WEBINAR RECORDING

Revving up Your Home Health Operational, Clinical and Financial Processes to Produce Better Results

Create consistent, predictable revenue and reduce the friction between systems with technology built for your specific needs. Hear from industry experts at HealthRev Partners and WorldView as they dive into multiple ways home health agencies can clean up claims, better track clinical documentation, and rev up those referrals! 

 

 

WEBINAR TRANSCRIPT

Alright. Well, we don't wanna delay too long. We know everybody's got a busy day. Appreciate you carving out time out of your day for this.

So let's go ahead and get started with our webinar for today. So first of all, wanna thank you for joining our webinar today entitled revving up your home health agency, Operational, Clinical, and Financial Processes to Produce Better Results. We hope that you'll find this insightful and ask that you enter any questions in the Q and A panel during the webinar. There'll be time to answer them at the end of the presentation.

And lastly, we've been having a few technical difficulties today with some bandwidth issues, for our presenters.

So we wanna prevent distractions during the presentation. So don't be alarmed if we turn off our cameras. We just don't want anything to take away from the content being presented today.

And with that said, let me go ahead and give you our agenda for today. So So we're gonna start with some brief introductions and an overview of both HealthRev Partners and WorldView, and then we're gonna move into the topics of the day. So getting the referrals that you want, authorizations and eligibilities, developing clinical documentation that tracks, and submitting a clean claim the first time, and lastly, wrapping up with Q and A. So with that, let me introduce our presenters today.

My name is Jim Lezzer. I'm the vice president of strategic partnerships here at WorldView.

I have over twenty years of business development experience in health care revenue cycle and SaaS technology solutions.

And my passion or superpower, whatever you wanna call it, is building trusted relationships and developing partnerships.

Our presenters for today are absolutely subject matter experts in these topics, and I'm really, privileged and pleased to be able to, meet with them today. I'd like to introduce Michael Greenlee, founder and CEO of HealthRev Partners. Michael brings over twenty years in health care and improving operations and driving agency growth. He's been recognized numerous times for producing high value results and has been sought out to be a mentor to others. And also with us today is Tanya Blair, vice president of revenue cycle management at HealthRev Partners. She's bringing over thirty five years of extensive health care experience in revenue cycle with comprehensive knowledge from beginning to end of the process.

So with that, I'd like to turn it over to Michael to provide us a brief overview of HealthRev Partners. Michael?

Hey. Thanks, James. So we are a tech driven revenue cycle management company.

We specialize in home health, hospice, and palliative care. With all of our clients, we really focus on three distinct areas of an agency. One is always about protecting revenue. Number two is through the services that we provide.

And then three is through the consulting to help agencies grow and scale. So we've built our own proprietary software called Velocity.

Velocity allows agency owners and administrators, and other, employees access into the data of the services that we're providing with real time analytics.

So I always like to tell people that they could grab a cup of coffee in the morning, flip open their laptop, and with five minutes or less, see the overall health of their organization.

Awesome. And, Michael, we did have another slide if you'd like to comment anything about the items here.

Well, yeah, just I think, really, the thing about RCM is when you're outsourcing, you know, it's the transparency factor of, hey. Can we see everything that's going on and what analytics are being provided with the services that, you know, they're using within, you know, any type of vendor. So we like to provide very clear, consistent data. We also have our own clinical in, we'll call it clinical intel reports that they can see from every clinician that they have on staff specifically, you know, how they're ranking in overall clinical documentation. And we can even drill down specifically and show where their areas of concern would be and based off the documentation, how that's really impacting the agency for long term growth.

Excellent. Thanks so much, Michael.

You're welcome.

And to provide a little bit about WorldView, for those of you who are aren't familiar with WorldView, we are a process workflow and automation platform that our goal is to create efficiencies that help increase cash flow and facilitate growth for provider organizations.

And we work from intake to completion of care to organize, track, and automate document processing. And, really, at the end of the day, it gives you the ability to focus on patient care and clinic clinician satisfaction.

Now three of our value propositions or or, key values that we focus on are highlighted below. When we talk about strong partnerships, we don't mean just strategic partners, but also our customers.

We seek to create deep partnerships that drive our product growth and development, and our goal is to help our clients overcome the ever evolving challenges that you're facing.

We go beyond out of the box solutions, and an example of this is our partnership with HealthRev Partners.

We're looking to add value to our clients in new and innovative ways, and we're gonna share more on that later on. And lastly, we believe that we're as much of a service organization as we are a technology company.

One of our key goals for every client is to seek to have full adoption of our solution, and we provide twenty four seven support in order to help our clients ensure that they get the answers they need when they need them.

Getting Referrals You Want

So with that, let's dive on into our content for today. Michael, you and I have spoken numerous times about how competitive the market is and that there are a lot of challenges in building relationships to get good referrals.

So how do agencies get the referrals that they really want?

Yeah. It's a good question. So, you know, you've got the competitive market for referrals, but at the same time, we still have agencies that are rejecting referrals mainly due to staffing. Right? They can't take on the referrals.

But, you know, when I look at when I look at referrals, it's the lifeblood of any business. So the first thing that I always like to do when we're looking for growth is, number one, I wanna know what my reps are doing today, and is it effective. Right?

You know, are they driving around handing out goodies, or do they have a specific target list?

Are they seeing the right physicians that fit within that market and do they have solid talking points?

Because I'll tell you when when trying to get referrals the number one reason most agencies fail is they lack to have a strategy.

So without that strategy, they're gonna drive away physicians. In other words, they're gonna waste their time. So it'd be no different than in the content that we're providing today in this call. If we don't have good content, chances are people would see that we're having another seminar, webinar, and they'd be like, I'm I'm not gonna join that.

Maybe I'll just listen to it because we don't wanna waste anybody's time, especially in the the times that we're living in now. Right? We're all wearing multiple hats and and and serving multiple needs. But I will tell you behind the referrals is is a matrix.

And if your if your reps have a matrix, that's gonna be easier for them to get their foot in the door with stronger perspective referral sources. And I will tell you that agencies that have mastered this are proving that data driven conversations with physicians is by far the best strategy to build strong relationships with with those referral sources.

That's really interesting. Can you give us an example of what that data driven conversation looks like?

Well, it can kinda it can be really broken down into three different things. One would be your value proposition. So when you look at that, you look at your data of the information you have plus preparation is gonna equal more productive conversations and conversions. And what I mean by if you have the data, what a lot of marketing and sales reps hate to do is they hate to prepare.

But if you if you had a big meeting with a big medical office where, you know, that referral could really take your your agency to the next level, You gotta really spend a lot of time preparing for that that meeting. Right? You gotta do away with canned pitches that those don't work, and you have to have a position specific talking track, which includes data.

So an example of that would be, if you got a physician and you know the physician's patient population, that's really good. But on top of that, do you know the quality of care that their patients are receiving from the current post acute option?

So in other words, how are you better than who they're referring to now?

And if you can get those data points, then you have that potential competitive advantage. You have the ammunition over your competition. So it could be hospitalization rate, you know, within thirty days of the start of care. It could be your total, patient cost following, home health agency. You know, you're talking about your twelve month risk adjustment or your total cost of care. Whatever that value prop is, that's gonna give you that ammunition, that is what's gonna help you to start moving some of those referrals your way.

But the access to the data and having that information is critical for those reps to be able to craft the most effective pitch for that particular physician.

I'd imagine that it's it's tricky for them to be able to manage a lot of that information. Are there any tools you think that agencies should be giving their marketing and business development teams to support that effort?

Well, you've gotta have a good CRM for sure. I mean, that way, the reps get a complete view of all the business opportunities.

They can make well important decisions about who they're targeting and why.

They can track their activity and the results. That's a big one.

They can organize the territories, and then, of course, you'd want that CRM to be mobile.

So, you know, when they're out on the road or whatever, you know, they'll have the ability to pull up any past meetings, review any notes, make comments, again, track that activity, and, of course, schedule any follow-up meetings.

Excellent. Thank you. That's really insightful. So the three key takeaways then in getting the referrals that you want are, number one, create strong referral relationships. Having that strategy and metrics makes the conversation more compelling for physicians, and the outcome that you you can expect is increased market share.

Number two, knowing your ratings and knowing where you stand compared to your competitors allows you and your reps to craft more effective pitches to a physician, and number three would be to specialize and know your results. So highlighting what you do best and the outcomes you produce is incredibly valuable in those physician conversations. Is there anything you'd like to add to that?

Yeah. You know, the other thing is how do you build so, you know, if you got your your value prop, you've got the right CRM right to track our activity, then it comes down to how do you build a prospecting model that is scalable.

So what what we advise is, you know, if you're if you're looking at at either revamping your referrals, or if you're if you're just starting out saying, hey. We gotta we gotta, you know, get more referrals.

The best way to approach it would be start by identifying in your area, you know, who are the top therapists, specialists, medical offices in that area. From there, that's when I would hire reps that best fit that territory.

Now if you already have reps, then there might be a chance that you're gonna have to reorganize that territory because what you wanna be able to do is your most experienced reps, you're gonna wanna put them in the right territory for the great for the great success or the greater success.

But once you identify your top your top therapists and specialists and you've got the reps, then what you wanna do is you you wanna make sure you train the heck out of them. Right? You know, through specific therapies, through payer claims, through specialists.

But then it doesn't stop there. Right? So then you gotta think about, okay, how do we divide these accounts?

So it's very common that a lot of agencies and and really a lot of businesses overall, what they'll do is they'll take their prospects and even their clients, and they'll usually divide them up in a, b, and c accounts.

So from a referral standpoint, if I was to divide up all the referrals in my territory or my my state, I'm gonna divide them up in a, b, and c accounts. So my a accounts, those are the top twenty five percent ranking doctors and medical offices in my territory or my area.

And for all a accounts, I'm gonna visit them weekly.

Then my b accounts are gonna be the next top twenty five, and I'm gonna visit them biweekly. And then my c accounts are everything below that, and I'm gonna visit them monthly. And the one thing I would tell all agencies, because people tend to forget this is that your best referral sources right now, if you think about everybody I'm calling to think about, who are our best referral sources? Please remember that your comp those are your competition's best prospects.

So when you wanna grow your referral, the whole the whole premise around creating an a, b, and c account is if you know the majority of your referrals are gonna come from a and b, but you got a lot of your reps still spending a lot of time with c accounts.

When you close a new a account or you close a new b account, you could actually reduce the amount of c accounts that you're seeing. Right? Because there's only so much time in the day. So let's say today I wrote another a account. That's gonna be great for us, but I've got five c accounts. I may trade those c accounts to somebody else because I wanna spend more of my time with the a accounts.

And so you continue to reduce that, and, eventually, hopefully, all you have is a and b accounts. And then every every six months or a year depending on your size, you would wanna reevaluate that. So every year, you would look at your your a accounts, your b accounts, c accounts, and, again, reorganize those in the right order. And then a couple other things that about prospecting that even in our side of the business, that's that's a challenge is if we're all honest, salespeople, marketing people, they hate prospecting. Right? It's it's just it's hard to do.

So we created, or I created something called seven touches in twenty one days. And those seven touches in twenty one days, basically, if you look at a month, take out the weekends, you basically have twenty one, twenty two working days in a month.

And if we're looking at writing a new customer or let's say I'm an agency and I'm looking to get into a new referral, I'm gonna put in that seven touches in twenty one days. And those seven different touches could be different ways for me to get in front of this, you know, physician or this medical group.

And then eventually, after my seventh touch, if, let's say, I can't get a response or they're, you know, they're not interested or whatever, I'm gonna recycle that particular physician or medical office, to start back up in another three months. So, again, kinda goes back to having that right CRM.

That physician basically tells me to take a hike or they're not interested at this time.

My hopes are at some point, the referral source that they're given to now is gonna make a mistake. Right? And I wanna continue to build that relationship. And the more contacts I have, or with them, it it is you know, I'm starting to build build that trust because in prospecting, this is where a lot of people fail.

Consistency is the key because that's what's gonna build trust. You do what you say you're gonna do. And then last thing I'll touch on when we move on to the next topic is don't ever forget about new physicians entering your market. So have someone within the the the agency always keeping up that, hey.

If there's a new physician in the in the market, let let's let's start going after them as well. So, hopefully, you know, that that's helpful in that referral piece because, again, like I said, this is the lifeblood of all business, and this part of it really has to be mastered.

That's really insightful. I'll tell you what. I was writing notes throughout that whole, your whole, presentation there, and I think that's probably the topic for our next webinar that we do with HealthRev Partners.

I'm sure we could spend quite a bit of time diving into that.

So Yeah. Let me touch on one last thing. So another thing that I think is important is after every meeting and we we do this as well. After every meeting, we complete what we call an as we agreed email.

And so if I was to meet with the position group and we had a good meeting, within twenty four hours, I'm sending them an email, and I'm really recapping that conversation with them. Because if there's any next steps, I wanna put it in that email with that timeline.

Because then when you send that as we agreed email to them and you're recapping that call, you can both sides can really use that email as, like, a work slip of, okay. Here's here's what we're doing next to keep that conversation and keep that relationship going.

So probably that's the it's it's so simple, James, but I'm telling you that as we agreed email after every visit is probably the most important thing that can help all agencies build just tremendous relationships, not only with their clients, but, of course, with the prospects and their physicians. So you take anything away from what I just said on the referral thing, implement the as we agreed email right after a meeting, and I'll tell you, it will it will change it will change your business relationships.

That's a great tip. That's real. I I love that. Absolutely.

Awesome.

How Can We Fix Our Intake Process?

So with that, I appreciate that, Michael. Let's turn it over to Tanya.

Michael helped us understand what to do to get more referrals coming in. So can you help us understand what to do to really optimize that intake process and get patients into care?

Sure. Absolutely.

As someone who's been involved in home health billing for well over twenty five years now, I'm often asked what I consider as the most important tool to ensuring claims are paid.

My answer is always the intake process, which kind of throws people off since they think I'm on the back end and I should just be worried about billing everything and collecting everything.

But billing starts at intake. If your information is not correct from the beginning, you will not be paid in the end.

So I always say it's it's helpful to streamline the referral process, establishing clear communication channels with physicians, hospitals, and other health care providers who refer patients to your agency, utilizing a referral form or a checklist that includes all the necessary information about the patient, their medical condition, and the care they require.

Once you receive a referral, conducting a thorough initial assessment to determine the patient's eligibility for home health services, which may include the review of the patient's medical history, current medical needs, and living environment.

Another important step in that intake process is verifying your insurance coverage and reverifying that coverage on a monthly basis. Since patients often change insurance policies, this will help prevent unnecessary write offs at the end of care due to failure to obtain authorization or other payer specific rules not being followed.

It's an important part of the home health agency intake process. To make this process as efficient as possible, it's best to have the dedicated staff member or a team who are responsible for verifying your insurance coverage and communicating this information to the patient and their family.

This is followed by having a good authorization process in place.

Be prepared before you obtain attempt to obtain your authorization by knowing the requested number of visits by discipline that are needed, the patient's name, their date of birth, the insurance name, the insurance policy ID number, the diagnosis codes for services requested, and the referring MD and his NPI his or her NPI.

Also, think about how are you handling patient co pays and deductibles?

Who is communicating that information to the patient and the family? It really should be done at the time that the insurance is verified so the patient is not caught off guard in the end if they're receiving a bill for copay or deductible.

Ensuring that documentation flows in and out of one platform.

Are you utilizing portal access or are you making phone calls?

If you're using portals to obtain authorization, sometimes that can be done within five to fifteen minutes on average. Whereas if you have to make a phone call, you could sit on the call for an hour and a half trying to obtain authorization.

So anything you can do to eliminate, you know, using using multiple systems, making sure that you're processing and tracking documentation, How are new referrals being handled from branch to branch?

How are your orders being delivered and follow-up on? How are medical records reviewed?

These are all questions to think about, during that intake process.

I think that's, about it on that for now.

Yeah. You know what, James? What's crazy, and what's at the same time heartbreaking is there there's a lot of agencies that we work with that when we take over on their billing side, we we see a lot of claims missing authorizations.

And so, again, it really touches on what Tonya's talking about is intake is usually, you know, overlooked.

When I when I tell you, it's like, man, you work so hard to get the referral, then you got now you got the intake. The intake is so critical to to master that bad boy too. I I, you gotta master referrals. You gotta master the intake because the last thing you wanna do is leave money on the table. Right? I mean, agencies already being pushed in with margins that you know, these two to put these two systems relegate your referral and and your intake, man. They they have to be in sync, because just missing just certain things and and not having to follow-up on that is is depressing because that's that's revenue that that you're not gonna get.

Is that are those authorizations missing on the, initial auth or the re auth or both?

Sometimes both. Sometimes initially, authorization is not obtained upfront or it's not obtained timely.

Many insurance carriers will not go back, you know, more than forty eight hours for authorization. So if you're not requesting that authorization timely, you were missing out on revenue, because you're you're not gonna get paid for those services that were performed outside of the authorization.

And then making sure that your clinicians are communicating with your intake staff, to let if more visits are needed.

And, actually, some of the other things that I see that are a big issue are clerical errors.

Just whoever is entering that intake information into your EMR, making sure that the patient name matches what's on the insurance card, making sure that there's no clerical error in how you've typed out the date of birth or the insurance ID number. All of those things will prevent that bill from paying, and sometimes it's not called timely.

Wow. And I would imagine that has a significant impact financially on the agency when that's just absolutely returned to provider or rejected for payment?

Absolutely.

Excellent. Well, to summarize, so what we have is the three key takeaways for creating the best intake process are, number one, it's documentation workflows. And, really, if I could make sure that I've got this right, Tanya, I want you to definitely chime in.

It's really looking at making sure documentation flows in and out of one platform as much as possible and making sure that inform input information, excuse me, is as as clean and accurate as it can be the first time around.

And to the extent possible, eliminate multiple systems being used to process and track documentation, and that that's gonna create efficiency.

The second takeaway would be, consistency and process, ensuring that you have standard SOPs for how patient records are processed and and tracked. And then lastly, trying to eliminate any inconsistent processes through the use of technology and trying to automate what makes sense to automate.

Is there anything you'd like to add there?

No. I think you've covered it.

Okay. And HealthRev Partners does have a resource on their website that provides detailed information on this. We'll be sure to share that with you, either in the chat or, as a supplementary, item at after the webinar is completed.

How Can We Best Track Clinical Documentation?

So with that, Michael, I'm gonna turn it back to you. So based on your experience working with agencies around the country, what are some best practices that you'd recommend in improving clinical documentation?

Yeah. So when we built Velocity, the purpose in in building it was the fact that from an agency owner's perspective, if I've got five or a hundred clinicians, if I don't have a way to track how good is their documentation, then I have to think to myself, how do I how do I become better? Because, really, at the end of the day, clinical documentation is the brand of the agency. Right? Of course, the patient care and all that other stuff, but it really starts with the documentation.

Just like our services start with how good are we at coding and billing. Right? We can give all the lip service, but if we can't perform at a high level, that's our brand. So when we built it, we we wanted to build that that clinician intel.

So if if I'm an agency, I wanna know and I bet most most people on the call, they could probably say who their top five clinicians are.

They could probably even tell you who their the bottom five clinicians are. But the question is, what about the ones in the middle? And then how do you get everyone better? Because if you don't know where the changes are coming from, either by your internal QA team or if you, you know, use a company that that does it, if if you're not provided the data, then it's really just a transaction.

Right? So but you're not getting any value out of, okay. How do I get these people better? Because my philosophy is if we can get clinical documentation, the agency's clinical documentation improved, then that's less changes we're making, and that's less changes they're making.

Right? So so we're not spending so much time making changes. They're out there seeing more patients.

You know, what are the top five changes that overall for an agency? You know, what are those?

What's the average number of changes that either your QA team or your vendor are making on a per chart basis?

Here in the next slide, I'm gonna show you some, I think, fascinating results that may blow your mind. It still blows my mind every time I I show these stats. The other thing that's really important is not only the number of changes, but specifically the things that are being changed, what's being impacted? So if it wasn't changed, how would that impact my agency in terms of either reimbursements or outcomes or star ratings? Because I can tell you, we we do a lot of comparison trials, and the reimbursement typically in the comparison trial is usually pretty good because most everybody focuses on reimbursement.

I'll tell you the biggest gap we see, is in outcomes.

Is they're not being scored correctly at the get go, so it's hard to improve a patient when you're not really scoring it correctly in the first place. Right? So that can have an impact.

Who are your most valuable clinicians? Those are the ones that I want training other clinicians.

You know, what is your revenue before and after? Right? And then, of course, what are the the major changes that are impacting your ROI?

All that data to me, if I'm if I'm on an agency and I've got all my clinicians in a boardroom, I wanna know who I need to be working with and, specifically, where do I need to be working with them at? Because it got too much stuff going on that I need that I need that data to tell me that information so then I can take that information, get with my clinical team, get with my director, whoever it is, and start putting some training in place to improve that documentation.

I think that's critical because that you talk we're talking about how do we become more efficient.

If you can get your current team, they become more efficient, then you may not need as many players on the field than you have now. Now just depends on, you know, what you're trying to do and your growth your growth goals. But with whatever team you have, you have to become efficient, and data is gonna help you identify where training development is needed and then specifically what type of training and development we need to do with each particular, you know, clinician.

Excellent.

And if you go to the next slide, I think so at the end of every year, what we do is we take all the data together, and I I share this because, again, this was mind blowing to me. But so the number of changes made to the clinical documentation, we take the average number of changes from, ten point one. It went from ten point one to twelve point two, and that was just with OACC.

But when you look at your top five clinicians and this is safe to say that everybody on the call could do this. If you look at your top five clinicians, think about this.

The number of changes per ten charts is about thirty, which means your top clinicians were making on average about three changes. Right? That's good. But your bottom five clinicians, the average number of changes we're making on per ten charts, the very worst clinician you have on your staff, we're making about a hundred and ten changes.

Then it goes down to ninety eight to sixty four, sixty two, and then sixty. So your best of your bottom five is still double what your top five are.

Wow.

Think of that information. Think about how you can use that information and say, okay. I mean, how do I get on a buddy system or whatever that you gotta do to reduce these numbers? But if I'm if I'm running an agency, if my worst one's at a hundred and ten, either a, I'm getting rid of them, or b, I'm committed to developing them, and then I'm taking that hundred and ten.

And then every month or every quarter, I'm looking at that same number saying, okay. I want this number to be down to eighty five. I'm taking it from one ten to eighty five. Then the next quarter, I wanna take that from eighty five down to sixty.

Now you have a game plan and a scorecard that you can start using with each one of your clinicians to ensure that they are the the very best, documentation clinicians in your area.

And then of course, I'm huge on competition. I'm a sports guy.

If if I owned an agency, I would have a I'd create a top ten clinical board and where everybody could see it because even though my clinical team says they don't like competition, I still think everybody likes to compete. And if you're the very top clinician, meaning you're the very best in the agency, you don't wanna be moved to number two or number three. Right? And if you're not on the top ten, by golly, hopefully, if you got the right ones on your staff, they wanna move into that top ten.

So I would create a top ten clinician board. I'd have it posted all over the the agency, and I'd make a big deal about it. That's that's changing that culture into saying, man, we want everybody being excellent at what we do. And then, hey.

You can always put incentives for personal and professional growth.

I think that's critically important as well. But, overall, I'll get giddy about the clinician top ten board because I love it. I think everybody should do it. Probably nobody will take my advice, but that's okay. I would do it.

Well, I would imagine, it's probably shocking for the bottom five clinicians to see those number of changes initially, but it probably does drive clinician satisfaction over time, being that the agency is investing in those individuals.

Well, you got the game plan. Right? And that's the that's the deal. Like, most people now, they don't know. You You know, they don't know where to start.

With the data, you not only know where to start, but then you could score quarter over quarter or month over month, and you'll start seeing massive results.

It's I mean, it's a game changer.

Excellent. So I know you wanted to move on to some additional slides, measuring KPIs.

Yeah. So I just wanna throw these in here because, you know, when we're talking about, you know, strategy, we get we get asked a lot about, hey. What are some KPIs that we should measure ourselves to? And this this is not the gospel. Okay? But it it does give numbers that, you know, from intake to, you know, your unbilled, things that just can be overlooked. It you know, I think this is a good starting point for everybody to say, okay.

Where are we at today? And where will where do we wanna get to? Because we know we gotta be more efficient. We know we gotta implement technology to help us, you know, do things faster and quicker and more more effective.

But I also wanna be able to grade myself to say, okay. Here's best practices. Here's where we're at, and why are we here?

And so whoever all the way from from intake to when that claim is is built, who's responsible for these these data points? So to the left, I've got common challenges that kill revenue.

So these are our top six that we see consistently across the board is number one, there's there's a lack of structure flowing from department to to department. So when I talk about your clinical, your operation, and your financial team, all of them have to be in sync. And each each department should know the the importance of the other department. Right? Because they if they're they're not all in sync, revenue is always gonna be a challenge.

Right?

We see a lot of duplication of of job duties, people kinda doing the same thing, so it's it's not really clear who's responsible for what.

Technology is a big one.

You know, either through the EMR is not set up correctly.

Either the payers aren't set correctly, it's not flowing correctly, or, you know, the clearinghouse they're using, that's not set up correctly or being used properly.

Management structure within each step of the process, having someone within the management structure that is responsible and has to report to someone these numbers. Right? With specific reasons why the numbers are the numbers. Someone has to be held accountable to these numbers.

Because if you don't have a matrix, how do you manage the performance?

And then the last thing is the unbilled. There's a lot of oversight, or underside or oversight.

Lot of people not looking at their own bill, in other words, is what I'm trying to say, James.

And so I wanted to get some stats on that. So less than ten percent of your unbilled age over thirty days, that's where you should be at. And then track and trend all the health reasons. Why specifically? Because if if you outsource billing or if you do it in house, the person that is is billing out those claims, at the end of the day, should be the quarterback. And what I mean by the quarterback is they're seeing everything.

So that person has to have the ability, the the knowledge and ability to communicate to everyone else before that claim gets to them what they are seeing with each specific claim, what's the trends with rejections, denials, where claims getting held up. That that person is the main person that needs to be communicating with everyone else what specifically is going on and creating that that log per se of all the different reasons of, you know, the payers, you know, doing whatever they're doing. And then it's gotta be fixed on the front end. It can't be fixed on the back end because then you're constantly fixing things on the back end. There's no consistency.

You're creating, you know, insanity.

And and you're wondering, why aren't we getting paid for this stuff in a timely manner? So, hopefully, some of this data here because I think everyone will get a copy of this. This would be if this would be a great place to start and say, okay. Where are we at compared to what best practices say we should be at?

Excellent. And so you also wanted to talk about staffing and and some of the reporting related there.

Yeah. So the other thing is, again, we we've gotta be able in today's times, we gotta be able to do more with with sometimes less.

So we we get asked all the time about, hey. When I'm staffing, you know, what should that look like? What should peep people be able to do within the agency, you know, based off their specific, job duties or responsibilities? And so we put together just a little bit of, you know, what your team should be able to do when it's coming from intake all the way in into payment.

And then I also wanted to provide because, again, I I just don't wanna have a webinar for the sake of having a webinar. Hopefully, this is good takeaways where it's worth everyone's time to jump on the call and say, hey. You know, if we got these reports, we wanna start pulling these, tracking these reports, you know, from your review your claim acknowledgment or your NOAs. We still see a lot of agencies losing money because NOAs.

Run that admission report. Reverifying insurance is a massive one.

Your d your DSL, I'm gonna I think I'm gonna talk about that here in a second, which I get pretty passionate about the DSL.

You need to run that on a prepared level. You also need to run that on a Medicare and a non Medicare level.

And then we always say don't use w hip dummy hip codes on on final. But, anyway, hope hopefully, because a lot of people don't know in terms of staffing and positions, what should they be able to do versus what are they able to do? Right?

So, hopefully, this is beneficial to to those on the call that they can use this information and and say, okay. Based off our staffing, where we at versus where we need to be.

Excellent.

Yes. And the the last is the, impact of the DSO.

Yeah. So, it's all about cash flow. Right? If we don't have money, we don't have revenue. We we really don't have a a way to pay our bills or our employees or offer different incentive programs or benefits or whatever the case may be. And, you know, again, we live in a competitive world where you've gotta be able to offer those type of benefits.

So I always tell all agencies that and where we start with everybody is what is your current DSO, your daily sales outstanding? And what I mean by that is typically you're you're or not typically, but your DSO is how long does it take, you to convert a sale into cash. Right? So a typical business is gonna be a net thirty.

Health care is a little bit different. It's gonna be on average of forty five to sixty days.

Kinda depends on your payer mix. But what's important about it, if you if you look at the key metric analysis here, this is a this is a real customer that that we help, but I wanted to show it. So their their net patient revenue is sixteen million.

In their current accounts receivable, they had about four point one million dollars, that hadn't been paid. And so you know? And this is on our website too, so people can go and kinda calculate theirs if they want, but it's gonna give you your DSO. So their DSO in this example is ninety one point nine days.

Now down here at the bottom where you see the target metrics, that says that we wanted to get that down from ninety one point nine down to sixty. So if we did that, what's the impact?

But here, when you under the, current key financial metrics under that ninety one point nine, what you see is the AR to cash account. So this is your cash flow. So in this example, theirs was a hundred and forty two point seven percent. So in other words, they've got a hundred and forty two dollars going out, and they only have a hundred dollars coming in. So when you look at it, if I needed to to get a lot of credit from a bank or if I wanted to, you know, maybe purchase another agency or if I even wanna position my agency to sell, it's gonna be very tough at an ARDA cash account of a hundred and forty two point seven percent.

Those who look at and say, hey. You're probably having a hard time paying your vendors, your employees. I mean, we're not we're not gonna give you a loan.

But in this example, by taking them down to sixty so our delta was to take them down to, by thirty one point nine days. What's fascinating is by doing that, just lowering it by thirty one point nine days, which we did in less than sixty days, it took their AR to cash account, if you see down at the bottom there, to down to sixty two point three percent.

So for now, they've got sixty two dollar sixty two cents going out, and they've got a dollar coming in. And then we improve their cash flow, real money in their bank by one point four million dollars.

But this is the starting point to say where we at financially. What's the overall health? From this information, you take this information, then you start diving into your payer mix. You start diving into your trends of rejections, denials. You start piecing that all together. And within sixty to ninety days, you could have this fully rectified and be in a in a total different position than what you're in today. But and and everything we're talking about that we're given is is it's really simple.

Just a lot of agencies don't have the information, and so we wanna provide the information because every what we do in serving patients in our communities and taking care of people is critical.

And so part of our mission and what we do is we wanna get as much information out to help help agencies know where they need to be. And, you know, either, a, they can they can, you know, do it internally or, you know, there's a lot of great options out there of people that can help them with this.

Excellent.

Thank you. So so in summarizing the three key takeaways on improving clinical documentation, so one is numb number one is know your metrics. So know how clinicians are doing on specific items within the documentation.

And then number two would be providing not only professional development, but customizing it to remediate the gaps in knowledge and understanding and really kind of drive meaningful conversations about specific cases with those clinicians so that they can see exactly where and how to improve.

And lastly, conducting discharge reviews is going to help and show improvement in outcomes and show how the they they've improved over time. Is there anything else you'd like to add to this, Michael? No.

I think I think I hopefully, I nailed it. I don't know, though.

I don't know. We'll find out in the q and a, I guess. That's right. Alright.

How Do I Submit a Clean Claim - The First Time?

And so, Tanya, wanna turn this last one over to you.

So I spent a lot of my career in acute care revenue cycle. One of the challenges that we saw with hospitals was errors and claims that resulted in either a return to provider or denial or an underpayment because things weren't coded correctly.

From our conversations, I understand that's the same in home health as well.

How do you recommend agencies ensure that they're sending clean claims?

Yeah. Thanks for that question. I it it kinda goes back to intake. So part of the clean claim checklist that we use is verifying that the patient's name, date of birth, demographic information is correct.

Again, the name should match what's on the patient's insurance card.

If the insurance card says Jane Doe, but they go by Janie Doe, it doesn't matter. It it it has to match exactly what's on that card or it could end up in a denial.

Verifying that the insurance and policy ID numbers are accurate.

Obtaining any necessary authorization for services, and ensuring each authorization number is on the claim that and matches the service provided. So sometimes they will give a separate authorization numbers based on the skill.

Verifying that the physician's name and NPI number are correct and that the physician is PECO certified. There is a way to verify that through the NPI NPI registry at c m s h h s dot gov.

Verifying that all visits are included on the claim with the correct CPT codes, HCPCS, revenue codes, etcetera, matching specific insurance guidelines or the contract, and verifying that the correct number of units are also on the bill.

Some of the additional requirements for traditional Medicare is ensuring that that NOA and some of the Medicare Advantage Plans as well are ensuring that the NOA is submitted and accepted within five days of start of care date, that all services for the period have been provided and the physician has signed the plan of care and all subsequent orders.

The face to face encounter has been signed and completed.

The OASIS has been submitted and accepted by IKEA's within thirty days.

And for those RCD states which are Florida, Illinois, Ohio, North Carolina, and Texas, making sure that you have, added the the u ten on the claim as well.

Another a couple other items are verifying that all diagnosis codes are up to date. They match current coding guidelines based on the dates of service.

As we all know every year on October first those diagnosis codes get updated. So if you're submitting a claim with dates of service for April but those codes updated in October and you're using a claim for a diagnosis code from the previous year, it will result in denial as well.

Some other things to think about, at any time possible, if you can submit those claims electronically so that you are making sure you get it's almost immediate sometimes confirmation as to whether or not they've been received, versus manually hand keying those claims and also running into clerical errors by manually hand keying those.

Couple other things that's not really related to submitting the clean claim, but just following up on the claims.

There's so many of the insurance plans have timely filing guidelines that are anywhere from sixty days to one year. And if you wait, you know, three months to verify if a claim paid or not, you may miss that timely filing guideline and not be paid for those services.

You just always wanna make sure that your NOA was submitted and processed within the five days to avoid any of those penalties.

For traditional Medicare, you basically should be following up on that EOE within fifteen days.

Medicaid, depending on which Medicaid plan, is typically between one to four weeks, and all other payers should be followed up within the thirty to forty five days.

Some of the other things, I think just making sure that you're billing on the correct form whether it's UB four or a fifteen hundred and that there's medical necessity for the services that were provided.

Excellent. And you mentioned that there's a clean claim checklist resource document on the HealthReg Partners website as well. And we'll be able to include those links and and follow-up, emails to this.

Excellent. Anything else that you wanna add to that?

Alright. I think that covers it. Thank you.

Okay. Great. Michael, anything you'd like to add about clean claims?

No. I just say, you know, billing, not all payers are created equal. And so, you know, it's it's it's becoming harder and harder, you know, to get paid. And as you can tell just through the list of everything that Tanya just mentioned, you've gotta ensure that, you know, your team is is up to speed on all that. Because, again, you you don't need bottlenecks. You need the revenue coming in. You need it coming in timely.

You know? They're they're you know, we've we've built them, but you also can get them within different different methods. But, you know, you should be able to forecast your claims, and you should, you know, be able to to anticipate, you know, at least three months in advance what is coming through the door. If, you know, if you're gonna effectively grow and scale the agents, then you've got to be able to forecast be be able to forecast every single payer that you have. And if you can't do that today, that that is something that, you know, needs to needs to happen. You gotta be able to do that in order to, you know, continue to reinvest in the agency and grow the agency.

Great. Thank you. Thank you for that.

HealthRev & WorldView Partnership

Alright. And at the start of the presentation, we talked about, the partnership between WorldView and HealthRev Partners. And and, again, we're looking to create new and innovative value for our clients. So HealthRev Partners and WorldView have been friends in the industry for quite a long time, and recently, we decided to create a more formal partnership.

So in the coming months, WorldView and HealthRug Partners are gonna be integrating our technology to improve the workflow that our clients are experiencing.

So as you see in the diagram today here, basically, what ends up happening is when a referral is coming in, it'll be processed in WorldView, and then that patient record will be created in the EMR. And then for our clients that are using Velocity, WorldView will automatically create that patient record in Velocity as well. So the result is that clients are gonna be able to gain better visibility into which claims are being held up because of unsigned orders or missing documentation.

And and this speaks right to the heart of HealthRev's mission, which is helping people get to consistent, predictable revenue.

Now even though we don't have this integration today, what I want to reassure you is that there's value in each solution individually, and there's no reason why you couldn't roll out one or both. It's gonna be really impactful if you do. And so we're really excited about bringing this integrated solution to market later on this year and hope that you are as well. Michael, anything you'd like to add here?

No. I I'm I'm super excited about it. I I I think this is a long time coming, and this is gonna be just a great thing for agencies in streamlining this this pretty challenging of a process.

Excellent. Thank you.

Q & A

Alright. And with that, we'd like to, thank everybody for your attention and and time today and answer any questions.

Before we go to q a q and a, Michael, your slide about, the impact of DSO really struck me. And I I do wanna ask, you know, I think a lot of agencies are probably sitting there going, hey. If I have a big backlog of AR that's sitting there that's in aged claims, like, how would I go about getting this stuff collected?

Well, you know, there's, you know, recovery is is what we call it. But but, basically, what you would do is you would look at any claim, really past ninety days, that, you know, you you get all the contracts. You'd look at contracts and see, okay. What's what's the timely filing?

And then you would work the oldest to the to the newest, and even probably separate it by amounts. Right? It could be larger amounts and smaller amounts.

But you start working each one of those specific claims, and then you you document within those claims the specific reasons why it's still aging, right, at that point so you you can really track and trend all this information.

But when you figure that DSO, you know, that's that's gonna help you. And then, you you know, you can like I said, you can figure that DSO on a per payer level so you can really identify what are my top three payers that I'm having the most challenges with and then start tracking and training that data.

But that that's the way I'd go about doing it. Or, you know, of course, they can they can call somebody, you know, that's in the space, you know, even us if they wanna call us. And and and we we, you know, basically put a whole team on that. And, you know, usually within sixty, ninety days, all those claims have been worked. And we clean up the AR at the same time because, again, there could be there could be monies that actually paid. They were just applied to the wrong line.

There can be things that were just never applied at all, in their AR. So it depends on how clean the AR is. But, if I'm in that situation, I definitely want my AR clean. I wanna make sure that he's been applied cleanly. And then I also wanna look and see that the ones that didn't pay or maybe that were written off, I'd wanna know specifically those reasons because you can find that there could be some people that are handling that billing that could write off claims that they probably shouldn't write off. They'll they'll hide that money from you thinking that those monies just didn't pay when really the work just wasn't done and the claim wasn't followed up on.

That's great. Thank you. And, looking at the questions, one that one did come through that was saying, you know, outsourcing is kind of a scary proposition. You know? Basically, Michael, for if I were in your shoes or or if you were in their shoes, you know, what would you consider, when determining whether outsourcing is right for you?

So we we create a calculator that basically takes what's been billed and what's been applied by month. So we look at the rolling twelve months.

And when you go through each, particular month and you see what's been billed, you got your adjustments, your net billed, your your bank deposits, what's been applied.

Then you're really looking at what's the overall RCM performance divided by the percentage of deposits that's been billed.

And so, you know, you might see that number somewhere around sixty to seventy five percent.

So, you know, you could be missing twenty five to to thirty percent of your revenue just right there.

And so, you you know, you can look at we've got a calculator that says, okay. Here's your internal. Here's your build revenue. Here's your uncollected revenue. Here's your adjusted revenue.

Look at your internal cost, and that's gonna give us your overall net revenue and up and give us your overall net revenue percentage.

And then from there, you can look and say, okay. If I was to outsource it, what would it cost? And then, again, you look at your billed revenue, the uncollected revenue of what, you know, that RCM vendor is tracking or training to, which will give you your adjusted revenue. And then you look at your your outsourcing cost, and then that's gonna give you your your net revenue and your net revenue percentage.

Majority of the time when we do this, we do this with the customer.

There's about twenty to twenty two percent of revenue we can gain from a customer by running this analysis.

So it's very easy to run. The numbers are their numbers. And then, really, from there, they they've just got a decision to make to say, okay. The numbers support it, and then making sure that they they pick the right vendor that, you know, they they have a good relationship with and that they they trust.

Excellent. Thank you. Well, that takes us right up to the top of the hour, and, that's our time for today. So we wanna say thank you again to everyone for attending our webinar on revving up your home health agency, and we hope that you found this content insightful.

If you'd like to learn more about either HealthRev Partners or WorldView or both, please feel free to reach out to any of us at the email addresses here on the slide.

We'll be happy to talk with you or direct you to the appropriate people on our team. And lastly, we wanna remind you that we'll be providing a link to the recording of this webinar to all registered attendees by the end of the week. Thank you so much. Have a great rest of your day.