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Best Practices for Managing Your HME Back-Office Operations
This session will explore, in depth, some best practices associated with managing your back-office operational teams. These teams generally include order confirmation, billing, collections, and cash posting. Topics we will discuss include: work flow, technology tools, incentives, and metrics. How do you get maximum production and quality from your team while keeping the individuals engaged and ensuing constant growth and development of the team?
About the Speaker
Joey Graham is an industry veteran with over 20 years of experience in DME operations and revenue cycle management. In his current role as Executive Vice President & General Manager for Prochant (formerly The Prometheus Group), he is focused on delivering greater profitability to clients by combining industry-leading processes with a team of highly-skilled specialists. His past roles include executive roles at large DME and software companies including Brightree. He has a bachelor’s degree in finance and an MBA from the University of West Florida. Joey started his HME career right out of high school, spending several years as a service technician.
The HME Revenue Cycle
Know Thyself
• Start with a deep understanding your pain and opportunities
• Thorough analysis of EMR / database (billing system)
• Current status of KPI’s
• Payer & product mix
• Current services, geographical spread
• Process and documentation efficiency
• Proportion of clean documentation
• Rework loops as an outcomes of pre-billing inefficiencies & set-up issues
• Map the IT Security infrastructure
• Resolve any potential connectivity, speed, data security and access management issues
• Jointly agree on what success will look like
• Key focus areas
• Objective and realistic milestones
• Rules of partnership / engagement
Solution Design
• Identify accountable parties, ensure ownership is clear
• Standardization of processes is extremely vital for scalability and dependency
• Before implementing, pilot the SOPs with experienced resources
• Avoid involving less experienced resources during testing
• Stakeholders must sign-off on standard work
• Create a change-control process for standard work
• Identify metrics to track, report and joint review
• Evaluate transactional volumes throughout RCM
• Plan appropriate staffing levels
Building Scalable & Performing Teams
• Convert Standard work into job roles (think Franchising!)
• Define competency levels as a function of complexity
• FEB Level 3 competency mandates more experience to confirm orders than data entry or eligibility verification
• Skills required for appeals and complex patients are high, relative to working other standard denials
• Create standardized training modules for each role, optimize the learning curve
• Mix interns / low-experience resources with senior resources for a scalable organization. Ensure roles are properly staffed.
• Define pay structure for applied competency to motivate lower level resources & create career path
Onboarding People
Hire and build teams completely inline with your company values
Train Interviewers to evaluate both skills and cultural fit
Train people on clarified standard work
Incentivize them to learn faster, and to deliver beyond mediocrity
Rewards not only operational efficiency, but also provider outcomes
Provide room for mistakes and quick recovery
Plan extra staff for early exits based on performance, absenteeism and other reasons
Cross train with caution (not everyone can do!)
Enabling Tools and Traction
• Build a Culture of Proactivity
• Reinforce mindset of preventing denials - Clean ‘straight through’ billing
• Make working resources accountable for preventable denials
• Continuously training people in problem solving
• Watch the right leading indicators – AR touch points, clear prioritization practices, daily operational triggers, red flag control
• Track the right lagging metrics -14 key KPIs
• Create workflow capabilities to work, track, measure and report daily
• There’s a limit to using spreadsheets
• Daily control and problem solving is essential for disciplined outcomes
• Develop daily, weekly and monthly dashboard to measure process and people effectiveness
• Audit traceability for both people and processes
HME RCM Back-Office Operations
Order Confirmation
Hold Management
Claims Transmissions (Submission)
Front End Rejections
Cash Posting
A/R & Denial Management
Special Processes
Order Confirmation
Work Queues
Deep QA Check, add KX Modifiers
Error Log / Feedback System
Minimize & Promptly Address Inventory Issues
Document Management
Avoid confirming without proper documentation
Ensure documents are properly “filed” timely
48-hr Turn around time
Hold Management • Work Queues / Allocation (TFL as priority)
• New vs Follow-up Queues
• 4 Types of Holds:
• CMN / Prescriptions – better yet, be proactive!
• Prior Authorizations – again, be proactive.
• Misc. Auto. System Holds (i.e. PAP Compliance)
• Manual Hold
• Document Management
• Notes & Tasks
Claims Transmission
• Final QA on Claims Files
• Error Log / Feedback System
• Batching & Billing Errors
• Paper Claims
• Patient Statements/Invoices
Front End Rejections
• Work Queues
• Every Rejection Worked Every Day
• Rejection Analysis & Prevention
• Notes & Tasks
Cash Posting
Managing Daily Deposits (Lockbox)
ERNs vs. Paper Checks
EOBs/Checks Scanned within 24 hours
Patient Payments & Credit Cards
“Completeness” of Posting
Posting denials/rejections (w/in 48 hours)
All adjustments/transfers posted
Recoupments handled accurately
Missing payers added
Document Management
Denial Management
• Work Queues / Allocation
• Goal: work all denials within 48 hours of posting
• Prioritization – incl. appeal limits
• Document Management
• Notes & Tasks
• Denial Analysis & Prevention
• Quality Assurance
AR Management
• Work Queues / Allocation
• Prioritization – incl. TFL & processing time
• Follow-Up
• Claims Status (Unaddressed)
• Document Management
• Notes & Tasks
• 48-hr TAT on Info. Requests
• Feedback Loop
Special Processes
• Oxygen Contents
• RUL – Equipment Replacement
• Periodic Maintenance
• Mass Updates
• Convert to Purchase
• Month End
Joey Graham Executive Vice President
& General Manager
(980) 201-3082
www.prochant.com
Questions?
Thank You!