Tuesday, April 20 | Thought Leadership, Revenue Cycle/Billing

4 Must-Know Clinical Practices for Revenue Cycle Success

By Netsmart

Given the lasting impacts of the Patient-Driven Groupings Model (PDGM) on the home health industry, employing the most efficient processes for documentation, diagnosis coding and OASIS accuracy are vital to keep your revenue cycle operations on track and to optimize reimbursement. 

In a recent Netsmart + McBee webinar moderated by Vice President and McBee Chief Nursing Officer Jeri Ann Kelly, industry experts Karen Tibbs, McBee director of OASIS quality assurance, and Matthew McGowan, McBee advisory consulting manager, shared strategies for bolstering your revenue cycle under PDGM. 

1. Eliminate gaps in referrals/intake

While the intake process prepares the patient for the clinician to complete a comprehensive assessment, it also prepares that patient for a clean claim. 

During this process, revenue risks can arise via capture of incorrect demographics, invalid face-to-face (F2F) and incomplete insurance verification and eligibility. If not mitigated, these risks can translate into financial consequences, including decreased conversion percentage, delayed billing and denials. 

How can you mitigate these risks?

  • Designate specific staff educated on agency payers 
  • Maintain up-to-date checklists for all steps 
  • Conduct welcome calls to verify information and scheduling
  • Employ a clinical and clerical staffing model

2. Streamline comprehensive assessment process

This physical assessment supports payer eligibility, sets the foundation for managing that episode and, most importantly, determines the reimbursement you will receive. 

In this assessment, incomplete OASIS collection, clinical documentation and insurance and eligibility verification can negatively impact your revenue, resulting in case mix inaccuracies, denials and compliance risk.

How can you mitigate these risks?

  • Create an F2F addendum checklist 
  • Hold timely additional discipline evaluations with collaboration
  • Establish and maintain clinician OASIS competency 
  • Enforce documentation submission deadlines
  • Conduct quality assurance (QA) oversite  
  • Utilize key performance indicators (KPIs)

3. Reduce coding errors 

One of the most important aspects of accurate revenue capture, ICD-10-CM code assignment determines clinical grouping from the primary diagnosis and patient comorbidity adjustment. The ability to identify comorbid conditions and associated claims reimbursement is paramount to the success of your revenue cycle. 

However, risks arise via non-compliance with official ICD-10 guidelines, inaccurate comorbidity capture and incorrect primary diagnosis. These errors can result in case mix inaccuracies, compliance risk and denials, all of which can severely handicap your revenue cycle. 

How can you mitigate these risks?

  • Employ certified coders
  • Ensure coder competency 
  • Gather comprehensive patient medical information 
  • Establish a compliance diagnosis query process 
  • Utilize KPIs

4. Close the case management gap

Successful management of patient episodes, visits and outcomes achievement are vital to the overall success of your organization clinically, operationally and financially. 

Risks associated with case management include incomplete documentation, inaccurately captured new diagnoses, siloed discipline care and improper use of telehealth visits. These risks can yield disastrous outcomes on your revenue cycle, including increased Low Utilization Payment Adjustment (LUPA) rates, non-compliance and denials. 

How can you mitigate these risks?

  • Analyze LUPAs 
  • Conduct clinician education
  • Encourage collaboration and communication
  • Manage visits by goals and outcomes rather than discipline
  • Implement a clinician scorecard

To learn more about supercharging your revenue cycle in the world of PDGM, listen to the complete webinar here.  

 

 

Meet the Author

Netsmart - color - PNG
Netsmart ·

Communities

From the CareThreads Blog

How Technology Drives Game-Changing Workforce Satisfaction

Thursday, January 26 | Thought Leadership,EHR Solutions and Operations,Care Coordination

EHRs have evolved to serve as a foundational launching point for integrated, coordinated healthcare. Hear how county providers can optimize the capabilities of their EHRs to help recruit and retain high-quality clinical, financial and operations staff to support overall workforce improvements.

More

NAHC President Bill Dombi Shares 2023 Industry Outlook

Wednesday, January 25 | Thought Leadership,Post-Acute Care,Value-based Care

From workforce issues to value-based reimbursement models and legislative & regulatory change, there is plenty for hospice and home care agencies to keep an eye on in 2023. The National Association of Home Care & Hospice (NAHC) President Bill Dombi discusses the trends of the new year and offers his expert advice on how to navigate the coming months.

More

The Future of CCRCs: Success for 2023 and Beyond

Tuesday, December 20 | Thought Leadership,Post-Acute Care,Value-based Care

According to a recent report, there will be a “healthy demand” for Continuing Care Retirement Communities (CCRC). That doesn’t mean there won’t be any challenges. Leaders of these full continuum communities are still dealing with issues like inflation and recovery from the coronavirus pandemic. Senior care expert Eva Bering, MSN, MHA, RN, NHA, shares her thoughts on what leadership and boards of not-for-profit life plan communities need to focus on for future success.

More