Orders Tracking: A Guide to Compliance, Patient Care, and Cash Flow in Home Health and Hospice

What is orders tracking in home healthcare and hospice?

Orders tracking in home health and hospice is the process of monitoring the status of physician orders for services, supplies, and medications, specifically plans of care and supplemental orders in home health and certifications of terminal illness (CTIs) in hospice. This function includes tracking the order from the time it is created to the time it is signed and dated by the physician.

Orders tracking is not only essential to ensure that patients receive the services and supplies they need in a timely manner, but also essential to coverage of all care undersigned physician orders represent a core compliance requirement under the Conditions of Participation (CoPs).

Why? The CoPs require home health and hospice agencies to have a system in place for tracking physician orders. This is because physician orders are the legal basis for providing care to patients. Without signed physician orders, an agency could be in violation of the CoPs and could lose its accreditation.

From a financial perspective, failure to obtain signed orders in a timely manner 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, Consulting Director on common struggles with orders tracking and ways to streamline the process.

First, let’s explore the benefits of strong orders tracking practices in home health and hospice for those who are unfamiliar.

Benefits of Orders Tracking for Home Health and Hospice Agencies

Many startup agencies are unaware of the ways streamlining their orders tracking can benefit their business. Similarly, established agencies may have outdated processes and need a refresher. On whatever end of the spectrum your agency resides, here are the benefits you could reap from getting your orders tracking right:

  • Improved patient care: Orders tracking can help to ensure that patients receive the services, medications, and supplies they need in a timely manner. This can improve patient satisfaction and outcomes.

  • Increased compliance: Orders tracking can help to ensure that organizations are in compliance with regulations. This can help to protect patients and the organization from liability or denied claims following audits or additional documentation requests (ADRs).

  • Lower unbilled volume: Efficient orders tracking processes can resolve pre-bill requirements for signed orders in a timely manner and prevent a backlog of held claims.

Common Home Health Agency Struggles with Orders Tracking

First and foremost, making sure your agency is up to date with the latest technology is a must. Brian Harris explains, “Many clients come to us struggling with a centralized system. We notice that agencies can face major difficulties tracking orders with paper-based systems. This can make it difficult to facilitate the submission and receipt of orders and identify any potential problems.” If this sounds like you, SimiTree is here to help. Keep reading for ways to remedy your current process.

“Another common struggle we see is inadequate means of communication amongst team members or lack of clear responsibility for the function. Poor communication can lead to delays in orders being completed and sent to the physician.”

This will also impact the resolution of issues encountered following initial submission, such as responses indicating the order was sent to the incorrect physician.  The trickle-down of poor communication can be endless, and almost always is partnered with or results in the following:

  • Inefficient processes: Lack of definitive accountability and poor communication can result in low productivity, gaps in workflow, and an increased volume of aged unsigned orders.

  • Lack of training: Staff members may not be properly trained in how to track outstanding orders. This can lead to errors and delays.

  • Lack of resources: Home health and hospice agencies may not have the resources to invest in a sophisticated orders tracking system. This often leads to a low prioritization of the orders tracking function due to assigned resources being responsible for several other operational functions on top of orders tracking.

  • 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.

How to Streamline your Orders Tracking Process

Mitigating orders tracking issues can be achieved with a few simple steps, but agencies must place a committed focus on taking these steps.  SimiTree recommends the following actions below to optimize an organization’s orders tracking process to ensure full compliance with regulations and minimize the impacts of billing delays on cash flow.

  • Assign sufficient and dedicated resources: The biggest mistake we see organizations make is assigning a partial resource(s) to this process and putting it low on the list of their priorities. Even if a full-time resource is not needed, agencies must ensure assigned team members have this process as a top priority and are hitting weekly metrics for follow-up on unsigned orders.
    • Depending on technological capabilities, SimiTree recommends one (1) FTE for every 200 – 300 physicians for which an organization receives orders.
  • 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.

  • Spend the majority of time on follow-up: Another common challenge we see agencies encounter is that their orders tracking resource spends most of its time on initial submission and the checking in of signed orders, with very little time spent following up with physicians on outstanding orders. While each of these functions is important, a lack of follow-up will prevent an organization from uncovering and resolving issues impacting unsigned orders in a timely manner.

  • Develop and maintain a structured follow-up process: SimiTree’s recommended orders management process includes the following key elements:
    • Follow up on orders at the physician level, not the patient level. This will reduce the number of follow-up efforts needed and prevent physicians from getting annoyed at multiple calls.
    • Follow up on outstanding orders at a minimum every seven (7) days to prevent the orders from aging.
    • Each follow-up effort should include both a phone call to the physician’s facility and a resubmission of the outstanding orders.
    • Identify physicians that operate out of the same facility and attempt to find a resource within that facility that can be a one-stop-shop to triage the orders for several physicians at once.

How SimiTree Can Help

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. 

SimiTree is here to provide guidance and support to your organization as it develops its workflows, including insight into technology options to enhance your team’s capabilities. 

If your agency’s core issue is the availability of sufficient resources to dedicate to this process, 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.

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