Latest / The Home Health & Hospice Profitability Podcast / How One Small Denial Exposed a $210,000 Problem

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How One Small Denial Exposed a $210,000 Problem · 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 TechEx.
• 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 Wealth 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.
• 1:04
  SPEAKER_01: I have with me Amanda Sheldon, our director of revenue cycle management at Walters Billing Solutions.
• 1:09
  SPEAKER_01: Welcome, Amanda.
• 1:10
  SPEAKER_02: Hey, thanks for having me, Dad.
• 1:12
  SPEAKER_01: So glad to be back for our part three of our three-part series.
• 1:17
  SPEAKER_01: The final one, The Last Frontier.
• 1:19
  SPEAKER_01: Let's go.
• 1:21
  SPEAKER_01: Well, cool.
• 1:22
  SPEAKER_01: So let's continue on and talk about, you know, kind of pick up where we left off in the last podcast and talk about what's the difference between working in denial and fixing a denial?
• 1:33
  SPEAKER_02: Yeah.
• 1:34
  SPEAKER_02: So working in denial gets a clean page, right?
• 1:36
  SPEAKER_02: Maybe through an appeal, maybe a request for reprocessing.
• 1:39
  SPEAKER_02: You know, sometimes called payer, hey, I think you denied this an error.
• 1:42
  SPEAKER_02: We had off on file.
• 1:45
  SPEAKER_02: You guys should reprocess it.
• 1:46
  SPEAKER_02: They'll send a clean department.
• 1:47
  SPEAKER_02: Clean department will reprocess it and get clean kid.
• 1:49
  SPEAKER_02: Maybe they send a corrected claim, but fixing a denial means preventing it from happening further, right?
• 1:55
  SPEAKER_02: So find the root cause and correct it.
• 1:58
  SPEAKER_01: The most important part of that, I would imagine.
• 2:00
  SPEAKER_02: Yes, the very most important part.
• 2:02
  SPEAKER_02: And less work for your biller, to be honest.
• 2:04
  SPEAKER_01: Yes, yeah.
• 2:05
  SPEAKER_01: Once you fix it, it's it's done.
• 2:06
  SPEAKER_01: You don't have to go back to it.
• 2:07
  SPEAKER_02: Yep, exactly.
• 2:08
  SPEAKER_02: Proactive instead of reactive.
• 2:10
  SPEAKER_01: Makes a lot of sense.
• 2:11
  SPEAKER_01: So how can you tell an agency you're stuck rebuilding the same problem over and over again?
• 2:16
  SPEAKER_02: So if the same denials are showing up month after month, you're probably stuck in the rebilling cycle, right?
• 2:22
  SPEAKER_02: When it happens, you're not you're not really fixing anything.
• 2:24
  SPEAKER_02: You're just getting really good at chasing the money.
• 2:26
  SPEAKER_02: And the problem with this is that it prevents your cash flow and ultimately it it stunts your growth, right?
• 2:31
  SPEAKER_02: Because everything's delayed.
• 2:33
  SPEAKER_02: Different departments blame each other.
• 2:35
  SPEAKER_02: And while it looks good when the money does finally come in, you've just paid your billing staff for time following up on claims and correcting claims that you know should have been correct when they went out the door.
• 2:45
  SPEAKER_02: Um so definitely always look for a root cause, always.
• 2:49
  SPEAKER_01: Yeah, we see that the best agencies, the most profitable agencies have really good processes.
• 2:54
  SPEAKER_02: Yes, absolutely.
• 2:55
  SPEAKER_01: Right.
• 2:55
  SPEAKER_01: And and conversely, a negative process is is just chasing your tail on the same problems over and over and over again.
• 3:03
  SPEAKER_01: So identifying that that root cause is so vitally important.
• 3:07
  SPEAKER_01: So if you see that there's there's multiple RTPs because I don't know what what the example is, but be but because of this reason, yeah, right, it might be because of a lack of education on the on the marketing side, it might be a lack of education on the billing side, you know, that they just don't understand how to build this particular claim.
• 3:26
  SPEAKER_01: Or I've I've seen cases where you know a Medicaid claim should have been billed on a 1500 and it was billed on a UB04.
• 3:33
  SPEAKER_01: I'm probably dating myself now.
• 3:34
  SPEAKER_02: But yeah, no, that's something I PM4, you're good.
• 3:38
  SPEAKER_01: Okay, good, good, good, good.
• 3:39
  SPEAKER_01: So that was when I was doing it.
• 3:41
  SPEAKER_01: But uh yeah, so those things happen, right?
• 3:42
  SPEAKER_01: Yes, that's but fixing the issue, understanding the issue, and that's really what what we tell our clients is you you've got to understand why, not just change it, understand why it's happened so that you can fix the fix the problem.
• 3:56
  SPEAKER_02: Yes, payer trends a hundred percent.
• 3:58
  SPEAKER_02: Payer trends is is the biggest, especially when you're working aging, like as a biller, like looking for payer trends.
• 4:05
  SPEAKER_02: And that's part of you know, that's why when we when we start with an agency and we pull their accounts receivable, we pull it and we, you know, we review it and pivot it out so we can really get like a good full picture and see where the money is.
• 4:16
  SPEAKER_01: Yeah, yeah, it makes sense.
• 4:18
  SPEAKER_01: You called me a while back and and told me about uh a client with a hundred dollar problem.
• 4:22
  SPEAKER_01: And I thought it might be it might be fun to talk about that today.
• 4:25
  SPEAKER_01: So so walk us through that.
• 4:27
  SPEAKER_02: Yeah.
• 4:27
  SPEAKER_02: So um one of our clients had received a few denials.
• 4:30
  SPEAKER_02: Basically, they were out of auth on a certain bill code.
• 4:34
  SPEAKER_02: Too much of the service had been been provided according to what she was getting from Medicaid.
• 4:39
  SPEAKER_02: So it was just one patient, it was like an isolated thing, but it were, but it was like multiple claims for that one particular patient, right?
• 4:47
  SPEAKER_02: So we started, we started reviewing the denials.
• 4:51
  SPEAKER_02: And one of the things we do is pull the Medicaid billing requirements for that state.
• 4:55
  SPEAKER_02: And we do that because we want to verify if auth was obtained appropriately.
• 4:59
  SPEAKER_02: Did they, you know, request auth per visit or did they request it for 15-minute increments?
• 5:04
  SPEAKER_02: Because the auth department, I mean, they tell you right when you do the request, the the auth is not a guarantee of payment.
• 5:10
  SPEAKER_02: Um, so you know, the the auth department most of the time isn't going to correct you and say, hey, you should be requesting this in 15-minute increments.
• 5:16
  SPEAKER_02: They're just gonna say, Yep, you're good.
• 5:17
  SPEAKER_02: Here's the number that's off, and you know, you're good to go.
• 5:20
  SPEAKER_02: So anyway, we then reconciled what was authorized and how much of the service was provided.
• 5:26
  SPEAKER_02: And when you did that, we started looking at the rates, and that just opened up a candy arms.
• 5:33
  SPEAKER_01: So, so tell me, well, so so continue on because that's that's interesting.
• 5:37
  SPEAKER_01: So it started off with just a simple, let's just fix this claim to what?
• 5:43
  SPEAKER_02: We have a much bigger problem, right?
• 5:45
  SPEAKER_02: So, so during our review, we started looking at the rates um to verify if the services have been paid per visitor per unit, so we could go back and make sure that the authors were tamed correctly.
• 5:54
  SPEAKER_02: And when we did that, we we looked in their EMR and we saw that the agency had been billing Medicaid with their expected rates, but the expected rates that were entered in the EMR were not reflective of the rate increase that had been issued.
• 6:10
  SPEAKER_01: Wow.
• 6:11
  SPEAKER_01: So so how big of a of a difference or an impact was that?
• 6:16
  SPEAKER_02: So it was a it's this particular client served a Medicaid waiver patients.
• 6:20
  SPEAKER_02: So it wasn't, it was like, I think they might have had like$18 in and they should have been paid like$25 and change, right?
• 6:26
  SPEAKER_01: Wow, that's a big difference.
• 6:28
  SPEAKER_02: Right.
• 6:28
  SPEAKER_02: And she's got a larger set a larger census.
• 6:30
  SPEAKER_02: And so we when we realized this, we were like, okay, let's see how many of these visits have actually occurred.
• 6:37
  SPEAKER_02: So then we went into the EMR and we pulled every single visit for all patients that had that particular insurance.
• 6:44
  SPEAKER_02: We pulled it and we filtered it by bill code, and you know, we we started reviewing it.
• 6:49
  SPEAKER_02: And what's so crazy is that these claims weren't even on the agency's aging report because they appeared to be they were paid.
• 6:56
  SPEAKER_01: Yeah.
• 6:56
  SPEAKER_01: Right.
• 6:58
  SPEAKER_02: Yep, exactly.
• 6:58
  SPEAKER_02: Yep.
• 6:58
  SPEAKER_02: They and they had she had absolutely no idea.
• 7:01
  SPEAKER_02: So, and a lot of agencies don't know this, but most payers are lesser off, right?
• 7:05
  SPEAKER_02: And so what that means is, you know, the payer will either pay the established rate based on their contract, or you know, if it's a government-run program like Medicaid, um, the Medicaid published rates, or build charges, whichever's less, right?
• 7:20
  SPEAKER_02: So a lot of agencies don't know that.
• 7:22
  SPEAKER_02: And so we identified that their rates had been set up incorrectly for almost a year.
• 7:27
  SPEAKER_02: Now, this payer has a 180-day time and filing guideline.
• 7:32
  SPEAKER_02: So on top of that, they were also billing in 15-minute increments and not rounding, right?
• 7:39
  SPEAKER_02: So they were billing the per unit, which was what the setup is what the regulation said they had to be, you know, billed in 15-minute increments.
• 7:47
  SPEAKER_02: Um, but they weren't rounding.
• 7:49
  SPEAKER_02: So when they were billing, the claim was going out with 37 minutes on it, and it was very specific.
• 7:55
  SPEAKER_02: There were decimal points involved in the units, there was a whole thing when they should have been billing 45 minutes.
• 8:01
  SPEAKER_02: So that's more, you know, but the not rounding is you know, then inflated it even more how much they had been underpaid.
• 8:08
  SPEAKER_01: Wow.
• 8:09
  SPEAKER_01: So so were you able to quantify the difference?
• 8:12
  SPEAKER_02: Yeah, it was so it was I'm I'm gonna say it was like it was like 210,000.
• 8:17
  SPEAKER_02: 210,000.
• 8:19
  SPEAKER_02: Wow, yeah.
• 8:20
  SPEAKER_02: We could only go back 180 days to recover that.
• 8:24
  SPEAKER_01: So was that 210,000 the stuff that we could recover, or was it the entire period?
• 8:29
  SPEAKER_02: It was the entire period, yep.
• 8:31
  SPEAKER_02: So we ended up so we ended up going back and and recovering about 90, almost 98,000 worth of claims.
• 8:37
  SPEAKER_02: So huge difference, huge, massive difference, yeah.
• 8:40
  SPEAKER_01: Wow, yeah, and unfortunately they last they lost half of it because of timely filing, because of education, right?
• 8:46
  SPEAKER_01: So, you know, so so often we see that, and this is not not on the biller by any means, but a provider may have someone from an admin team, oh, they can do the billing.
• 8:58
  SPEAKER_01: We'll just show them how to how to key it and bill it.
• 9:01
  SPEAKER_01: Yeah.
• 9:02
  SPEAKER_01: And that's where you're really without that proper background or that that proper knowledge base, yeah, you're gonna have issues like this, right?
• 9:10
  SPEAKER_01: And I'm not saying that was the case here.
• 9:12
  SPEAKER_01: I mean, that's that's that sounds like a pretty complicated issue.
• 9:15
  SPEAKER_02: It does, yeah.
• 9:15
  SPEAKER_01: Um, but certainly understanding the the the the whole revenue cycle and understanding the billing components and and how important it is to go back to your contracts, make sure that your billing system is set up correctly, make sure that you understand how to bill is quite different than just putting someone in there to key the claims, right?
• 9:32
  SPEAKER_01: Right.
• 9:33
  SPEAKER_01: And it's that's that goes back to that money just shows up mentality, right?
• 9:36
  SPEAKER_01: It's like hey, we send a claim, and yeah, money does show up.
• 9:39
  SPEAKER_01: However, there may be a lot lesser amount than than should be there.
• 9:43
  SPEAKER_02: Exactly.
• 9:44
  SPEAKER_02: Yep, and and to take it one step further too, like that this money wasn't even on her aging report.
• 9:48
  SPEAKER_02: So, like she this client didn't even know that she's that's right, it's not even on a radar.
• 9:52
  SPEAKER_02: Yeah, like it's not it's it's not like she pulled the aging report and she's got$210,000 in Medicaid and she's like, What's going on?
• 9:57
  SPEAKER_02: Like this this is literally this is these are the things that you find from experience, from understanding the whole the whole situation and honestly just just being able to ask questions.
• 10:07
  SPEAKER_02: Like, I mean, and I'll tell you their days where I'm looking at a claim trying to help the team, and I'm like, I I don't I have no idea.
• 10:13
  SPEAKER_02: We gotta call, we gotta try to find a provider rep because is this is such an ever-changing, ever-evolving business.
• 10:18
  SPEAKER_02: Like, there's no way you can you can understand and maintain it, especially when you're in our space where it's you know, multiple different states and you know, the the whole the whole kit and the beagle.
• 10:29
  SPEAKER_02: It really is very, very involved.
• 10:31
  SPEAKER_02: So this this was definitely this was the result of having tons and tons of experience and seeing this.
• 10:37
  SPEAKER_01: And that was that's something that you do for your clients is is you go back to the to the to the contracts and make sure that they're set up correctly, that you understand how how they get paid.
• 10:46
  SPEAKER_01: And you often find issues aside from this hundred dollar problem.
• 10:50
  SPEAKER_01: Yeah, I put that in quotes, right?
• 10:52
  SPEAKER_01: Yeah because that's what tipped this one off.
• 10:56
  SPEAKER_01: You're you're constantly going back and finding these these kinds of issues.
• 10:58
  SPEAKER_01: That have you had other examples where this is you've you found differences between the contracts and what was set up in the EMR?
• 11:05
  SPEAKER_02: Yeah, definitely.
• 11:05
  SPEAKER_02: Yeah.
• 11:06
  SPEAKER_02: So we all we also had another client that was a home health agency, and they had patient had a dual plan, right, where they were eligible for Medicare and Medicaid, and it was managed by Melina, which is uh another large insurance carrier.
• 11:19
  SPEAKER_02: And um, the agency had been sending the claims out on 1500 forms, right?
• 11:23
  SPEAKER_02: And so the 1500 form is required by the Medicaid portion of the patient's plan, but really they should have been sending it onto the UBO4 and getting paid, I think their contract was like 90% of the Medicare rate.
• 11:37
  SPEAKER_02: So all this time they're sending these claims out and they're getting paid$60 couple dollars on their visits.
• 11:42
  SPEAKER_02: That's that are probably costing the agency$120,$150 till it's all said and done with your labor burden and your salaries and mileage and all that.
• 11:50
  SPEAKER_02: And they should have been getting paid a far greater amount, right?
• 11:53
  SPEAKER_02: So we actually went into the EMR, corrected their payer setup for that dual uh plan, and started sent resent all the things that were within timely on UBO4s and they started getting paid that percentage of Medicare.
• 12:07
  SPEAKER_01: Wow, what a big difference! Did were you able to quantify that or no?
• 12:10
  SPEAKER_02: No, because it because it was it was like the EMR was reflecting a certain dollar amount and we had to do some manual back end billing in the clearinghouse just because of the way that the EMR was set up.
• 12:20
  SPEAKER_02: But we did we did fix it so everything moving forward went out accurately, and it was just it was a lot, it's a lot of work.
• 12:29
  SPEAKER_02: I mean, the client we recovered a hundred, almost a hundred thousand ninety-eight thousand dollars for um was you know, that was over three thousand claim line corrections.
• 12:37
  SPEAKER_02: And we had to make sure that the units were rounded appropriately.
• 12:40
  SPEAKER_02: So if it was 30 minutes, we put it to 45.
• 12:42
  SPEAKER_02: If it was, you know, seven minutes they were over, we had to round it back down, and then we had to multiply to make sure that we entered the rate of the rate correctly from this whole thing.
• 12:52
  SPEAKER_01: So when you get a new client, yeah, what else do you look at in in terms of the contracts, in terms of the EMR, what goes in?
• 12:59
  SPEAKER_01: What's the first thing that you look at with the with the new client that goes in?
• 13:03
  SPEAKER_01: I mean, give me some more some more guidance on on what we should be looking at.
• 13:08
  SPEAKER_02: Yeah.
• 13:08
  SPEAKER_02: So we look at we take accept a new client, we always ask for their contracts so we can re review them.
• 13:14
  SPEAKER_02: And, you know, we we check to make sure, you know, is everything set up correctly?
• 13:20
  SPEAKER_02: Are you getting paid accurately, right?
• 13:22
  SPEAKER_02: As soon as we start looking at remittances, we're looking, okay, are you paid correctly?
• 13:26
  SPEAKER_02: I mean, our team goes so far as running a PDGM calculator on claims to make sure that they were paid accurately.
• 13:31
  SPEAKER_02: Um and that's you know, it's just it's just so super important um to make sure that expected versus what was received match.
• 13:40
  SPEAKER_02: Um but yeah, so we'll we'll check to make sure that um, you know, do kind of like a high-level EMR audit and and we go in and say, okay, hey, you these claims feel like they're being billed out incorrectly.
• 13:50
  SPEAKER_02: If the agency is agreeable, we make the corrections.
• 13:52
  SPEAKER_02: If they prefer to make the corrections, we show them how to make the corrections, you know, and make sure that, you know, are are the hick pick and the revenue codes correct?
• 14:00
  SPEAKER_02: Are they getting reimbursed on S codes?
• 14:01
  SPEAKER_02: Do they need to be sent on 1500s or are they going on UBO force?
• 14:05
  SPEAKER_02: You know, that way, that way they can have accurate projections um for their reporting and make good financial decisions leading forward.
• 14:13
  SPEAKER_01: We know that when we bill claims, there's a lot of adjustments that could be made before we get paid, right?
• 14:22
  SPEAKER_01: So so we bill what we expect to get, and then there may be a downgrade in the in the uh the payment, like for example, on a home health, it might be hey, we didn't we didn't do the visits we thought we were gonna do, so we're now gonna be paid lupa rates instead of instead of a full you know episodic rate.
• 14:40
  SPEAKER_01: Yeah, for example, right?
• 14:41
  SPEAKER_01: You might get papped, you might there's a lot of things that might happen where you get you get downgraded how often, and I think I think in those situations, I guess, it's easy for a provider to get lazy and say, you know, if they see payments coming in lower than they expect, okay, that's just an adjustment and move on, right?
• 14:59
  SPEAKER_01: Or for the billing team to do that, right?
• 15:00
  SPEAKER_01: It's just because it's it's a common thing.
• 15:02
  SPEAKER_01: Yep.
• 15:03
  SPEAKER_01: How often should they be looking at that and saying, okay, what's the what's reconciling what was expected versus what was paid and understanding that difference?
• 15:12
  SPEAKER_02: So so I I would suggest, in my experience, at least meeting and discussing the the financials from that aspect regarding like your billing, your aging, and all of that, uh, and your adjustments at least once a month.
• 15:26
  SPEAKER_02: And and honestly, like for us, we don't make any adjustments on our end.
• 15:30
  SPEAKER_02: We don't write off any claims without prior approval from the agency.
• 15:33
  SPEAKER_02: And so even if you're an agency that has an internal billing team, like I would highly suggest adjustments and write-offs have to be approved by executive leadership, right?
• 15:42
  SPEAKER_02: Because then it brings it to your attention, right?
• 15:44
  SPEAKER_02: So if you're an agency owner and you have no idea that you've got all of these looph adjustments, you know, now it's right in front of your face once a month.
• 15:51
  SPEAKER_02: And you have you're forced to look at and go, okay, why do we have like, where is all this money?
• 15:55
  SPEAKER_02: You know?
• 15:56
  SPEAKER_02: And then you can educate your clinicians, you can educate your marketers, you know, you it's all of these things, and they all, you know, we talk about it all the time.
• 16:03
  SPEAKER_02: It sounds very repetitive, but it is, it's so true.
• 16:06
  SPEAKER_02: It really, it really is so true.
• 16:08
  SPEAKER_02: If you have to sit down and look at it, and and what really gets leadership's attention is when you attach a dollar to it, right?
• 16:15
  SPEAKER_02: So another thing we tell our agencies to do is to come up with specific unique denial or yeah, adjustment or denial codes for your EMR, right?
• 16:24
  SPEAKER_02: So, like so, for example, sequestration is I think C0253, right?
• 16:28
  SPEAKER_02: So that's what it comes up on the Medicare remit.
• 16:30
  SPEAKER_02: So make sure when those adjustments are happening, if it's sequestration related, that it's getting entered in the system with a C0253, because most EMRs, you can pull a report by the adjustment codes and you can see, okay, we had$65,000 in sequestration over the last six months, you know?
• 16:48
  SPEAKER_02: Yeah.
• 16:49
  SPEAKER_02: Or okay, we had, you know, this many adjustments in, you know, I don't even know, lupus or whatever it is, right?
• 16:56
  SPEAKER_02: And then it gives you the opportunity to to educate your team and allow you the opportunity to grow.
• 17:03
  SPEAKER_01: Yeah, makes a lot of sense.
• 17:05
  SPEAKER_01: What's the worst billing problem you've ever walked into or billing issue that you've ever seen?
• 17:10
  SPEAKER_02: Oh boy.
• 17:10
  SPEAKER_02: Okay.
• 17:10
  SPEAKER_02: So I know you've seen a lot.
• 17:12
  SPEAKER_02: Yeah, um, okay, so so honestly, and I think a lot of hospices would agree, hands down, room and board, unpaid room and board for hospices.
• 17:20
  SPEAKER_02: Um, we have one right now that came to us, had almost half a million dollars in on paid room and board, and had never received one one dollar for it.
• 17:30
  SPEAKER_02: And they, I think they've been in business since 2022.
• 17:34
  SPEAKER_01: Why is that?
• 17:35
  SPEAKER_02: So I think it's it's a lot of things, okay?
• 17:39
  SPEAKER_02: So so I'll kind of explain.
• 17:41
  SPEAKER_02: So they their their previous billing team wasn't billing claims out accurately, right?
• 17:50
  SPEAKER_02: So the EMR was set up to go out with an 8-1 bill type, and which would typically seem correct for HOSS, right?
• 17:58
  SPEAKER_02: That's not like too far out there.
• 18:00
  SPEAKER_02: But for this particular state's Medicaid, it needs to be the bill type code needs to be reflective of the facility type.
• 18:09
  SPEAKER_02: And this is all like very involved stuff, you don't have to understand all this, but um because of that, every time that they sent a claim to Medicaid, it got rejected.
• 18:19
  SPEAKER_02: But they couldn't figure out what the rejection was for.
• 18:21
  SPEAKER_02: Okay.
• 18:22
  SPEAKER_02: So it wasn't until they signed on with us and we started building their claims accurately that they actually got denials, real denials, because patients had managed care plans at the time.
• 18:33
  SPEAKER_02: Right.
• 18:33
  SPEAKER_02: So it couldn't even go, it wasn't even supposed to go to Medicaid.
• 18:36
  SPEAKER_02: It had to go to whatever, you know, Medicaid managed care plan the patient had.
• 18:41
  SPEAKER_02: And they they didn't even know that.
• 18:43
  SPEAKER_02: They had no idea all this time they had all this huge breakdown in their process, and they had no idea because their billing team wasn't even successful in getting an accurate denial.
• 18:52
  SPEAKER_01: Okay, so the so the billing team broke down on that process.
• 18:55
  SPEAKER_01: Yeah, how could management have detected that a lot earlier?
• 18:59
  SPEAKER_01: Is there something they could have looked at, some kind of a report that they would have seen?
• 19:05
  SPEAKER_02: Pulled, pull your aging report.
• 19:07
  SPEAKER_01: Your aging report.
• 19:08
  SPEAKER_01: It was on the aging report.
• 19:09
  SPEAKER_02: Yeah, and so that was actually when they started with us, that was the first thing I said.
• 19:13
  SPEAKER_02: Well, do you know how to pull your aging report?
• 19:14
  SPEAKER_02: And he was like, I I am I I'm not sure.
• 19:17
  SPEAKER_02: I just, you know, I just go here in the EMR and I said, okay, that's not your aging report.
• 19:21
  SPEAKER_02: Just because something is in the pending payment tab doesn't mean that it's actually pending payment, right?
• 19:26
  SPEAKER_02: And a lot of EMRs will move something to like a paid tab.
• 19:28
  SPEAKER_02: This is a common one with Valf Guide, they'll move it to a paid tab, even though the claim was never paid.
• 19:34
  SPEAKER_02: It's just because you attached a remittance to it.
• 19:36
  SPEAKER_02: So it could have been denied, but it will move them, move it to a paid tab.
• 19:39
  SPEAKER_02: So it's super important to understand where the reports are and how to run them.
• 19:43
  SPEAKER_02: So first thing we do with our clients is show them, hey, here's where your aging is, here's how to look at it.
• 19:48
  SPEAKER_02: I go so far as showing them how to pivot it out themselves, right?
• 19:51
  SPEAKER_02: Of course, I will always send it to them, but I I definitely tell them, like, I want, I don't want you to ever take my word for it and you shouldn't take anybody else's either.
• 20:00
  SPEAKER_02: If you're ultimately responsible for the health and well-being of your agency, you should know how to run the financial reports.
• 20:08
  SPEAKER_02: Don't take anybody's word for it.
• 20:09
  SPEAKER_02: And so once I showed him and he pulled it, he was like, Oh my gosh.
• 20:15
  SPEAKER_02: Like I didn't even realize.
• 20:17
  SPEAKER_02: Like this was here this whole time, and I didn't question it because it wasn't, I wasn't looking in the right place.
• 20:25
  SPEAKER_01: Well, he's probably happy on that that call with you because now he's got a windfall coming, right?
• 20:30
  SPEAKER_01: Can you bill all that back?
• 20:31
  SPEAKER_01: Can you yeah?
• 20:32
  SPEAKER_02: So we build, we build everything that we could.
• 20:34
  SPEAKER_02: Now, some of it is not a timely filing, right?
• 20:36
  SPEAKER_02: So Medicaid's pretty strict with that.
• 20:38
  SPEAKER_02: And Medicaid in that particular state requires an NOE, right?
• 20:42
  SPEAKER_02: So they didn't have the right plans, they weren't getting NOEs.
• 20:46
  SPEAKER_02: It was a whole thing.
• 20:46
  SPEAKER_02: So we now do eligibility for that client for their room and board patients.
• 20:49
  SPEAKER_02: So we can make sure that we're communicating with them.
• 20:51
  SPEAKER_02: Hey, this, you know, patient needs a an NOE and this is where you which plan you should get it from.
• 20:56
  SPEAKER_02: But it it definitely, it definitely opened up his eyes.
• 20:59
  SPEAKER_02: Um, and we were able to recover some of it.
• 21:02
  SPEAKER_02: We're still working for some of those order claims, especially the ones that were rejected.
• 21:05
  SPEAKER_02: We're actually meeting with a field representative later this week.
• 21:08
  SPEAKER_02: But, you know, he he never got paid one dollar of his room and board until he signed on at us.
• 21:14
  SPEAKER_01: That's amazing.
• 21:14
  SPEAKER_01: That's amazing.
• 21:15
  SPEAKER_01: What a great story.
• 21:16
  SPEAKER_01: What a what a great win and a great outcome.
• 21:18
  SPEAKER_02: It is, yeah.
• 21:18
  SPEAKER_02: It's awesome.
• 21:19
  SPEAKER_02: It's awesome for us.
• 21:20
  SPEAKER_02: We are so we get so excited when clients get money that they thought they lost.
• 21:23
  SPEAKER_02: Like it we can jump up and down.
• 21:25
  SPEAKER_02: It's it's it's so funny because it's like you just it gives me such joy to see them thrive.
• 21:31
  SPEAKER_02: It really does.
• 21:32
  SPEAKER_02: Because ultimately, at the end of the day, like it allows them to be worried about their patients, which is why anybody gets into this business.
• 21:37
  SPEAKER_02: Nobody gets into this business thinking they're gonna get rich, right?
• 21:39
  SPEAKER_02: Nobody, if you do you're crazy, like it's there are far better businesses to get rich off of.
• 21:45
  SPEAKER_02: This one is not it, but it it allows them, you know, to focus more on patient care and reaching more patients and hiring the best staff and providing top quality care, and that's what it's all about.
• 21:56
  SPEAKER_01: That's awesome.
• 21:57
  SPEAKER_01: You know, your your mind goes to collection, and my mind goes to the accounting piece of that.
• 22:01
  SPEAKER_01: And and so I'm yeah, my my mind is racing because it's like, you know, I have so many conversations with clients about profitability, and then we talk about payer sources, we talk about cash flow and all of that, and we talk about visit rates, yeah, right.
• 22:16
  SPEAKER_01: And I'll say, listen, you know, uh what what are you getting paid on this on this particular insurer?
• 22:22
  SPEAKER_01: Oh, I'm getting great rate, I'm getting 110 bucks a visit, whatever, whatever the case may be, right?
• 22:26
  SPEAKER_01: Yeah, but that assumes you're getting paid 100% of the time.
• 22:29
  SPEAKER_01: Yep.
• 22:30
  SPEAKER_01: Right?
• 22:30
  SPEAKER_01: And so you really got to pull your billing reports, understand, hey, if you're getting paid every on every third patient on that particular payer source, or you're getting a lot of denials from that insurance that payer source, you might be paying 300 bucks a visit to take care of that patient, right?
• 22:47
  SPEAKER_01: Because you're not getting it, you're not getting the revenue.
• 22:49
  SPEAKER_01: So it's costing you a lot, a lot of money.
• 22:51
  SPEAKER_01: And without getting those reports, understanding you know what they're telling you, really you're doing the agency a disservice and your financials are going to be severely impacted by that.
• 23:01
  SPEAKER_02: Yeah, absolutely.
• 23:02
  SPEAKER_01: Yeah, so so great.
• 23:04
  SPEAKER_01: Well, that's a wrap on part three of our revenue cycle management.
• 23:08
  SPEAKER_01: I'm sure there's other questions that may come, Amanda.
• 23:10
  SPEAKER_01: So, how can how can someone get in contact with you if they have follow-up questions?
• 23:13
  SPEAKER_01: I'm sure you'll be able to be be amenable to answering any questions.
• 23:16
  SPEAKER_02: Yeah.
• 23:17
  SPEAKER_01: Yeah.
• 23:18
  SPEAKER_02: If anybody has any questions, you can feel free to send me an email.
• 23:20
  SPEAKER_02: My email is a sheldon, so that's h-e-l-d-on at waltersvailing.com.
• 23:27
  SPEAKER_02: And then um you can always call me at the office.
• 23:29
  SPEAKER_02: My phone number is 727-322-5111 and the extensions two two six.
• 23:37
  SPEAKER_01: Great.
• 23:38
  SPEAKER_01: Amanda, thank you so much.
• 23:39
  SPEAKER_01: I appreciate all your time.
• 23:40
  SPEAKER_02: Yeah, absolutely.
• 23:41
  SPEAKER_02: Thanks for having me.
• 23:42
  SPEAKER_02: Really appreciate it.
• 23:43
  SPEAKER_02: This was fun.
• 23:49
  SPEAKER_00: Thanks for listening to the Home Health and Hospice Profitability Podcast.
• 23:53
  SPEAKER_00: If you enjoyed today's episode, make sure you subscribe so you don't miss what's coming next.
• 23:58
  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.
• 24:07
  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.