The success of your HME revenue cycle depends on the success of your front and back offices. We have already discussed the steps involved in managing your front office. Now, it is time to understand the rest. Back-office management is a complex, multilayered process. We break it down for you below.
Order confirmation is the process of generating claims and/or accounts receivable (A/R) and conducting a deep quality assurance (QA) check on orders before billing. Inventory issues with quantity and serial numbers often delay this step. Logging these errors allows you to share critical feedback with your intake, eligibility, prior authorization, and order fulfillment teams.
Hold management is the period in which A/R has been generated, but not yet billed. There are four types of holds: certificates of medical necessity (CMNs)/prescriptions, prior authorizations, automated system holds, and manual holds.
The responsibility for holds usually falls to the documentation, authorization, confirmation, billing, and respiratory teams. By properly staffing these areas, you can manage holds more effectively.
Claims transmission is the process of batching, transmitting, and receiving electronic and paper claims/invoices to/from the provider’s payers. Quite often, billers first encounter claims when they come back as denials. As a result, your team may need to implement an up-front process of reviewing claims for billing logic such as modifiers, coding, diagnosis codes, HA0 records, and authorizations.
Front-end rejections are claims that the payer or clearinghouse rejects immediately, usually due to minor issues. We understand that providers have higher priorities, but minimal effort is needed to clear work queues daily and prevent a backlog of rejections. You need to review, correct, and analyze rejections weekly to prevent these problems.
Cash posting is the process of applying payments, adjustments, and denials to line items in A/R. To ensure accurate and timely posting, providers may track all monies deposited, itemize by type and payer, and provide checks and back-up documents using a document management system. Most cash posting occurs via auto-posting, which uploads an electronic remittance notice (ERN) into the billing system and applies payments to line items.
Strong cash posting makes strong denial management possible. Denials are claims that were accepted for adjudication and were rejected by the system for not meeting one or more of the payer’s requirements. Once denials are sent to the EMR system, you should work them within a 48-hour period. To do so, you might prioritize your timely filing, appeal limits, and high-to-low balances.
A/R management is the process of managing a firm’s A/R balances, primarily those that have billed, but show no front-end rejections or denials. Like denials, you will place A/R due for follow-up in the work queue and prioritize it based on timely filing and high-to-low balances. We suggest a workflow management tool to track actions taken, follow-up dates, and productivity for each A/R balance.
Not all processes fit neatly into the HME revenue cycle model. Below are examples of what we refer to as special processes.
Back-office processes are shown above in black.
If you are struggling to carry out your back-office operations, our team of trusted billing experts is ready to listen. To speak with a trusted revenue cycle partner, contact us today!
Prochant helps HME providers become more profitable by combining superior billing and process outsourcing with highly-skilled specialists. We audit existing front and back-office processes, rapidly implement changes, and conduct proactive analytics to enable providers to consistently exceed industry benchmarks. Headquartered in Charlotte, North Carolina, our clients include leading medical equipment providers and health systems.