Your HME revenue cycle thrives on the success of your front and back offices. We recently discussed the steps involved in managing your front office. Now, it is time to understand the rest.
HME back office management is a complex process. So, we are breaking it down for you below.
Order confirmation involves creating claims or accounts receivable (A/R) and running a quality assurance check on orders before they bill. Often, this step is delayed by inventory issues with quantity and serial numbers.
Once you log these problems, you then have key feedback to share with your intake, eligibility, prior authorization, and order fulfillment teams.
Hold management is the period in which A/R is generated, but not billed. There are four types of holds: certificates of medical necessity / prescriptions, prior authorizations, automated system holds, and manual holds.
The documentation, authorization, confirmation, billing, and respiratory teams are responsible for these holds. When you properly staff these areas, you can manage holds more effectively.
Claims transmission includes batching, sending, and receiving claims to and from a provider’s payers. Often, billers first see claims when they come back as denials. As a result, you should review claims for billing logic such as modifiers, coding, diagnosis codes, and authorizations.
Front-end rejections are claims that the payer quickly rejects, usually due to minor issues. Although providers have higher priorities, they still need to clear work queues daily in order to prevent a backlog of rejections. In addition, you should analyze rejections weekly to prevent problems.
Cash posting applies payments, adjustments, and denials to line items in A/R. Most posting occurs through auto-posting, which uploads an electronic remittance notice into the billing system and applies payments to line items.
For accurate and timely posting, you might track all deposits, itemize them by type and payer, and provide checks and back-up documents using a document management system.
Denials are claims that were accepted, but then rejected by the system for not meeting one or more of the payer’s requirements.
Once sent to the electronic medical records (EMR) system, you should work denials within two days. In order to do so, you might prioritize your timely filing, appeal limits, and high-to-low balances.
A/R management involves handling a firm’s A/R balances, usually those that have billed, but show no front-end rejections or 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.
Not all processes fit neatly into the HME revenue cycle. Below are examples of what we call special processes.
Are you struggling to manage your revenue cycle? Our billing experts are here to help. To speak with a trusted partner about your HME back office, contact us today!
Prochant is the nation’s leading HME billing and process outsourcing company. Our highly-skilled team helps providers become more profitable by outsourcing or enhancing front- and back-office processes. We rapidly implement changes and proactively monitor metrics to ensure client success. Headquartered in Charlotte, North Carolina, we work with top medical equipment providers and health systems.