From bedside nurses and operational leaders to OASIS, billing and coding experts, the team at HEALTHCAREfirst has been in your shoes, working in many of the roles within home health and hospice agencies. Ronda Howard is one of them.
Q: What made you choose to join HEALTHCAREfirst?
A: It was an opportunity to make an impact in the home health and hospice industry, especially when you can join an industry leader like HEALTHCAREfirst. And then to get to be part of ResMed’s connected network, it was an easy decision. We all complement each other very well. Together, we’re creating a seamless experience, ultimately enabling providers to improve the quality of care for their patients and the financial components along that journey play a critical role in the success of the agency.
Q: What life experiences do you bring to your job?
A: I’ve worked in RCM for a long time, but I also draw from my experiences in acute care and ambulatory surgery. Before joining HEALTHCAREfirst, I worked for a provider that specialized in “complex claims.” That role involved working on niche cases that were a little out of the ordinary, like motor vehicle accidents and out-of-state Medicaid cases. Providers don’t usually handle cases like these because they don’t know how to work with the guidelines. If my vast and varied experience has taught me one thing, it’s that the basic principles of billing, cash flow and denials are the same throughout the industry.
Q: With your experience, what do you think is most critical in a services provider?
A: Finding a vendor that is very knowledgeable about your particular business and the issues you face is very important. There are a lot of vendors out there that want to be in every single space. They want to do outpatient surgery. They want to do anesthesia. They’ll also throw in acute care, home health and hospice. I call them a jack of all trades, but an expert of none. At HEALTHCAREfirst, we specialize in home health and hospice. That’s what we are trained in. That’s what we know and do best.
Another essential quality to look for in a vendor is someone who has a good reputation in the industry. RCMs open and close every single day. HEALTHCAREfirst, on the other hand, has been in business for over 25 years. We’re not going anywhere.
You should also look for a partner who’s seen and done it all – one who strictly follows the regulatory compliance, knows how to bill correctly, has extensive experience with complex claims and fully understands the ever-changing guidelines.
Trust is also a major factor in choosing a partner. An agency is basically handing their checkbook over to their RCM vendor to look after their revenue on a daily basis. You have to feel very comfortable with that aspect and feel confident in your partner.
Q: What are some of the top challenges facing your industry right now?
A: Staffing and reimbursement are definitely the top two that I hear from all of our agencies.
Staffing, as you know, has always been a challenge in home health and hospice and has only becoming more and more difficult. Wages in post-acute care have been increasing, which is great news, but that means people are more selective about the jobs they take. You see a lot more job-hopping these days as well. Many skilled employees are going after the higher-salaried positions that let you work from home. There’s also a certain part of the workforce that just isn’t coming back to the industry. Many workers who were off for COVID found other ways to make a living and have stayed in their new lines of work. Other employees will leave with short notice or limited notice, which can put the agency’s financial health at risk. Billing and coding are complex roles that require expertise, training, and quick turnarounds. It helps to have an expert partner that can step in and help out at a moment’s notice and isn’t impacted by agency turnover.
Constant reimbursement cuts from Medicare require more and more due diligence to simply get paid. For example, if you don’t have the authorization, they don’t allow you to get a retroactive authorization. They want more and more documentation – and they all have different billing requirements. Plus, we’re seeing mass adoption of Medicare Advantage (MA) Plans by the patients and while those payors say they follow the same guidelines as Medicare – they often don’t. There are more than 30 MA plans, and each are unique in their requirements. There is more pre-work needed, more auth documentation required, more billing demands to meet, and a lot more work to just keep up to date on all the fluid regulations.
Q: How does your company help solve these challenges?
A: Clinicians have a lot on their plate as it is. Having to worry about the financial aspect of the business, and, in some cases actually having to pitch in and help with it, is not the most efficient and valuable use of their time. Their primary focus should be all about the patient, not operational tasks like billing and coding. We see agencies just write things off because they can never figure out how to get the claim to the payor correctly. That should never happen.
So, to solve issues like this, we essentially become the agency’s business office. We work out of their EHR so they can see everything we are doing; it’s a fully transparent process. We just don’t actually sit in their office. We take over the billing and coding, authorization management, cash application and payor setup. We track down aging AR and work to get them the full reimbursement owed. We keep abreast of all regulatory changes to make sure they remain compliant. It’s all the things that their team really shouldn’t have to focus on. When the teams can fully focus on the patients, it’s a benefit for everyone.
By handling these functions and getting their claims out the door cleaner and faster, we’re going to improve their reimbursement. They’ll get their cash in a timelier manner, allowing for improved cash collections and fewer denials. We’ve also found that when your clinicians can focus solely on patient care, it leads to increased job satisfaction. Clinicians are called to care for people – not spend their days doing paperwork. And we enjoy it – let us handle the billing, coding, documentation, OASIS and more!
Q: What is the most satisfying part of your job?
A: The most satisfying part is when we get to partner with a home health or hospice agency that is really struggling, and they don’t know what to do. They have a large number of unpaid claims, and they are in dire financial straits. We’re able to come in, assess their accounts receivable, clean it all up and make them viable again. After 60 to 90 days, they start to see the cash flow in again and you can see their faces light up with relief – and then happiness knowing their agency will still be around to make a positive impact in the community. That’s when I know all our efforts are worth it.
See the difference HEALTHCAREfirst can make
For more than 25 years, HEALTHCAREfirst has been the premiere provider of RCM services, CAHPS surveys and advanced analytics for home health and hospice organizations. Trust us to help you accelerate reimbursement, maximize cash flow, reduce risk of denials, and go beyond compliance.
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