Revenue cycle management (RCM) for home health and hospice

With the ever-changing regulatory environment and soaring popularity of Medicare Advantage plans, billing is increasingly complicated. Our mission is to alleviate billing headaches and collect what you are owed for the services you provide.

Our home health billing experts have the knowledge, training, and experience to process claims accurately and quickly. The result is fewer billing errors, faster turnaround time, and improved cash flow.

There’s a lot at stake for home health and hospice agencies when it comes to billing, coding and documentation review. Errors and omissions can lead to delayed, denied or rejected claims that can decrease reimbursement. Detecting and resolving these issues are critical to your agency’s success.

Our expert approach to billing can save you valuable time, helping to ensure accuracy from the beginning and enhancing your bottom line.

An often labor intensive and lengthy process, most agencies don’t have the time or dedicated staff to take on AR recovery. Outsourcing to our team allows your agency to focus on day-to-day operations and quality clinical care, while we handle problem payors.

We review and resubmit all unpaid claims, notify your agency of any clinical documentation and/or coding errors and fix them for resubmission. We also provide tracking of our progress and appeals status — giving you a real-time view of our work on your bottom line.

According to CMS, an additional documentation request (ADR) is generated when documentation is necessary to support a Medicare claim. Our experts assist with ADRs —  researching the claim, preparing documentation, ensuring a timely response, and managing the full process until the issue is resolved.    

Whether it’s due to training, process knowledge or simply a lack of time, many agencies aren’t prepared to handle these critical ADR requests.

Our ADR assistance includes:

• Thorough claim research: A comprehensive review of the specific claim in question to identify the root cause of the ADR, and analysis of the clinical documentation and coding to confirm compliance with CMS requirements.
• Customized documentation preparation: Gathering and organizing all necessary records, including physician’s orders, clinical notes, and supporting materials to prepare a detailed response to the ADR.
• Timely and accurate submission: Adherence to strict CMS deadlines to prevent penalties or claim denials, along with accurate and compliant responses.
• End-to-end process management: We are here for you until the issue is resolved, providing updates to keep you informed along the way.

This includes additional documentation request (ADR) assistance as well as a detailed chart review. When an agency receives an ADR, that process sometimes includes a full chart review — which involves a more in-depth level of assistance. A thorough examination of the patient’s medical record can identify gaps in documentation, inconsistencies, or areas where information might be unclear to the payor.

Ongoing clinical training on a range of topics can help agencies avoid trouble with claims, denials, coding inaccuracies and more. Failure to continue education around these challenges can lead to reimbursement issues, low Star ratings, decreased referrals and overall success.

Our training spans OASIS, coding and documentation practices, financial operations, appeals and more — helping to improve your bottom line and enhance quality care.