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Tips for Effective Home Infusion Revenue Cycle Management

Written by: Mediware on Monday, August 1, 2016 Posted in: Home Infusion

Revenue cycle management image-01Managing your home infusion business’ revenue—also known as revenue cycle management—is an ongoing process that needs constant attention. Here are some tips that can help you reduce your DSO and ensure consistent payments on all your claims, which helps keep the cycle going.

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  1. Refine your workflow
    To ensure that you get paid on a regular basis, implement some reminders and follow-up steps in the claims process.

    • Check statuses and work queues daily, so you never miss a deadline, such as a 72-hour authorization
    • Create templates to prefill detailed written orders (DWO) for physician signature, and include reminders to ensure the DWO gets signed in a timely manner
    • Establish a follow-up date and create a reminder for every claim, so you can be notified to check the status 30 days after submission so if there’s a problem, you know right away
    • Print reports every day, so your teams know which claims need to be addressed that day
    • Keep track of denials, and appeal or correct them within the allotted time
    • Log every denial and note the reasons for the denials, so you can be aware of areas that are consistently problematic
  2. Add quality control
    If you don’t already have a quality control process, implement a system to check and double-check each claim before submission.

    • Validate that all fields have been entered
    • Ensure that you have the assignment of benefits and the correct contract information
    • If more than one payer, ensure that primary and secondary are set up in the correct order
    • Ensure that all required documentation is in place
  3. Collect and analyze data
    Analyzing your metrics helps you spot problem areas and prioritize tasks. Some of the data you should regularly monitor include:
  • Days sales outstanding (DSO)
  • Overall accounts receivable (AR) and percentage of AR still outstanding after 90 days and after 120 days
  • Claims adjustments—including amounts and reasons why
  1. Cross-train your employees
    Obviously, billing and collections can’t come to a standstill when staff members are sick, on vacation, etc., so be sure that your employees have the skills to assist each other during absences.
  • Schedule team meetings to discuss each staff member’s billing activities
  • Create payer “cheat sheets” for each patient in treatment—complete with details such as non-standard payer preferences, relevant HCPCS codes, etc.—to guide back-up employees through billing process

Establishing and following these guidelines takes some time and effort, especially in the beginning, but it’s worth it in the long run. Ongoing claim management, fueling a steady flow of outgoing claims and a steady flow of incoming cash, is key to effective revenue cycle management. See how Mediware’s infusion reimbursement services can reduce your bad debt and grow your collections today!

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