A large Home Medical Equipment (HME) billing service provider is looking to aggressively expand its RCM business. In the business world as well as in the healthcare field growth is good. However, with growth comes a unique challenge; which may or may not be solved. Even though evolving or growing medical facility services may not change, the internal processes related to claims submission, income cycle, billing and coding, and revenue cycle management need a serious overhaul in order to stay efficient and sustainable as they scale up the operation.
In order to cope with adversaries in growth, processes need to be flexible and adaptable. Common tenets of a scalable business include the use of appropriate technology, adherence to state and federal regulations, documented processes and procedures, streamlined workflows, and effective measurement tools to gauge business growth.
A basic situation
You must understand that the in-house team and manual processes would not be able to scale and would impact your profit margins. This situation prompts them to search for an outsourcing Home Medical Equipment (HME) billing partner to handle portions of their revenue cycle management. It then becomes important that this partner be able to cope with the planned aggressive growth and not impact delivery for current customers.
The solution to the situation rose!!
Future healthcare (Pseudo name) was chosen to be the preferred vendor based on their competency and growth story. Future healthcare without wasting any time contracted specialty medical billers and coders for their HME reimbursement operations. These experts will work with the existing team to modify processes and workflows to meet the business needs of the customer. Future healthcare HME then utilized system management software designed by their contracted biller as it came in handy during this endeavor. With their state-of-the-art billing platform, Future healthcare was able to optimize the processes, improve efficiency, and provide real-time reporting to their patients and in-house staff. And all of this, while improving the RCM priorities of the HME supplier!
Future healthcare delivered the solution to the customer ahead of schedule and quickly helped in ramping up with business needs. Not only did the medical facility successfully run the pilot, but they also won several new clients to meet their end goal of expanding business and revenue.
As a result, turnaround times actually decreased, despite a huge increase in workflow. The customer was able to maintain a 48-hour turnaround time in cash posting and sales orders and a 12-hour turnaround time for their critical clients.
For AR & Denials, the billers have consistently maintained their AR days which have resulted in better cash flow for their clients. The customer has been so impressed by the processes and techniques used to handle their business; they’ve actually adopted their workflow technology to use internally for their captive center. Future healthcare solutions helped in increasing efficiency and accuracy among their internal teams.
Although the mentioned healthcare facility did not have experience in the (HME) Home Medical Equipment industry, their competency in business expansion and business continuity planning as well as their flexible solutions approach made this a great partnership. Indeed, Future healthcare has experienced aggressive growth itself over the past few years, so they were uniquely qualified to accept this challenge.
Results of RCM in Home Medical Equipment
- Better turnaround times for payment posting and claims orders, despite aggressive growth
- Maintained AR days resulting in better cash flow
- Improved efficiency of internal teams making continued growth possible
- Access and visibility to real-time reports
- Processes and best practices to cope with aggressive growth