Home health and hospice agencies anticipating tighter margins next year are considering how to overcome a skinny Medicare reimbursement rate, inflationary costs for labor, fuel, and supplies, and the financial pinch from renewed sequestration.
The key to growth in a more challenging financial environment is locking into place a mechanism for an efficient revenue cycle that keeps cash flowing, SimiTree financial consultants say.
A knowledgeable revenue cycle management team can help agencies monitor key performance indicators, reduce aging accounts receivable, perform frequent cash reconciliation, and quickly identify any upstream obstacles bogging down claims processing.
The right billing and collections staff can also help agencies grow by seamlessly addressing billing for new service lines like Home Infusion Therapy (HIT) or palliative care, options that many agencies are eying as an antidote to leaner profitability next year.
“Generally, SimiTree advises agencies to diversify and develop multiple streams of revenue where possible,” said Lynn Labarta, SimiTree Vice President of Post-Acute Revenue Cycle Management.
“But it’s important for agencies to fully understand the dynamics of an expanded line of service, and strategically assess whether it will be beneficial,” she said. “And one of the considerations will be whether the agency has the right billing staff in place to move forward.”
The role of billing in home health
Moving into unknown territory can be daunting for an agency, Labarta said, but having access to specialized billing staff with a network of resources and consultants can make all the difference.
A knowledgeable billing staff will insulate the agency from a rocky start with cash flow issues caused by processing delays, denials, and billing confusion during the learning process.
The new Home Infusion Therapy (HIT) benefit offers one example of how important it is for billers to understand the nuances of billing to effectively implement new lines of service without cash flow problems, Labarta said.
Effective on Jan. 1, 2021, the relatively new benefit allows home health and several other types of providers to provide certain types of home infusion drugs. HIT covers professional services such as skilled nursing, patient monitoring, and patient education – services not otherwise covered under the Durable Medical Equipment (DME) benefit.
But Labarta said agencies often experience a bumpy start with the launch of HIT billing. Claims are frequently rejected due to a tricky enrollment process. There is also frequent confusion about the need for a corresponding DME claim and misunderstanding about Medicare’s policies for HIT G codes. Duplicate billing is particularly easy for HIT claims, and often causes problems for agencies.
“Do you have a well-trained billing staff who really understands the requirements for HIT billing?” Labarta said. “Without it, you may be missing out on the cash infusion expected from the new service line.”
Weighing the pros and cons of HIT billing
The HIT benefit is one of several new service lines currently growing in popularity among home health providers.
Other popular service expansions include the Hospital at Home program, which provides higher acuity care to patients in the home; palliative care, which focuses on symptom management for patients with serious and chronic conditions; and therapy allowed to be provided to patients in the home by home health agencies under Medicare Part B.
If your agency is considering one of these new service lines, the consultants at SimiTree can help weigh the pros and cons and determine whether it’s the best move.
SimiTree consultants work with agencies to explore many factors which are part of the decision-making process, including an assessment of initial costs and investment as well as an evaluation of necessary referral sources, connections, and existing resources.
In almost every case, the agency will need billers with the training and expertise to easily transition into new requirements and ensure claims are correctly submitted so that the new services can be quickly and fully reimbursed.
SimiTree has the right billing expertise
The billing and collections experts at SimiTree have the industry expertise and training to make your new venture profitable faster, with fewer start-up glitches, and a full spectrum of knowledgeable support from our consultants.
Our billing experts become a seamless extension of your office, providing the skill, speed, and proficiency needed for regulatory compliance in processing claims.
We add a layer of transparency in clear, concise reports that provide a window to operational issues impacting timely billing and hindering payment. Our proprietary collections tool quickly identifies any upstream revenue obstacles which may slow down the claims process, so that you can take corrective action to get paid faster.
Use the form below to reach out to us today and let’s get started helping your agency become more profitable.
Learn more
Want to learn about new opportunities available to providers under Medicare Part B? View our on-demand webinar by visiting the Resources page on the SimiTree website. You’ll find the recording webinar under the Consulting tab HERE.
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