Best Practices for Managing Your HME Back-Office Operations

This session will explore, in depth, some best practices associated with managing your back-office operational teams. These teams generally include order confirmation, billing, collections, and cash posting. Topics we will discuss include: work flow, technology tools, incentives, and metrics. How do you get maximum production and quality from your team while keeping the individuals engaged and ensuing constant growth and development of the team?

About the Speaker

Joey Graham is an industry veteran with over 20 years of experience in DME operations and revenue cycle management. In his current role as Executive Vice President & General Manager for Prochant (formerly The Prometheus Group), he is focused on delivering greater profitability to clients by combining industry-leading processes with a team of highly-skilled specialists. His past roles include executive roles at large DME and software companies including Brightree. He has a bachelor’s degree in finance and an MBA from the University of West Florida. Joey started his HME career right out of high school, spending several years as a service technician.

The HME Revenue Cycle

Know Thyself

• Start with a deep understanding your pain and opportunities

• Thorough analysis of EMR / database (billing system)

• Current status of KPI’s

• Payer & product mix

• Current services, geographical spread

• Process and documentation efficiency

• Proportion of clean documentation

• Rework loops as an outcomes of pre-billing inefficiencies & set-up issues

• Map the IT Security infrastructure

• Resolve any potential connectivity, speed, data security and access management issues

• Jointly agree on what success will look like

• Key focus areas

• Objective and realistic milestones

• Rules of partnership / engagement

Solution Design

• Identify accountable parties, ensure ownership is clear

• Standardization of processes is extremely vital for scalability and dependency

• Before implementing, pilot the SOPs with experienced resources

• Avoid involving less experienced resources during testing

• Stakeholders must sign-off on standard work

• Create a change-control process for standard work

• Identify metrics to track, report and joint review

• Evaluate transactional volumes throughout RCM

• Plan appropriate staffing levels

Building Scalable & Performing Teams

• Convert Standard work into job roles (think Franchising!)

• Define competency levels as a function of complexity

• FEB Level 3 competency mandates more experience to confirm orders than data entry or eligibility verification

• Skills required for appeals and complex patients are high, relative to working other standard denials

• Create standardized training modules for each role, optimize the learning curve

• Mix interns / low-experience resources with senior resources for a scalable organization. Ensure roles are properly staffed.

• Define pay structure for applied competency to motivate lower level resources & create career path

Onboarding People

Hire and build teams completely inline with your company values

Train Interviewers to evaluate both skills and cultural fit

Train people on clarified standard work

Incentivize them to learn faster, and to deliver beyond mediocrity

Rewards not only operational efficiency, but also provider outcomes

Provide room for mistakes and quick recovery

Plan extra staff for early exits based on performance, absenteeism and other reasons

Cross train with caution (not everyone can do!)

Enabling Tools and Traction

• Build a Culture of Proactivity

• Reinforce mindset of preventing denials - Clean ‘straight through’ billing

• Make working resources accountable for preventable denials

• Continuously training people in problem solving

• Watch the right leading indicators – AR touch points, clear prioritization practices, daily operational triggers, red flag control

• Track the right lagging metrics -14 key KPIs

• Create workflow capabilities to work, track, measure and report daily

• There’s a limit to using spreadsheets

• Daily control and problem solving is essential for disciplined outcomes

• Develop daily, weekly and monthly dashboard to measure process and people effectiveness

• Audit traceability for both people and processes

HME RCM Back-Office Operations

Order Confirmation

Hold Management

Claims Transmissions (Submission)

Front End Rejections

Cash Posting

A/R & Denial Management

Special Processes

Order Confirmation

Work Queues

Deep QA Check, add KX Modifiers

Error Log / Feedback System

Minimize & Promptly Address Inventory Issues

Document Management

Avoid confirming without proper documentation

Ensure documents are properly “filed” timely

48-hr Turn around time

Hold Management • Work Queues / Allocation (TFL as priority)

• New vs Follow-up Queues

• 4 Types of Holds:

• CMN / Prescriptions – better yet, be proactive!

• Prior Authorizations – again, be proactive.

• Misc. Auto. System Holds (i.e. PAP Compliance)

• Manual Hold

• Document Management

• Notes & Tasks

Claims Transmission

• Final QA on Claims Files

• Error Log / Feedback System

• Batching & Billing Errors

• Paper Claims

• Patient Statements/Invoices

Front End Rejections

• Work Queues

• Every Rejection Worked Every Day

• Rejection Analysis & Prevention

• Notes & Tasks

Cash Posting

Managing Daily Deposits (Lockbox)

ERNs vs. Paper Checks

EOBs/Checks Scanned within 24 hours

Patient Payments & Credit Cards

“Completeness” of Posting

Posting denials/rejections (w/in 48 hours)

All adjustments/transfers posted

Recoupments handled accurately

Missing payers added

Document Management

Denial Management

• Work Queues / Allocation

• Goal: work all denials within 48 hours of posting

• Prioritization – incl. appeal limits

• Document Management

• Notes & Tasks

• Denial Analysis & Prevention

• Quality Assurance

AR Management

• Work Queues / Allocation

• Prioritization – incl. TFL & processing time

• Follow-Up

• Claims Status (Unaddressed)

• Document Management

• Notes & Tasks

• 48-hr TAT on Info. Requests

• Feedback Loop

Special Processes

• Oxygen Contents

• RUL – Equipment Replacement

• Periodic Maintenance

• Mass Updates

• Convert to Purchase

• Month End

Joey Graham Executive Vice President

& General Manager

(980) 201-3082

joeyg@prochant.com

www.prochant.com

Questions?

Thank You!