3 Major Problems with Your Revenue Cycle Management

Updated: Oct 7


Every home care and hospice should consider a complete review of their revenue cycle processes. This forces the organization to determine any potential risks that harms financial performance. The process as a whole is rigorous and requires stringent practices to ensure agencies are paid in a timely manner. However, many in the industry suffer due to improper training, inaccurate processes, clinical coordination, and lack of knowledge of best practices.

Understanding your payer sources

Many agencies are uninformed about payer sources and their requirements for claim submission as well as authorization processes. Organizations consistently deplete away cash due to a code that changed or a write-off of an account balance that proved to be the wrong contractual adjustment. These costly mistakes are unnecessary and avoidable, especially when you’re already fighting for every penny as you wait several weeks at a time for money to return to your organization. In addition, many agencies are unaware of the specific criteria they need to meet in order to ensure payment. Basically, staff are untrained and are uninformed about processes that could lessen their burdens with revenue cycle management.

An inefficient process

Some organizations today function without much flow or coordination. For example, the billing department may sit separately from front desk operations. This obviously proves to be a struggle when a claim arrives and travels through several departments before it’s attended to. The time that is added until a reimbursement is inconvenient for the entire team. Patient care coordination is paramount just as claim coordination.

Staying up to date with software

Agencies today are not up to date with the latest release notes from their EMR. Some agencies assume that any defaults with the system may just be a part of the software. These established defaults have forced agencies to create workarounds, but these only create an additional domino effect. Agencies instead need to ensure they’re able to address and optimize their systems at least once a year to prevent any avoidable mistakes.

Geographical challenges, difference in the requirements from the Fiscal Intermediaries (FI), as well as changes in policy require constant education and reeducation of your billing teams. MHA can supplement the lack of training or provide additional training to support the revenue cycle teams. We have many experts in the industry that have spent years dealing with and attending to changing policies with payors. As the the old saying goes, if you have seen one payor then you’ve seen all payors. Contact us to learn how we can assist with your revenue cycle.



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