If You Haven’t Done a Post-PHE AR Reset, It’s Time

If You Haven’t Done a Post-PHE AR Reset, It’s Time

Think back to what your AR processes looked like before the COVID-19 pandemic – how much do they have in common with the way your medical billing accounts receivable processes look today?

If they’re too similar, I’m sorry to say that your organization is likely falling behind the challenges facing medical providers today. And that’s because things have changed for providers – both internally and externally. Medicaid disenrollment is ramping up, junk health plans are on the chopping block, and CMS is adjusting to a new world. Internally, you’re probably coming off of years of adjustments to shifting patient volumes, changes to your staffing and technology, and keeping up with the ebb and flow of government programs. Everything has changed – and your approach to medical billing accounts receivable processes should have too. If not, your revenue cycle health is at risk.

It’s time for an AR reset, and there are a few things revenue cycle leaders can do today to make sure you’re on top of the changes you face.

  • Determine the last time you evaluated AR processes: If you’ve been keeping up with your approach to AR, congratulations, you’re ahead of the game. But if you haven’t had a refresh since 2021 or earlier, it’s time to reassess.
  • Assess the level of sophistication of your AR: There’s no reason to get stuck in the past. Take some time to evaluate where your AR processes stand today so that you have a strong awareness of your starting point.
  • Check the last time your KPIs were refreshed: You can’t manage what you don’t measure. If there’s any initiative or concern that your organization is prioritizing but you don’t have associated KPIs, it’s time for a refresh.
  • Review ownership and responsibility: Who owns your AR? Who’s responsible for making the most important decisions? Are they supported in navigating the coming challenges? If this isn’t something you’ve looked at since the height of the COVID-19 pandemic, you’re overdue for a refresh.

It’s most important though that you view this as an opportunity – a chance to bring your AR processes up to date so your organization can take advantage of fast-coming changes in healthcare. If you want to learn more about the possibilities that lie in front of you, feel free to contact me.

Hemant Apte, Chief Executive Officer in

Hemant Apte, Founder & Chief Executive Officer of 3Gen Consulting, is a seasoned executive leader with deep domain expertise in US healthcare management practices. He founded 3Gen Consulting in 2006 and has been instrumental in offering thought leadership to his clients and providing services and solutions that are unique in the market.

Home Health Coding Changes under the Home Health Final Rule

Home Health Coding Changes under the Home Health Final Rule

After much speculation, CMS has released the 2023 Home Health Final Rule (HHFR). It includes updates to the home infusion therapy and home health service payment rates for CY 2023. 

Revenue cycle leaders will want to pay attention to these changes from a coding perspective, because it will impact not just home health coding overall, but specifically OASIS coding

How the Home Health Final Rule Intersects with OASIS Home Health Coding 
Under the rule and with the implementation of OASIS-E, a diagnosis won’t exist to put on a recertification OASIS. Still, the orders to take care of the patient and plan of care will have to be coded [1]. 

Know that under the final rule, CMS is ending the temporary suspension of OASIS data collection for non-Medicare and non-Medicaid (home health agency) HHA patients. This means HHAs will have to submit all-payer OASIS data for the Home Health Quality Reporting Program (QRP), starting with the CY 2027 program year. This will require two quarters of data for that program year. CMS is finalizing a phase-in period that runs from January 1, 2025 to June 30 of the same year. Failure to submit data during that period will not result in a penalty [2]. 

Background on OASIS Coding for Home Health
The launch of OASIS-E was delayed because of the COVID-19 pandemic, being rescheduled for 2023 along with the expansion of the Home Health Value-Based Purchasing (HHVBP) model. This delay gave HHAs a bit more time to prepare for OASIS coding requirements and make sure their OASIS data accurately reflected the status of their home health patients. 

OASIS-E implementation launched along with the HHVBP model on January 1, 2023. This means that HHAs who haven’t started will need to begin a transition plan. While rolling out too early is no longer a concern, it will be critical to design a training plan that supports a continuous approach to education that helps clinicians understand the data elements that make up OASIS home health coding and how each of these elements aligns with their care responsibilities. 

How to Ensure OASIS Coding Accuracy
Coders face increased complications under these OASIS changes. They’re dealing with a wide range of documents from multiple providers in multiple care settings. You need to be working with coders who can perform accurate reviews while navigating the changes in information access that have come about in terms of OASIS coding under OASIS-E. These tips will help you navigate increasing complexity and ride the wave of coding changes while improving the health of your revenue cycle. 

Have a Plan
It is important that you approach OASIS coding strategically. While it is possible to simply start training your coders, you’ll likely miss critical opportunities to not only streamline your coding practices, but also to avoid the pitfalls that come with this kind of change. 

Make sure your approach doesn’t simply continue the status quo. Now is the time to align any high-level initiatives you have in improving revenues, increasing efficiency, and improving staff confidence with your OASIS coding training tactics. 

Choose the Best Metrics for Home Health Coding
Part of your OASIS coding plan should be coming up with the metrics you want to monitor as you implement change. Consider prioritizing KPIs in revenue cycle performance. For example, Net Days in Accounts Receivable can help monitor whether you have clean claim issues caused by coding. You’ll find similar results by watching metrics like Aged A/R as a Percentage of Total Billed A/R to monitor how coding issues might be slowing your revenue cycle and A/R liquidation. Aged A/R as a Percentage of Total A/R is also useful in tracking receivable aging and collectability. If it begins moving upward during your OASIS efforts after holding steady or even decreasing, you know this might be an issue. 

Work with Trained Coders
If you’re working with coders who are either newly trained on OASIS coding or aren’t catching on quickly enough, you’ll have issues in home health coding accuracy. These issues can result in unnecessary readmissions and patients not receiving the care they need. 

You will need connections with coders who have the right qualifications and who are able to maintain them without causing you significant burden. This challenge can be a complicated and expensive one, especially considering how often coding requirements change in the home health environment today. This is why many organizations consider working with outsourced OASIS coders instead of taking on the ongoing responsibilities themselves. 

Find the Right Partners
Even if you are absolutely sure you want to build your OASIS coding team in-house, you should consider the option of working with a third-party partner. 

This is because having a few conversations will help you understand the efficiency you could create. You also might be missing awareness of the potential pitfalls around OASIS coding – something you don’t want to discover through trial and error. 

To help you get this conversation started as early as possible, we’d like to invite you to contact us so we can discuss the potential benefits of finding the right OASIS coding partner today.

[1] J. Famakinwa, “How Coding Could Change Under The Home Health Proposed Payment Rule,” Home Health Care News, 23 August 2022. Available: https://homehealthcarenews.com/2022/08/how-coding-could-change-under-the-home-health-proposed-payment-rule/.

[2] “CY 2023 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Requirements — Final Rule (CMS-1766-F),” U.S. Centers for Medicare & Medicaid Services, 21 October 2022. Available: https://www.cms.gov/newsroom/fact-sheets/cy-2023-home-health-prospective-payment-system-rate-update-and-home-infusion-therapy-services-0.

Accounts Receivable Management Tips for Healthcare: It’s Time to Standardize Your Metrics for Denial Management

Accounts Receivable Management Tips for Healthcare: It’s Time to Standardize Your Metrics for Denial Management

Claim denial rates are still a major concern for accounts receivable management in 2022. For example, denial rates for marketplace payers have reached rates as high as 80% according to the Kaiser Family Foundation [1]. But this is only the beginning. COVID has put upward pressure on denial rates for a while now. All of this means that revenue cycle leaders should be taking a fresh look at their denial management practices, not only considering accounts receivable management services but also seeing this as an opportunity to investigate new and more effective approaches to denial management.

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