within the workflow and can delay the receipt of signed orders. The physician can welcome the utilization of streamlined electronic processes as well, thus building the relationship needed to ensure quick turnarounds on signatures.   

Providers should work with their business development/intake team to determine the most effective way to promote and educate physicians about these available options if they initially resist adopting them. 

Automation and Workflow Optimization: How automation can improve order processing efficiency 

As automation and AI become more prevalent, providers should keep themselves open to solutions that reduce the manual invention needed in the orders tracking process.  This could include automatic transmission of an order locked by clinicians/quality review, automatic resubmission of orders at certain time frames, and automatic checking in of signed orders once received.  Checks and balances should still exist with these processes, but this could significantly increase productivity for the function as a whole. 

*KEY TIP* Maximize technology: As noted earlier, facilitating the orders management process through paper significantly slows down the timelines for each task within the workflow and can delay the receipt of signed orders. Look for opportunities to improve efficiency through your EMR, physician portals, or other third-party vendors. Learn more about seamless payer setups for maximum reimbursement.  

How SimiTree Can Help 

SimiTree's Expertise in Order Management: Our Approach to Order Management  

While this article is intended to guide agencies in developing efficient orders management processes, it merely scratches the surface of opportunities available to achieve this efficiency. Get in touch today with a free consultation. If you’re still unsure, read our quick sell sheet.  

SimiTree is here to guide and support your organization as it develops its workflows, including insight into technology options to enhance your team’s capabilities. Request more information on how we can help you with your revenue cycle and order management. 

Suppose your agency’s core issue is the availability of sufficient resources to dedicate to this process. In that case, SimiTree’s Revenue Cycle Management (RCM) team has a group of expert resources available to serve alongside your team in achieving the desired outcomes detailed above. For any other questions besides RCM and orders management, contact us today. If you need team support, explore our interim revenue cycle staffing solutions.