The HME industry has had a rough couple years with retaining and hiring new staff, rising labor rates, and maximizing company revenue. With so much to keep track of, billing can become a nightmare. Even your best staff members can pick up bad billing habits that create bigger problems. With DME/HME clients all over the country, our Prochant team understands the problems facing HME providers.
To help healthcare providers tackle their billing issues, Prochant HME billing experts Christina Blyth, Reimbursement Success Advocate, and Rachel Schools, Senior Consultant, came together to discuss some bad habits in HME billing and how you can learn to avoid them.
Bad Habit #1: Too many not on file claims
You’re an A/R collector and you’re following up on a claim that’s 45 days old. The claim has just hit your queue for follow-up. You ask yourself, “Do I have proof that the claim was accepted by the insurance carrier? Did I get a response?” You call the insurance company and they say that the claim is not on file.
Does this sound familiar?
When your claims aren't getting filed with the insurance company, you have no chance of being reimbursed. Many times, not on file claims are denied for timely filing. Payers have limits within which you can file your claims. If you don't meet timely filing requirements, then you'll have write-offs instead of payments.
How to fix this:
1) Create as many electronic claim submissions as possible. This way, you have proof that your claims are on file based on the clearing house’s response. If you have that proof, insurance carriers can't really argue with that.
2) For payers where electronic submission is not an option, foster a relationship with the insurance representatives you speak with regularly if you do a lot of A/R follow-up. Try to submit things via secure email or fax so you have written proof that you submitted your claim in a timely manner.
3) Get your hands on data. Go through the production reports of your A/R team. Find the payer with the largest amount of not on file claims. Start with one payer at a time, and then just work through the list. Think “atomic changes.” Do not try to address too much at one time.
As long as you address the largest issues first and correct them before moving on, you’ll find that your not on file claims reduce, and your cash flow quickly improves.
Bad Habit #2: Losing track of unpaid claims
You’re an A/R collector looking at a claim on your team’s software system. In theory, the system should be keeping track of the transmission of that claim, the response for the transmission of that claim, and the payer's actual official response telling you whether or not they've paid or denied it.
You get into the system and see no claim. Maybe you can tell that the claim was transmitted and accepted, but you don't have a denial. In other words, you have no idea why the claim isn't paid.
You now have a couple of options:
Option one: You can go find a web portal for the payer and see if you have a login, cross your fingers, and pray that you can check the status that way.
Option two: You call the insurance company and they tell you why the claim was denied, only to find out later that the reason they provided wasn’t the actual denial reason. A letter in the mail is what tells you what was wrong with the claim. One letter turns into too many to keep track of and you lose track of your unpaid claims.
How to fix this:
Digitize your papers. Have someone in your office scan papers, break them down, and tag them electronically. Save endless phone calls by setting up this routine task.
Why do this? For example, a provider may get a one hundred page stack of documents and one of those documents is a three-page explanation of benefits (EOB). The document has all denials, but there are 30-something patients on that one three-page EOB. It may take you two minutes to go through all three pages and post the denials, but if you’re not paying attention, you miss capturing some data. Now you didn’t post 30 denials, and that’s 30 new phone calls to make. Digitizing everything will help you not make this mistake.
Bad Habit #3: Timely filing write-offs
Straight to the point, you’ve gotten in the habit of timely filing write-offs. This is something many providers assume is just part of the game. Of course, you’re going to have some percentage that’s written off, but this doesn’t have to occur due to timely filing.
How to fix this:
Look at the last six months and take a sample of your write-offs. In the past, did you not confirm that your claims were filed on time? Did you accidentally regenerate billing that was passed on your filing?
When you identify the root causes of your problems, you can start to prevent them. You have to evaluate your data, find the trending cause, and then make sure you keep good records moving forward. Take the write-off and adjustment codes and make them very specific in your system. In the codes, start putting the root cause within the write-off reason so you can see which ones rise to the top. Whether you start this process with one payer or one department at a time, it will help you maximize your revenue.
Bad Habit #4: Not having a structured outreach process
You get a referral from a hospital. The referral tells you that Ms. Jones is being discharged and needs oxygen. After you’re given some medical records and a prescription, most of the time, there’s some official form you need signed. However, you’ve already got Ms. Jones leaving the hospital and need that DME equipment as soon as possible. The equipment gets delivered to Ms. Jones.
The order then turns into a claim that sits on hold, because you still need a form signed, like a certificate of medical necessity, from the doctor. The claim drops into a queue and doesn’t get sorted, so you start calling the doctor, but they don’t have any medical records. You put a follow-up for three days later, and the claim goes into Neverland.
How to fix this:
Make sure your outreach is structured by doctor or figure out a stricter hold management process. If you’re a healthcare provider, there are probably just a handful of referrals that make up most of your referrals. Instead of making multiple phone calls to doctors by working through a hold list, group your calls by doctor and address multiple patients in one interaction.
Be sure to keep up with your contacts. When you have made multiple attempts to collect documentation, your policy should be to call the patient and ask if they are still using the DME equipment (i.e. concentrator). If yes, notify them of the issue in obtaining qualifying billing documentation, and ask them to engage with their ordering provider. Go ahead and open the conversation to the need to make arrangements for payment if qualifying documentation is not received. If the patient is no longer using the equipment, pick it up.
Bad Habit #5: Not having a feedback loop between teams
An authorization not on file remains the top denial for six months in a row. The front end or intake team are not being immediately made aware of any product/equipment and payer combinations triggering these denials, so the issue is not being resolved upstream.
How to fix this:
When you get denied or have a write-off, you have to feed it back into your front end. Create a feedback loop so that all your teams are working toward the same goal, avoiding the trending problems that you’re seeing over and over again. Implement error reporting if you’d like to drill down. Having a well-oiled feedback loop will strengthen your whole process.
Prochant is the leading reimbursement firm with a dedicated focus on HME and pharmacy. We have DME/HME clients from all over the country and handle front-end and back-end billing functions. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national HME and pharmacy providers and health systems.