Revenue Cycle Management: The Heartbeat of a Successful Home Care and ID/D Agency

Nurse giving medicine to in-home patient

In order for a provider to give exceptional care, it must be profitable enough to attract and retain a qualified team, develop valuable programming for its client base, and budget for unforeseen circumstances. Improving revenue cycle management and identifying areas that, with some modifications, could result in better billability and resource planning is critical to running a successful agency. Below is a list of common pain points home care and ID/D organizations have solved with comprehensive agency management software and services.

Common Revenue Cycle Management Challenges

  1. Poor Billing Processes
    In situations where billing is not a smooth practice, providers are risking using incorrect information or missing information entirely. With every billing cycle, this puts the agency behind, even more so for agencies using manual billing. An agency management software offers billing services to keep everything moving forward on schedule and with accuracy, so the agency can focus on giving the best care possible.
  2. Disjointed Details
    Without properly managing details – and there are many to keep track of when it comes to billing – financial outcomes are negatively affected. Additionally, if details are not organized in a way that everything can be seen in one place, it’s more challenging to see what could be maximized. With an agency management software, agencies can benefit from a comprehensive view of details sortable by client, service, and more.
  3. Missing Integration
    Growing agencies are often in a phase of looking how technology can better serve them, and that may mean switching from several individual pieces of software to a single bigger software with integrations. For instance, by integrating an agency management software that includes time tracking and billing, an agency can identify when someone has six hours of billable time but eight hours on their times sheet and figure out where things may have gone wrong. Without the chance to find and correct these situations, an agency is losing valuable dollars. In addition, if an agency chooses to also integrate billing module with its payroll module this type of situation can actually be eliminated, as the same time documented with clients merges to payroll to pay the staff.
  4. Accidental Overserving
    Without easy access to important information, agencies aren’t sure if they are overserving clients based on what they are authorized for. By more carefully tracking what’s billable/not billable and how the authorized units/dollars are actually being utilized, they can see if they need more units or if they are able to serve clients better in a different way with less units. Using billing software, this information can be gleaned from one of many reports, not only pointing out areas for improvement but also providing documentation to make funding change requests.
  5. Billing Denials
    Although collecting on billing is different from state to state, one thing is the same: agencies want to keep the number of denials low. Reporting that brings critical information to attention is a valuable feature of agency management software. An agency can ensure contracts and numbers are set up right, therefore ensuring it is not overbilling. In states where an entire claim is either paid in full or denied in full, this increases getting paid. Combined with keeping on a good schedule, an agency can positively affect its cash flow and financial stability.

Improve Your Revenue Cycle Management

The most important step is pulling and analyzing reports, as this is critical to maximizing revenue. Reports such as Contract Utilization will give insight on risks to leaving revenue on the table (underutilizing) or minimizing expenses (overutilizing and not being reimbursed for those services). The Aging Report will show outstanding claims by funder, client, and more. A Billing Transaction Status Report will help track of an agency’s served versus billable and unbillable funds. And, a little-known secret to knowing things are on track? Agencies can use the Revenue Comparison Report in both three and six-month durations to help point out any problems or confirm that they are on the right track. This is also handy for variance analysis as a quick way to pull in information such as units served over that time period.

Find a solution that can meet the needs of your home care or ID/D agency and begin to benefit from improved revenue management.

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