To become an Elite 500 Home Health Agency there must be a Focus on Revenue Cycle Management: 

Lost revenue and poor compliance go hand in hand. They infiltrate a home health care agency together. Managing revenue cycle means improving compliance as much as it means ensuring complete and accurate billing processes and A/R follow up procedures.

Compliance is the responsibility of all staff, especially those with clinical and financial

responsibilities. In today’s Medicare environment — and it is not much different if a provider’s primary payer is insurance or the patient — mere automation is insufficient. Quality Revenue Cycle Management (RCM) processes are required today in the Affordable Care Act era more than ever.


In fact, RCM is the number one key to meeting today’s home health compliance challenges. Considering the current regulatory environment, where we are seeing sharp increases in ADRs, the imminent rise of collection agencies such as Recovery Audit Contractors, and intensive, relentless MAC, MIC and Z-PIC audits, home healthcare processes and systems dare not fall short of the challenge. 


RCM processes must build in compliance, not treat it as an afterthought or a luxury. Patient care is a complex proposition. Building in compliance requires that communication and interdisciplinary coordination are part of a plan of care that manages a patient’s medical needs. There are four key components to the process of building compliance into a plan of care:

• technology

• documentation

• coding

• billing

These four business pillars support RCM and form a foundation for compliance. Think of RCM as permeating the entire life cycle of a patient care episode, from referral to assessment to plan of care to patient record and finally to the revenue derived from that care. When a plan of care is carefully developed and managed through compliant systems and processes that all talk to each other, a complete management cycle results. When done right, the benefit of this cycle is that it provides the agency with a comprehensive, dynamic, profitable, accurate and compliant home healthcare business.

Most importantly, it results in the ability to provide the highest possible level of patient care, making the agency the first choice among doctors, hospitals and care planners.

Technology Is Only Part of the Answer

In order to achieve compliance in the contemporary regulatory environment, home healthcare providers must employ more than just point-of-care technology such as Kinnser and a centralized billing/coding system. It is imperative to utilize the RCM processes in order to verify assessments, review clinical processes and reconcile resulting data as part of compliant revenue generation. Incorporating RCM processes as part of an overall business strategy often results in improved reimbursement, bullet-proof billing compliance and Elite 500 clinical and financial outcomes.

Lost revenue and poor compliance go hand in hand because OASIS (REVENUE) and coding errors are often the result of incomplete and incongruent assessments. Billing mistakes typically occur because visit activities vary from physician orders. Data errors are frequently triggered by hurried keying into point-of-care and EMR systems. A well-developed RCM system as part of operations, implemented in real time, can mitigate most of these costly mistakes.

With compliance comes control and peace of mind. Compliance leads to more positive patient outcomes, fewer hospital re-admissions, more retained revenue, greater efficiency and more predictable cash flow, while providing the business peace of mind that comes only when patient outcomes match plans of care. A home health agency’s business depends on the quality of patient care provided. Doctors, hospitals, and care planners need an agency they can trust to deliver quality care and outcomes, period.

What RCM Is and Is Not

RCM begins with a complete data capture and error mitigation philosophy impacting every staff member and virtually every aspect of a healthcare provider’s business operations. This includes:

• accurate patient assessments, the cornerstone

• correct OASIS documentation

• clean patient data

• physician order monitoring

• visit reconciliation

• clinical coding with review

• QI oversight

• A/R management and collections follow-up

Systems must be designed into processes that identify errors prior to revenue generation.

Catching up with after-the-fact chart audits is no longer an adequate process in today’s

environment. Operations must have built-in processes that catch incongruence in real time while it is occurring...not after the bill has flown out the door.

RCM systems monitor all administrative and clinical components that contribute to the capture, management and collection of patient service data.

The heart of the RCM process is a team of specialists charged with the responsibility of establishing and implementing policies, procedures, and performance measures and standards.

RCM Begins and Ends With Clinicians

In order to obtain compliance within the RCM process, coding accuracy is indispensable.

For the average home healthcare agency, however, achieving the necessary level of accuracy on a consistent basis is often an impossible dream. Among the most prominent roadblocks to coding success is the speed with which codes change. Dozens of alterations take place each year, seemingly in the blink of an eye. In 2009 alone, a total of 290 new codes were established and on October 2, 2015 ICD-10 was implemented.

Coding errors create even more vexing challenges, the majority of which are related to

documentation accuracy and completeness. Co-morbidities are missed during this phase, opening the floodgates to improper sequencing and inaccurate primary diagnoses. Clearly, RCM must begin with management’s confidence that assessments are accurate. Crucial to this phase are clinical tools. It is management’s responsibility to assemble the tools — especially comprehensive and ongoing training programs — that will properly channel the critical thinking skills required and expected of field staff.

Then, even with confidence in your staff’s coding and documentation skills, ensure excellence by assigning RN coding experts to review every assessment to see that every plan of care reflects best use of ever-changing codes and regulations.

Accurate and compliant coding is not only the image of your standard of care that you broadcast to the community. It is the cornerstone of your ability to receive and retain revenue. Getting it right is the best way to grow your business and increase patient and doctor satisfaction with your plans of care. 

Cliché though it may be, there is a bottom line to consider here. Management’s focus on strong patient outcomes through compliance means greater revenue retention and the lowest audit risk. Clearly, effective RCM is a timely solution providing agencies with a foundation for a vigorous bottom line, a solid grip on financial activities, freedom to focus on priorities, and a welcome relief from compliance anxiety.

North Consulting Solutions, LLC

11160 Dover St., Ste A1
Houston, TX 77031

(281) 565.6525

Copyright  2021 

  • Google+ Social Icon
  • Yelp Social Icon
  • LinkedIn Social Icon
  • Twitter Social Icon
  • Facebook Social Icon