Providing quality, end-of-life care is the primary focus of hospice care, but it’s your billing function or, more specifically, your revenue cycle management (RCM) process that will determine whether you have the cash flow needed to pay staff and successfully manage growth.
In a recent Hospice RCM webinar, 58% of over 100 attendees polled said they either didn’t know or were unsure of what hospice RCM actually meant. To clarify, RCM encompasses all the administrative and clinical activities associated with revenue generation. It’s your entire billing process—from registration and claims submission to payment and collections. That means it touches everyone in your hospice agency—not just your billers.
Hospice claims are really just a reflection of all the clinical work performed by everyone on your team. If your clinicians at the point of care are not providing complete and accurate documentation upfront, then it’s going to reflect on the backend with rejected claims and delayed payments. That means, instead of focusing on patient care and other high-value activities, your staff are going to be spending valuable time chasing down claims to correct mistakes—if they have time to do that at all.
According to Medical Group Management Association (MGMA), the average cost to rework a denied claim is about $25, and more than 50% of denied claims are never reworked. That’s a significant loss of revenue and added expense that could have been avoided from the start.
Get Denials Under Control
Nearly half (48%) of webinar attendees polled saw denial rates of less than 5%, which is exactly where you should be aiming. However, close to a third (27%) exceeded 5%. It’s not unheard of to see hospices dealing with 20-30% of claims rejected each month.
Getting your denials under control is a key step in establishing a strong RCM. And one of the best ways to do that is by avoiding simple errors made during the intake process. Here are some common data entry mistakes to be aware of:
— Incorrect spelling of a patient’s name – Something as basic as not including the “Jr.” or “Sr.” on the name can delay payment.
— Incorrect Date of Birth or Date of Death – Once an incorrect date of death is posted to the common working file, it can be a difficult and prolonged process to get it corrected.
— Incorrect Payer ID number, Medicare Beneficiary Identifier (MBI) – As of January 2020, you will need to submit claims using the MBI number, which replaces the Health Insurance Claim Number (HICN).
— Certification Dates – These need to be accurate and cover the benefit period dates for the certification or recertification.
These are just a few examples of errors that can wreak havoc on billing. If they aren’t caught upfront, the claim will be denied later by the insurance company—leading to processing and payment delays that can last months. Proper training will go a long way toward solving the problem. But it’s also important to evaluate if the hospice EMR you have in place is supporting your staff during the intake and documentation process.
Systems adapted from other healthcare environments, such as home health, can be cumbersome to use and force hospice staff to create error-prone workarounds to document care. Hospice EMR software should keep hospice clinicians and staff on track by enforcing compliance with hospice-only questions, forms and alerts that guide staff through the admissions process—step by step, without missing information or deadlines.
Even with the right EMR in place, there may be other issues in your billing process that can lead to denied claims or delayed payments. Some hospices have turned to outsourced RCM services to help identify and remediate any issues. When considering providers, make sure the RCM service has experienced hospice billing experts on staff who understand the unique regulatory, payer and billing requirements of hospice care. They should be well equipped to handle every part of the billing cycle—from pre-claim review to collections to accounts receivable management—so your hospice can focus on patient care.
To learn more about common hospice billing pitfalls and key hospice RCM strategies, watch this webinar: From Red to Black: Get Your Hospice Billing Back on Track.