Hospice Revenue Cycle Management (RCM) is the management of the process through which hospice providers ultimately receive compensation for their services. It is essential that each stage of the process, pre-billing, billing, and post-billing – are managed well.
The RCM process for hospice services begins when a patient is referred to your company, and it concludes when their account balance is zero. It can be broken into three segments: pre-billing, billing, and post-billing.
RCM Pre-billing
Patient demographics, insurance coverage information, and copayment or deductible amounts are determined during the pre-billing stage to connect the patient’s needs to the services performed. Patients and their families will consult with the hospice to find out what services they require and plan payment processes accordingly.
RCM Billing
The billing stage of hospice RCM handles Medicare, Medicaid, and Commercial claim types. Claims must be adequately documented for eligible patients to receive full reimbursement. Complete claims containing all required data is essential in determining and eventually receiving revenue.
RCM Post-billing
Rejection and denial tracking and appeals, cash application, and result monitoring fall under the post-billing stage of hospice RCM. A robust system of claims corrections, appeals, and disputes is key to collecting your revenue. Management and oversight of that system to ensure reconsiderations are filed timely and result in prompt payment is imperative in a successful collections process. Because of their superior knowledge and experience in the intricacies of claims follow up, professional billing services can play an integral part in maximizing your collections.
Now that you know the stages of hospice RCM, how do you ensure that your cycle is successful? Keep the MAD method in mind to increase your revenue through organization and team accountability.
M – Measurement
You want to ensure that the measurements you take are accurate and purposeful for your company. These may include your claims, rejections, or denials as well as financial measurements such as cash collections and credit balances.
A – Accountability
It is important that the right members of your team are paired with the best role that they can fulfill. Keeping a leader accountable to at least one metric of the process will make for the smoothest and most effective RCM.
D – Discipline
An organized team will ensure that your RCM functions properly and efficiently. Setting up a defined set of practices and evaluating them with your team will not only establish a proficient workflow but also bring coherency to their individual processes.
Knowing the three billing stages of hospice RCM and using organizational methods with your team, such as the MAD method, can help to ensure that your Revenue Cycle Management functions as smoothly and effectively as possible.
For assistance with your hospice billing needs, contact Advanced Hospice Management today.
