Top Features you need in your Home Healthcare Software
With falling reimbursement rates, the rollout of PDGM, and increased compliance, Home Care Agencies are under pressure to do more with less. Improving the health of the revenue cycle is a complex process that needs both caregivers and financial administrator to work in synchrony to achieve optimal results.
Contrary to the popular perception that the revenue cycle process starts after billing is completed and claims are sent out, it starts at intake and continues through authorization, scheduling, billing, and collections. Seasoned revenue cycle administrators, establish processes to collect accurate information at intake, verify eligibility, keep up with authorization, scheduled the visits of caregivers based on authorization, and validate claims before submitting. A high percentage of denials have their root cause in eligibility and authorization issues. Establishing structured processes ensures that all participants in your home care services delivery team understand their responsibilities towards managing as well as optimizing revenue and collections.
Of course, having the right tools to proactively detect and manage exceptions through the entire revenue cycle help. An integrated platform that covers all processes including intake, authorization management, scheduling, billing, and collections, and provides features to manage the revenue cycle requirements of these processes is a must for ensuring optimal reimbursements.
Top 6 home healthcare claim denial reasons
A look at the top 6 denials that constitute as many as 90% of the claim denials points to the fact that many of these denials are preventable, provided the practitioners are conscious of their responsibilities, and the software platform leads them in a manner that optimizes submission of clean claims.
Let us take a deep dive into some of the nuances of the home care revenue cycle at each step of the delivery process, and how a robust platform can help you address these.
Challenges: Understanding the nuances of the home care revenue cycle
Often Intake, scheduling, billing, and clinical operate in silos. Understanding the nuances of home healthcare revenue cycle processes and taking an integrated view is critical to the financial success of home care agencies. The following are some of the challenges of the home care revenue cycle:
Patient information, Prior authorization, and Eligibility Issues
Not having accurate and complete information on the patient
Not knowing that you do not have accurate and complete information
Lack of a seamless process to verify eligibility during initial intake and ongoing verification for changes
Effective management of authorization
Scheduling and Care Delivery
Ensuring that scheduling is done only after authorization is completed.
Scheduling within authorized hours or visits is only allowed and preventing scheduling beyond authorized hours.
Capturing timesheet information from point of care clinical documentation.
Revenue Cycle
Validating claim information before sending claims to payers.
Too much manual effort to handle payer exceptions
Reporting and Analytics
Effective reports and collection tools to manage overdue claims and receivables.
Must-have Features in a Home Healthcare Software Platform
We provide below some of the features your software platform should have to effectively manage revenue and collections for Home Care Agencies:
Intake
Collecting complete and accurate information during the intake process is key to sending out claims with correct information. This will significantly reduce the number of denials and improve the time to getting reimbursements. Denied claims will slow down your cash flow cycle and take additional resources and time to collect and submit the claims.
The following are some of the features your software platform should have during the Intake Process:
Instant alerts to warn about missing or mismatched information during the intake
Option to verify eligibility seamlessly during intake
Batch eligibility verification to check for any changes after the initial intake
Ability to verify NPI and PECOS information for referring physicians during intake.
Automatically detect and notify the intake team with missing and mismatched information.
Scheduled exception reports with missing and mismatched information that can be sent via email.
Authorization Management
One of the main reasons for the rejection of claims is providing services to patients without proper authorization or plan of care. Providing services beyond the authorized frequency will lead to non-billable services.
The following are some of the features your software platform should have to manage authorizations.
Ability to monitor expiring authorizations to initiate the reauthorization process. This will eliminate the possibility of providing services without authorization.
Option to create schedules from authorization or plan of care. This will help agencies to stay within authorized services.
Reports to monitor and manage frequency compliance with the authorized plan of care
Reports to monitor authorized hours and delivered hours for the authorization period
Reports to monitor and manage authorized hours and dollar amount
Option to prevent scheduling beyond the authorization period and frequency
Scheduling
Scheduling is a very critical tool in managing your revenue cycle. Scheduling links authorization and plan of care to billing and claims. Scheduling based on authorization or plan of care will reduce potential denials and non-billable services. Capturing times from clinical documentation will save time and reduce data entry errors.
The following are some of the features your software platform should have to manage authorizations:
Prevent schedulers from scheduling outside authorized hours or visits
Validations to capture potential billing errors - mismatched plan and service, schedule beyond authorization date, duplicate services, etc.
Ability to automatically split schedules at midnight preventing denials by submitting claims with correct dates
Ability to capture time from point of care documentation and create charges – This will reduce data entry errors
Billing and Claims
Sending clean claims is the best way to effectively manage revenue in a home care agency. The higher the % of clean claims in the first pass, the better would be your cash flow cycle. A software platform with a built-in claim scrubber that can check for errors and allow the biller to correct the errors before sending the claims will be very helpful. The ability to customize claim formats to meet disparate claim requirements of various payers will reduce denials and improve collections.
The following are some of the features your software platform should have to manage claims.
Built-in claim scrubber with the ability to customize validations by the payer and improve clean claim submissions
Ability to look back to make sure authorizations and documentations are in place. This will prevent claims from being sent out without authorizations and documentation.
Ability to adjust claim formats (paper or electronic) to meet payer requirements. This will reduce manual interventions and errors before sending claims.
Ability to send invoices to payers, like community waiver programs, who do not accept standard claim formats (1500 – UB04)
Ability to send statements to patients for private pay,. or for co-insurance
Exception Reports
Exception reports are very useful in managing revenue effectively. Exception reports at various stages from intake to billing will enable agencies to identify errors early and correct them before claims are sent. Exception reports can also identify incomplete admissions, authorizations, and schedules enabling agencies to make sure all the services are billed on time. Printing and reviewing these reports will significantly reduce claim denials and improve collections.
The following are some of the exception reporting features your software platform should have to manage claims.
Intake exception reports listing missing intake information needed for claims
Report that will list admissions and authorizations without any schedules
List of schedules for which charges have not been created for various reasons
List of charges for which claims have been sent
Pre claim validation reports based on the claim scrubber
Financial Management Reports
Financial Management Reports will enable home care agencies to measure financial performance and proactively take measures to improve performance. These reports will help agencies to come up with benchmarks for revenue cycle management.
The following are some of the financial management reports your software platform should have to manage claims.
Aging report with user-definable aging buckets
Days Sales Outstanding Report by payer, business line, or location
Late claims report ensure that claims are submitted within the time limit for payers
The average number of Request for Anticipated Payment (RAP) and Final claim days for Medicare agencies
Trending reports comparing data over a period of time
Denial Reports
Conclusion
CareVoyant understands that Revenue Cycle Management is an ongoing process that starts when the patient admitted and continues through billing and collection. We have focused on building an integrated software that enables all participants within your revenue cycle and home healthcare delivery processes to understand their responsibilities in ensuring that collections are optimized. CareVoyant’s Home Care Software Platform has been engineered for easy configuration to effectively manage billing and collection responsibilities at each stage.
ABOUT CAREVOYANT
CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.
CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.
For more information, please visit CareVoyant.com or call us at 1-888-463-6797.
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