Have you heard the following expressions before? “Just send in a bill and the money comes rolling in!” “Anybody can do it.” “Revenue Cycle Management is easy.” These are statements made by those with the notion that revenue cycle management in the medical field is simple.
MHA’s expertise in RCM
However, this isn’t always the case. Agencies across the nation require assistance to both manage and run their revenue cycle process. Thankfully, the team of experienced RCM consultants at Maxwell Healthcare Associates understand the intricacies of medical billing, and the complications associated with federal and state regulations for home health (PPS/PDGM and FFS), hospice, palliative care and home infusion therapy.
These consultants have years of experience as RCM leaders within small, medium and large organizations in home care and hospice. We’ve been through audits, surveys, ADR’s, ZPICS, TPEs and intimately know the warning signs that require immediate action. We also know how a well-managed RCM should function and ways that the less organized RCM processes are identified, and how a better structure would bring accurate cash flow.
An MHA RCM evaluation consists of the following:
· Regulatory compliance
· Payor requirements
· Electronic Submission vehicles
· Uncover Revenue opportunities
· Efficiency practices of RCM staff
· Effective RCM processes
· Collection/Follow Up on unpaid balances processes
· Appeals processes
RCM evaluations identify areas where processes and education will help your agency achieve financial solvency, compliance and efficiency.
RCM evaluations review billing practices to confirm that the regulatory requirements are followed by EMR software and the policy/procedures of the home care agency. The knowledge base and understanding of regulations from an agency’s RCM staff is also assessed.
RCM evaluations review efficient and proper use of EMR software and brings suggestions to enhance the collection processes to employ untapped improvements offered by the EMR software. RCM evaluations also review the payor requirements and set up within the EMR software claim structures. It provides suggestions and instructions to assure that the electronic and/or paper claims are acceptable by the payor.
In addition, RCM evaluations review manual and/or external processes that can be automated and more effectively managed within the EMR software. This helps the agency to update the processes to achieve higher efficiency and transparency using single source resources when possible.
Finally, RCM evaluations review collection practices, including documentation of collection efforts to aid leadership awareness of potential lost revenue. This provides enhancement of current activities to minimize bad debt that results from missed claims filing deadlines, appeals, secondary payor balances or non-contracted/non-par payor sources.
Following an initial assessment, MHA provides documentation of findings with a suggested plan of correction/action that includes assistance and guidance of MHA’s RCM experts. Together, the proposed plan is implemented with MHA’s RCM experts at your side to guide your agency to become a compliant, efficient health care agency. Contact MHA to learn how our experts can help your organization.