Most organizations analyze costs and adjust to changing rates by improving performance and spending. Your homecare billing department should have the same type of agility. If you struggle with end-to-end revenue cycle management, it might be time to reevaluate your billing process and partner. Here are three important signs.
1. Your Successful Claims Submission Rates Are Below 90%
Timely claims submissions and low denial rates are central to a healthy billing process. A 2020 report found that the rate of denied claims varies, but some marketplace insurers denied as much as 80% of claims for a variety of reasons. Many agencies spend more money on labor costs to follow up on and resubmit denied or rejected claims.
Other organizations choose to write those claims off instead of dealing with the extra expenses and time of trying to fix them. But the most successful agencies use automation and software to maximize clean claim rates.
By industry standards, your successful claims submission rate should be 95% or higher. Additionally, 90% of all your claims should be paid on the first submission. These are high numbers, but meeting these metrics will ensure a dependable cash flow for your agency. It also prevents lost money and lost time following up on denied claims and resubmissions.
If your claims submission rate falls below 90%, it’s time to reevaluate. Your billing partner should be accountable for maintaining high marketplace insurance and Medicaid claims submissions so you can stay up and running.
2. Your Billing Isn’t Integrated Into Software
Many errors occur because of manual data entry or duplicating visit information data from your homecare software to your billing system. In contrast, modern integrated software allows data to flow easily between areas of your business and auto-populates information into your billing engine.
Payors must follow strict guidelines, and claims must have the right information. Without integration, you’re left manually exporting visit information. The result is a higher risk of error and claims denial and a slower return on Medicaid claims. Having revenue cycle management as part of your existing homecare workflow streamlines your process, gets your agency paid faster, and increases your bottom line.
3. You Don’t Have a Fully Staffed Billing Team
The billing process involves many moving pieces, from homecare claims and billing to accounts receivable and collections. If you’re trying to manage it all on your own or alongside other job duties, your revenue cycle may suffer and fall behind.
Professionals who specialize in claims, insurance billing, and accounts receivable have the training and industry knowledge to ensure your billing is compliant and efficient. Your agency or third-party billing partner should be fully staffed with billing and accounting experts as well as a support team so that your service always works for you. That way, your billing cycle continues to run smoothly while experts are on leave.
Improve Your Billing Process
Homecare agencies operate best with efficient and intuitive systems, and billing is no exception. The right billing team and homecare software can help your agency continue to deliver quality care while improving your cash flow and operational efficiency.