As our population ages and more people are taking advantage of home care services, the home health industry will continue to expand. For new home health agencies, deciding where to focus and assign resources might feel overwhelming. Home health billing and claims management through Medicare is complex, which is why we've developed an easy-to-understand guide to help new agencies get started.
As the “silver tsunami” of baby boomers aging into Medicare continues, so does enrollment in Medicare Advantage (MA) plans. A staggering 10,000 people are eligible to enroll in Medicare each day. From 2008 to 2017, MA plan enrollment grew from 9.7 million to 19.6 million. This growth represents 34 percent of all Medicare beneficiaries.
The financial health of your skilled nursing facility (SNF) depends on claims that are sent on time and accurately. If you’re in the SNF business, you understand the complex process of submitting claims and getting properly paid. The success of reimbursement depends on countless tasks going off without a hitch and in the right order. And if even one task goes wrong, it leads to big problems.
In 2016, CMS began rolling out a pilot program to enforce a more proactive oversight strategy on Medicare home health claims in an effort to reduce fraud and waste. The ultimate goal was to reduce improper payments and the cost of additional documentation and resources it takes for CMS to chase them. This "Pre-Claim Review" demonstration subjected home health agencies to additional billing scrutiny and red tape.
In a recent survey of hospital CEOs, the American College of Healthcare Executives reports that CEOs ranked financial challenges as the number one issue facing hospitals. Some of the top financial challenges these CEOs identified include Medicaid reimbursement, revenue cycle management, managed care and commercial insurance payments, and reducing operating costs.
It's clear hospitals should track specific financial key performance indicators (KPIs) to monitor and evaluate financial health and profitability. But at every turn, hospitals are expected to measure and deliver indicators – from quality to financial to clinical to operational. With so many required indicators to report, it may feel overwhelming for hospital leaders to know exactly which financial KPIs they should track. Our hospital revenue cycle experts at eSolutions have created a list of the top 5 financial metrics any hospital should closely watch.
Why is automation important in a claims clearinghouse? Automation adds intelligence and agility to your claims submission process and revenue cycle. This equals less stress for your team, cleaner claims and improved reimbursement.
Providers should use Electronic Data Interchange (EDI) as more than a simple pipeline to submit claims. Many organizations don’t tap into existing sophisticated EDI functionality that streamlines processes, finds missing revenue, improves cash flow and so much more. An advanced clearinghouse with automated features takes full advantage of EDI functionality.
If you're a healthcare provider outsourcing your medical billing, you put enormous trust into a third party biller to manage the most important aspect of your business - your revenue. Check out our latest infographic that outlines six key areas to watch closely if you outsource your Medicare billing.