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Your Home Health Agency Is Losing Money Before Billing Even Starts · The Home Health & Hospice Profitability Podcast

• 0:02
  SPEAKER_00: Every home health and hospice owner knows the feeling.
• 0:05
  SPEAKER_00: Census is up, the team is working harder than it ever has, and the margin still isn't there.
• 0:10
  SPEAKER_00: Your host has spent a career finding out why.
• 0:13
  SPEAKER_00: Doug Walters is a CPA with a master's degree in taxation, and before that, a home health agency owner himself.
• 0:20
  SPEAKER_00: So he's lived the problem before he built a career solving it.
• 0:24
  SPEAKER_00: He founded Walters and Associates in 1999, and the firm has since served more than a thousand home health and hospice providers nationwide.
• 0:34
  SPEAKER_00: Medicare and Medicaid cost reports, hospice cap, outsourced CFO work, and techs.
• 0:40
  SPEAKER_00: It anchors the Walters Family Companies, alongside Walters Billing Solutions, running revenue cycle and denials management for agencies, and Walters Strategic Advisors managing well for the owners who built them.
• 0:54
  SPEAKER_00: Three companies, one obsession.
• 0:56
  SPEAKER_00: The profitability of home health and hospice.
• 0:59
  SPEAKER_00: Here's Doug Walters.
• 1:00
  SPEAKER_01: Welcome back to the Home Health and Hospice Profitability Podcast.
• 1:03
  SPEAKER_01: This is the second part of a three-part series on revenue cycle management.
• 1:07
  SPEAKER_01: And I have with me again Amanda Sheldon, the director of revenue cycle management here at Walters Building Solutions.
• 1:15
  SPEAKER_01: So Amanda, welcome back.
• 1:16
  SPEAKER_02: Hey, thanks.
• 1:17
  SPEAKER_02: Happy to be good.
• 1:18
  SPEAKER_01: Great.
• 1:19
  SPEAKER_01: I know their the last uh episode was was well was well received, and uh we want to continue on to that series because revenue cycle management is such a big topic.
• 1:27
  SPEAKER_01: So certainly having you on several several episodes just makes a lot of sense.
• 1:31
  SPEAKER_01: So we can make sure that we get hopefully most of their clients' questions or providers' questions out there answered for them.
• 1:38
  SPEAKER_01: So let's talk about the blame game because you and I have talked about this quite a bit, right?
• 1:42
  SPEAKER_01: Uh you've worked every line in that blame game or that blame chain.
• 1:47
  SPEAKER_01: Uh so what what do you hear most?
• 1:49
  SPEAKER_01: And and talk about what that what we're really talking about here and a revenue cycle management as it relates to the blame blame game.
• 1:54
  SPEAKER_02: Sure.
• 1:55
  SPEAKER_02: And oh my gosh.
• 1:55
  SPEAKER_02: Okay, so honestly, and and I'm not saying this because I am, you know, I've done billing, you know, before, but most of the time it falls on the billing team, right?
• 2:04
  SPEAKER_02: Yeah.
• 2:05
  SPEAKER_02: And it's because a lot of agencies don't realize, right, like we talked about in our prior episode, that you know, the revenue cycle starts long before your billing team ever touches claim, right?
• 2:14
  SPEAKER_02: But if the money doesn't come in or claims are on hold, right, leadership immediately looks to the billing team for answers, right?
• 2:20
  SPEAKER_02: They want to know where's the money, why hasn't it been received, why are claims on hold, you know what's going on.
• 2:26
  SPEAKER_02: The issue with that is that the billing team might not always have the answers, right?
• 2:29
  SPEAKER_02: Maybe it's something on the clinical end.
• 2:31
  SPEAKER_02: Obviously, your billing team probably isn't typically involved in your orders tracking process, right?
• 2:35
  SPEAKER_02: Maybe it's something that falls on them, you know, and so because of that, then they, you know, they they don't always have the answers about the ability to solve them.
• 2:44
  SPEAKER_01: So uh they all they all have good intentions, yes, right?
• 2:48
  SPEAKER_01: So so why do good hardworking teams blame each other?
• 2:52
  SPEAKER_02: So truthfully, I think that the regulatory and compliant side of this business makes it increasingly difficult, you know, to even be able to bill a claim, right?
• 3:01
  SPEAKER_02: Let alone get paid for it, right?
• 3:02
  SPEAKER_02: Because you have to have so many, you know, pieces in order to be compliant.
• 3:07
  SPEAKER_02: You know, and then if you add in the reimbursement guidelines, right, provided by Medicare and commercial payers, it's it's almost impossible to completely grasp.
• 3:17
  SPEAKER_02: Right.
• 3:17
  SPEAKER_02: So I think the key is to to trust each other and to have good, solid processes in place and make sure that you have those checks and balances, good communication, and being able to understand how what one department does affects the other.
• 3:34
  SPEAKER_01: You know, one of the things in in our CPA firm, I just had a meeting just literally, literally a couple days ago about this, is that we've got a CRM client or contact relationship manager, and and the marketing team wants our our people to fill out those leads as they come in, right?
• 3:51
  SPEAKER_01: To make sure that you're you're you're recording this data.
• 3:54
  SPEAKER_01: Yep.
• 3:54
  SPEAKER_01: Because if you don't record that data, then first of all, the lead doesn't get followed up on.
• 4:00
  SPEAKER_01: If a client calls and has a question or needs some help, we're not able to follow up because we don't know about it, it falls between the cracks if we don't keep good records, right?
• 4:08
  SPEAKER_02: Yep.
• 4:09
  SPEAKER_01: And and also we want to have reporting from that, right?
• 4:12
  SPEAKER_01: We want to be able to pull that data and have good reports.
• 4:17
  SPEAKER_01: And so one of the things that I thought was important was to explain to my team why it's so important to do that, right?
• 4:24
  SPEAKER_01: Like how this process works overall, so they understand the importance of it, and therefore compliance will increase.
• 4:31
  SPEAKER_01: And that's been effective so far.
• 4:32
  SPEAKER_01: It's only been a couple days, but I think hopefully that solves it, right?
• 4:34
  SPEAKER_01: Yes, and it kind of makes me think through that with this process.
• 4:39
  SPEAKER_01: When you talk about, you know, everyone wants to do a good job, they all have their own ownership of the process, and the overall process is so very important, and they have a piece of that understanding the entire process of what everyone does.
• 4:52
  SPEAKER_01: Yeah, would that make sense to explain to everyone to kind of walk through how they all affect each other?
• 4:58
  SPEAKER_01: Yes.
• 4:58
  SPEAKER_01: Or do they do that?
• 4:59
  SPEAKER_01: Is that is that a common thing?
• 5:00
  SPEAKER_01: I don't know.
• 5:01
  SPEAKER_02: So I think it really depends on agency size, right?
• 5:03
  SPEAKER_02: And how much of your process you have outsourced, right?
• 5:06
  SPEAKER_02: So, like, and you know, how how good is your outsource company, right?
• 5:09
  SPEAKER_02: You know, there are some, you know, agencies that have like a consultant or they might have their orders tracking outsourced or, you know, whatever it is, right?
• 5:17
  SPEAKER_02: Um, but making sure that everybody kind of communicates together is really important.
• 5:21
  SPEAKER_02: I will say that it's funny because I I used to work for a little uh billing company for ambulance rides, right?
• 5:27
  SPEAKER_02: And one of the things that they did when I very first started there was you had to sit with each department for your first week, right?
• 5:35
  SPEAKER_02: And just see what each department did.
• 5:37
  SPEAKER_02: And that was so beneficial because you got to see, like, okay, this is what happens when the claim is keyed in.
• 5:42
  SPEAKER_02: This is what happens when, you know, the claim gets billed out.
• 5:46
  SPEAKER_02: This is what happens when the claim doesn't get paid.
• 5:48
  SPEAKER_02: This is how our patient collection department follows up.
• 5:50
  SPEAKER_02: And it was so, so, so very beneficial because you really got to see like how important your piece of the process was.
• 5:58
  SPEAKER_01: That's brilliant.
• 5:58
  SPEAKER_01: I love that.
• 5:59
  SPEAKER_01: Yeah, yeah, I can see.
• 6:00
  SPEAKER_01: Now the the challenge we have is is the time, right?
• 6:03
  SPEAKER_02: Yes, exactly.
• 6:04
  SPEAKER_01: We need someone in this role and we don't have time to let them spend weeks everywhere else.
• 6:07
  SPEAKER_01: I can see that.
• 6:08
  SPEAKER_01: I can see some providers saying there's no way we have time to do that.
• 6:11
  SPEAKER_01: Yep.
• 6:11
  SPEAKER_01: But uh but sometimes making that investment, even for a day or two, yeah, really pays off in the long run.
• 6:17
  SPEAKER_01: And and when a when a billing person is saying, I know what we're missing here and I know why we're missing it, yes, it's so effective in communication to get that that process fixed, right?
• 6:27
  SPEAKER_02: Yep.
• 6:27
  SPEAKER_01: Uh rather than just saying, I don't know, I I don't have that what I need, right?
• 6:31
  SPEAKER_02: Yeah, that's not my department or yeah, exactly.
• 6:33
  SPEAKER_01: Yeah, not yes, not me, but someone else.
• 6:36
  SPEAKER_02: I did my part, it's not not on me anymore.
• 6:38
  SPEAKER_01: Right, right.
• 6:39
  SPEAKER_01: So important.
• 6:40
  SPEAKER_01: So, what does money showing up look like at an agency?
• 6:42
  SPEAKER_01: I mean, we hear that all the time.
• 6:43
  SPEAKER_01: Money just shows up, right?
• 6:44
  SPEAKER_01: What does that mean?
• 6:44
  SPEAKER_02: Oh my, okay.
• 6:45
  SPEAKER_01: Yeah, walk me through that because we talk about that all the time too.
• 6:48
  SPEAKER_01: Yeah.
• 6:48
  SPEAKER_02: Yeah.
• 6:48
  SPEAKER_02: So that's funny because I literally had an agency, you know, like just tell me a few weeks ago that they didn't want to pay us to build their Medicare claims because, you know, the Medicare, the money just shows up in the bank, right?
• 6:59
  SPEAKER_02: And so I just was like, oh man.
• 7:01
  SPEAKER_02: You know, but it's because it's and it's not their fault, right?
• 7:03
  SPEAKER_02: They don't re they don't realize, right?
• 7:05
  SPEAKER_02: You don't know what you don't know.
• 7:06
  SPEAKER_02: Um, and they don't realize that, you know, there's strict timely filing, you know, guidelines around billing and strict timely filing guidelines around, you know, appeals and you know, claims that have been returned to a provider.
• 7:18
  SPEAKER_02: And on top of that, there are exceptions that can be submitted and oftentimes granted when there are provable extenuating circumstances, right?
• 7:26
  SPEAKER_02: So, like if you submitted your NOA timely, but for whatever reason it got rejected in your clearinghouse, maybe Waystar was down that day or Novalan was having issues, right?
• 7:33
  SPEAKER_02: There's an exception process that you can go through with Medicare in order to get the penalty waived and not lose any money on your final claims.
• 7:42
  SPEAKER_02: But if you don't understand all the work that's involved, it's it's really easy to just, you know, come to the conclusion that the money just shows up.
• 7:50
  SPEAKER_02: But it really is so much more than just sending claims and not having a good understanding of what is involved to get a claim paid can be documental to your financial health with an agency.
• 7:59
  SPEAKER_01: For sure.
• 7:59
  SPEAKER_01: And and uh, we see that on the accounting side too.
• 8:02
  SPEAKER_01: I mean, a lot of providers, especially new providers, operate based on what's in the bank account.
• 8:07
  SPEAKER_01: Yeah, yep.
• 8:08
  SPEAKER_01: Right?
• 8:08
  SPEAKER_01: Yep.
• 8:08
  SPEAKER_01: Yep.
• 8:08
  SPEAKER_01: It's like, okay, we've got some cash, we can make payroll, things are good.
• 8:11
  SPEAKER_01: Yeah, uh, or we're struggling, there's a problem because we can't make payroll.
• 8:15
  SPEAKER_01: So it's it's it's based on cash.
• 8:17
  SPEAKER_01: And you know, the question then becomes even if it's good, there's plenty of cash in the bank, maybe there should be a lot more cash in the bank, right?
• 8:24
  SPEAKER_01: Maybe there should be a lot, a lot of claims that weren't paid, also paid in and have that cash in the bank.
• 8:29
  SPEAKER_01: So that's if to your point, you don't know what you don't know, right?
• 8:32
  SPEAKER_01: So so certainly looking at that in detail makes a big difference.
• 8:35
  SPEAKER_01: So, how big is a gap between claims submitted and claims paid on a typical new client?
• 8:41
  SPEAKER_02: So there isn't one universal gap, right?
• 8:44
  SPEAKER_02: You know, but a healthy agency should be able to speak to every dollar amount, you know, between what it bills and what it ultimately collects, right?
• 8:54
  SPEAKER_02: So when we see a large gap with an agency, what we want to know is is it a legitimate contractual obligation or is it avoidable leakage, right?
• 9:03
  SPEAKER_02: From denials, documentation problems, missing authorizations, delayed billing.
• 9:07
  SPEAKER_02: Is it related to an EMR setup problem?
• 9:10
  SPEAKER_02: The real benchmark is not submitted versus paid, it's submitted versus expected collectible revenue and how long it takes to turn that into cash, right?
• 9:23
  SPEAKER_02: So, and for hospices, you know, we just had an agency join us in June that had claims RTP'd all the way back to December that hadn't been worked, right?
• 9:33
  SPEAKER_02: And so hospice has that sequential billing requirement.
• 9:36
  SPEAKER_02: So they had claims that hadn't been paid now for December, January, February, March, April, May, you know, so it really can it really is a domino effect if you don't understand that.
• 9:50
  SPEAKER_01: So so talk walk through that that sequential billing because that's an important concept.
• 9:54
  SPEAKER_01: So so you in that situation, May's not going to be billed.
• 10:00
  SPEAKER_01: You can't even build May, right?
• 10:01
  SPEAKER_01: Because you've got to you've got to go back.
• 10:03
  SPEAKER_01: So so walk through that.
• 10:04
  SPEAKER_02: Yeah, so and and there are some EMRs where you can just override the bill, the bill, the billing claim hold and send it anyway, right?
• 10:10
  SPEAKER_02: There are some where you can do that.
• 10:12
  SPEAKER_02: A lot of them you can't, but some of them you can.
• 10:14
  SPEAKER_02: The the most important piece of that is if that if you have a claim that's been RTP'd and you don't fix it, you can't, Medicare regulation says that you cannot, you have to bill everything in sequence.
• 10:27
  SPEAKER_02: So you like you can't bill the month of January until December has been processed, right?
• 10:32
  SPEAKER_02: And that is so, so, so, so important.
• 10:35
  SPEAKER_02: I mean, that's something even when it comes, and I know you and Lisa did um the other series about CAP, but that even plays into CAP problems then, right?
• 10:41
  SPEAKER_02: Because now your PSNR isn't right.
• 10:43
  SPEAKER_02: So it's, you know, it is such a huge piece of it.
• 10:46
  SPEAKER_02: And one RTP claim now is gonna have you delayed and could potentially lead to incorrect CAP reporting, cab overpayments that come back later, and your revenue, you know, you're not receiving your cash timely, and it's it's it's a whole it's a whole thing.
• 10:59
  SPEAKER_02: It's so important not doing it.
• 11:01
  SPEAKER_01: Yeah, yeah, it makes sense.
• 11:02
  SPEAKER_01: I'm not sure if this is a fair question, so bear with me.
• 11:04
  SPEAKER_01: I don't know if you if you can put a number on it, but if you can, what do you think the percentages of of denials that occurred in billing as opposed to somewhere else?
• 11:15
  SPEAKER_02: I think a lot, I think a lot of denials occur like upstream.
• 11:20
  SPEAKER_02: I really do.
• 11:21
  SPEAKER_02: And and I'm not just saying that because I've done billing in the past.
• 11:25
  SPEAKER_02: I honestly think that it's so easy to just say like you know, billing should handle it, or it's you know, billing's fault, because billing is the one who's ultimately responsible for what goes out the door, right?
• 11:36
  SPEAKER_02: So we're the ones that are generating the file and we're sending the claim.
• 11:40
  SPEAKER_02: The problem is that, you know, you you don't want your biller to also be managing all of your front-end processes because then that's time that they're taking from in your aged AR, doing exception requests, following up on your RTPs, you know, because they're managing your front-end processes.
• 11:57
  SPEAKER_02: So I mean, I I don't know that I can really say what percentage comes from billing, but I think, you know, it's a whole team, it's a whole team effort and you really want to fix your root costs, right?
• 12:11
  SPEAKER_02: So if wherever the problem is starting, even if it's in billing, right?
• 12:14
  SPEAKER_02: If it's a if it's a root cause problem, if your EMR is set up incorrectly, like have a have a clearly established role for someone who's gonna be managing that, who's gonna look at it, who's gonna make sure that rate increases are put in the system, that codes are set up to build correctly, you know, and and then, you know, have have your front-end staff just have a basic understanding of the revenue cycle process and like we just said, how what they do affects the next department.
• 12:40
  SPEAKER_01: You know, I I talked to a client a while back, this goes back maybe, maybe even six months ago, and it was a home health provider doing doing okay, you know, growing their business, uh, had a census of about 65.
• 12:53
  SPEAKER_01: And the DON was also seeing patients.
• 12:56
  SPEAKER_01: And we were having a cash flow issue.
• 12:58
  SPEAKER_02: Yeah.
• 12:59
  SPEAKER_01: And so on the on the accounting side, we're reviewing their financial statements, talking about cash flow issues, and and trying to identify where the issue occurred.
• 13:07
  SPEAKER_01: And when I found out that their their DON was also seeing patients without that kind of a census, I said, I don't know your DON.
• 13:14
  SPEAKER_01: I have never been to your office, but let me let me paint a picture for you.
• 13:18
  SPEAKER_01: I guarantee you there's files in that DON's office stacked up.
• 13:22
  SPEAKER_01: Stacked up, yep.
• 13:23
  SPEAKER_01: And that's where your money is.
• 13:24
  SPEAKER_01: Yeah.
• 13:25
  SPEAKER_01: And they're like, well, well, of course, there's there's stuff, there's a lot of paperwork in there, but we I'm like, listen, you can't afford to have that DON out in the field anymore, right?
• 13:34
  SPEAKER_01: There's there's a point in time where when you're a startup agency, yeah, that makes a lot of sense.
• 13:38
  SPEAKER_01: You only have a couple patients of DON, if they're willing, can see patients, and and that's fine.
• 13:42
  SPEAKER_01: But when you get to a certain census, it makes no sense, no time because the DON can literally not go through the paperwork.
• 13:49
  SPEAKER_02: Right.
• 13:49
  SPEAKER_02: Right?
• 13:49
  SPEAKER_01: She's too busy seeing patients, it's stacking up, and all of those charts sitting there is literally cash flow.
• 13:55
  SPEAKER_01: It's money.
• 13:56
  SPEAKER_01: Yeah, just sitting there.
• 13:57
  SPEAKER_01: Yeah, and the longer it sits there, the worse it gets.
• 13:59
  SPEAKER_01: Yep.
• 13:59
  SPEAKER_01: And it and the higher that stack gets.
• 14:01
  SPEAKER_01: So for those those listeners out there that that are in that that bucket, consider that because that's an that's an easy fix.
• 14:07
  SPEAKER_01: It seems expensive, but you really can't afford to not make that change, you know, to get that DON in the office full time and get that paperwork moving because that's that's upstream, right?
• 14:16
  SPEAKER_01: That's upstream.
• 14:17
  SPEAKER_02: Oh, yeah.
• 14:18
  SPEAKER_01: Examples of what you're talking about.
• 14:19
  SPEAKER_02: 100%.
• 14:20
  SPEAKER_02: Yep.
• 14:20
  SPEAKER_02: And then that is the reality for a lot of agencies.
• 14:22
  SPEAKER_02: Like you said, like the small, especially smaller agencies when they're first starting out, like, you know, of course, you know, there's gonna be times for your short staffed or whatever it is, and you're, you know, your DON has to run into a and do a visa.
• 14:32
  SPEAKER_02: But that is definitely get make sure that they're you know doing whatever job they were assigned to do, right?
• 14:38
  SPEAKER_02: Because there's a reason you hired up, right?
• 14:39
  SPEAKER_02: You know that you have QA that needs done, you know that you need this the charts audited, you know that you have, you know, clinical education that has to happen, right?
• 14:46
  SPEAKER_02: And they can't do that if if they're not doing the job that they were hired for, and right.
• 14:50
  SPEAKER_01: And I've been there, I you know, like I said, I you know, we I had the home health agency, we we did the same thing, and there's a point in time where you where you learn that lesson the hard way.
• 14:57
  SPEAKER_02: Yep.
• 14:58
  SPEAKER_01: And and the hard way is you know, continue that for a long cycle, and that DON gets burned out.
• 15:04
  SPEAKER_01: And then now you've got a bigger problem.
• 15:06
  SPEAKER_01: You know, now you lost your DON and uh and all the problems that go along with that.
• 15:10
  SPEAKER_01: So take heed to uh to lesson lessons learned, right?
• 15:13
  SPEAKER_01: Lessons learned for sure.
• 15:14
  SPEAKER_01: Give me a denial that started in marketing and any examples of that?
• 15:17
  SPEAKER_02: Yeah, so we actually have one client that continuously accepts referrals for an Ohio MyCare, or now it's next generation plans, and they the marketing doesn't, I guess, didn't realize uh that the client was not participating with that with that particular plan.
• 15:33
  SPEAKER_02: So yeah, so you know, those claims ended up at a write-off, right?
• 15:37
  SPEAKER_02: And and those plans are Medicaid plans, so they're even more like they they're they're not gonna pay, you know.
• 15:43
  SPEAKER_02: So because of that, right, and so this is another piece of like, okay, we're the billing team, but hey, we're showing you this is this is a problem now.
• 15:50
  SPEAKER_02: So we were able to quantify that, put a dollar amount to it, and and we've since taken over their eligibility piece for them.
• 15:56
  SPEAKER_02: And when they send us those patients to verify, because they still they'll still say, hey, we're gonna take this patient, right?
• 16:02
  SPEAKER_02: Because I I don't think that marketing has fully been educated.
• 16:05
  SPEAKER_02: So they'll they'll send us those patients and we have to tell them, you know, you you're at a network with this plan, and then they typically end up passing on those referrals.
• 16:13
  SPEAKER_01: Yeah, it kind of goes back to the discussion earlier about you know, walking each team through what everyone does and why, and and getting some education along the whole process.
• 16:23
  SPEAKER_02: Yep.
• 16:24
  SPEAKER_01: Yeah, it makes sense.
• 16:25
  SPEAKER_01: So when you take on a new client and you open an EMR system or take a look at their billing, what's the first thing that you look at that that says, hey, we got a problem here?
• 16:34
  SPEAKER_01: What's the first sign that you see that that's something's something's awry?
• 16:37
  SPEAKER_02: The high aging.
• 16:38
  SPEAKER_02: So so we look for trends of frost hires.
• 16:41
  SPEAKER_02: So typically what we do is we pull the agency's AR, the majority of them you can pull into an Excel spreadsheet.
• 16:47
  SPEAKER_01: And just for those that don't know, aging and AR, we're talking about country receivable.
• 16:50
  SPEAKER_02: Yes, counts receivable.
• 16:52
  SPEAKER_01: All the money that's owed to the agency.
• 16:53
  SPEAKER_01: Yep.
• 16:53
  SPEAKER_01: And the and the aging report, and the aging report is is by days, right?
• 16:57
  SPEAKER_01: So zero to 30 days, 30 to 60 days.
• 16:59
  SPEAKER_02: Yes.
• 16:59
  SPEAKER_01: It just ages the claims by certain buckets.
• 17:02
  SPEAKER_01: Yeah.
• 17:02
  SPEAKER_02: Yeah.
• 17:03
  SPEAKER_02: Yeah.
• 17:03
  SPEAKER_02: So, and those are for just your build claims.
• 17:05
  SPEAKER_02: This is not your claims on vote.
• 17:06
  SPEAKER_02: This is nothing to do with any unbuild or anything like that.
• 17:09
  SPEAKER_02: So, what we do is we pull the AR into Excel and then we pivot it out with the aging buckets, and then we typically sort it by payer from highest to lowest.
• 17:19
  SPEAKER_02: So then that that gives us a pretty good idea, um, is especially for like our billing team for organizational purposes.
• 17:26
  SPEAKER_02: Like, where are we gonna attack first?
• 17:28
  SPEAKER_02: Which payers have the highest dollar amount in your 60 to 90 bucket, right?
• 17:32
  SPEAKER_02: That might have a 90-day timely filing, like care centrics, or you know, which ones are Medicaid plans that, you know, how much is in 180, which payer has the highest amount, that's where we start.
• 17:42
  SPEAKER_02: But typically, you know, when we sort that out, that gives us a really good picture of what's been billed and hasn't been paid yet.
• 17:49
  SPEAKER_02: And that's usually a pretty good indicator that something isn't right.
• 17:52
  SPEAKER_01: Yeah, great.
• 17:54
  SPEAKER_01: So if an agency wants to have one person responsible for claims, who should it be?
• 18:01
  SPEAKER_01: And what should they look at weekly?
• 18:04
  SPEAKER_02: Okay, so the who isn't gonna be that's not a one size fits all, right?
• 18:08
  SPEAKER_02: You know, like we just said, sometimes the agency owners out making visits, right, because they're short staffed.
• 18:13
  SPEAKER_02: It it isn't, I mean, that obviously isn't something we ever recommend, but that's the reality that a lot of the a lot of our agencies are are living in right now, especially with a continued oversight.
• 18:21
  SPEAKER_02: Whoever's gonna own that role, um, they should be looking at a high-level dashboard of a few different KPIs, right?
• 18:28
  SPEAKER_02: So they want to look at their clean claim rate.
• 18:30
  SPEAKER_01: Um the KPI uh key performance indicator.
• 18:33
  SPEAKER_01: Yep.
• 18:33
  SPEAKER_02: Right, yeah, yep.
• 18:34
  SPEAKER_02: So they want to look at their clean claim rate, what percentage of their claims are going out clean and correct the first time without having to be retouched, right?
• 18:41
  SPEAKER_02: The days it took to build a claim, right?
• 18:44
  SPEAKER_02: Um, how long did it take for the claim to be ready, days to pay, right?
• 18:48
  SPEAKER_02: So from the time you send it until the time it gets paid, the denial rate, outstanding dollar amounts by payer, um, the amount of money at risk, and the top reasons for non-payment, right?
• 18:57
  SPEAKER_02: So do you have a ton of claims that are rejecting for off?
• 19:01
  SPEAKER_02: Well, then you know you have an auth problem.
• 19:02
  SPEAKER_02: Do you have a bunch of claims that have denied because you're out of network?
• 19:06
  SPEAKER_02: Okay, well, now you need to talk to marketing if they're not understanding, right?
• 19:09
  SPEAKER_02: You know, are you seeing a ton of claims where you ended up doing write-offs because the patient had a Medicare secondary payer and it wasn't caught, so you didn't send an NOA?
• 19:17
  SPEAKER_02: So now you need to go talk to your eligibility team.
• 19:20
  SPEAKER_02: You know, it it really they it really is a whole, like I said, it's a whole picture, right?
• 19:24
  SPEAKER_02: And they really should be asking themselves, what could we have done to to prevent this?
• 19:30
  SPEAKER_01: Yeah, yeah, makes a lot of sense.
• 19:32
  SPEAKER_01: All right, so last question, what would be the one thing an agency could do this week?
• 19:36
  SPEAKER_01: What what should they look at?
• 19:38
  SPEAKER_01: What should they review?
• 19:38
  SPEAKER_01: What should they fix?
• 19:40
  SPEAKER_02: So I would say review a handful of denials.
• 19:43
  SPEAKER_02: Maybe, maybe they just pull remittances that they received just for you know the last few days and ask yourself where where the problem actually started, right?
• 19:51
  SPEAKER_02: Which which department owned it, and how do we move forward from here, right?
• 19:55
  SPEAKER_02: If the agency can pinpoint where the breakdown occurred, then they'll most likely find find a source of revenue leakage that they can actually fix.
• 20:05
  SPEAKER_01: Yeah.
• 20:05
  SPEAKER_01: So even if you look back at all the claims that were paid or or place in RTP status or denied, you may identify some trends there, right?
• 20:13
  SPEAKER_01: Like this this continues to happen because we didn't have auth, or this continues to happen because we weren't in in network or we weren't eligible for that plan, right?
• 20:23
  SPEAKER_01: So that's a marketing issue to your point.
• 20:25
  SPEAKER_01: So that can tell you a lot, right?
• 20:26
  SPEAKER_01: That can tell you a lot of a lot of things in your process which might be broken, and and that's great advice.
• 20:31
  SPEAKER_02: I see.
• 20:32
  SPEAKER_02: Yeah.
• 20:32
  SPEAKER_01: Yep.
• 20:33
  SPEAKER_01: So thank you for that.
• 20:34
  SPEAKER_01: Appreciate it.
• 20:34
  SPEAKER_02: Yeah, absolutely.
• 20:36
  SPEAKER_01: Amanda, always a pleasure.
• 20:37
  SPEAKER_01: Thanks, thanks for this.
• 20:38
  SPEAKER_01: This is a wrap on uh the second part of our three-part series.
• 20:41
  SPEAKER_01: I'll see you on the next one.
• 20:43
  SPEAKER_01: Thanks again.
• 20:44
  SPEAKER_02: Thanks, Deb.
• 20:50
  SPEAKER_00: Thanks for listening to the Home Health and Hospice Profitability Podcast.
• 20:54
  SPEAKER_00: If you enjoyed today's episode, make sure you subscribe so you don't miss what's coming next.
• 20:59
  SPEAKER_00: You can also follow us on social media for more insights, updates, and practical ideas for running a stronger home health or hospice organization.
• 21:08
  SPEAKER_00: And if you'd like to learn more about how Walters can help your agency, visit Walters Accounting.com, Walters Billing.com, and WaltersAdvisors.com.