Family Home Care and Care at Home, two not-for-profit agencies with a 40-year history of serving the New York metropolitan area with managed care and private pay services in the home, were struggling to survive. At the time, they had hundreds of thousands of dollars in aging outstanding claims and were on the verge of closing because they could not financially sustain themselves.
To modernize their revenue cycle and secure long-term financial stability, they turned to HHAeXchange Revenue Cycle Management (RCM) Services. The choice was made under pressure, and when Jeffrey Maynard, Chief Financial Officer, joined the team one of his first tasks was to re-evaluate the decision to outsource billing to HHAeXchange. Ultimately, he determined that the high collection rate offered by HHAeXchange RCM services would be far more efficient than creating a new, internal billing department.
Typically, when you set up a billing department, you’re going to lose 1-2% of your billing due to all sorts of issues. It was apparent that HHAeXchange RCM had a very high collection rate, and it was clear that outsourced billing would be more efficient.
Jeffrey Maynard, Chief Financial Officer
Family Home Care and Care at Home
The agencies found that once they outsourced billing, cash flow improved and became more consistent with quicker payment turnaround on an ongoing basis. “RCM Services fixed and resubmitted our aged claims to the payers, and they began to be paid. In addition, they worked with our team to correct current issues – billing format and data conformity with payer requirements, client services in compliance with authorizations, and held billing edit issues. Very soon our collections performance exceeded 99% of our billing,” Maynard said.
One important distinction Maynard realized is that the RCM Services team doesn’t just bill and collect. They work closely with multiple teams across an agency on an ongoing basis, such as operations and finance, to provide guidance in areas like contract conformity and authorization and denials management. This way they can maximize the effectiveness of their own revenue cycle functions from intake to billing.
“They shepherd us through changes in payer process and state mandates. We receive a comprehensive set of reports and have management calls with them to discuss performance, challenges and issues. They also support our annual financial audits, responding to auditor documentation requests, and providing commentary on AR collectability.”
Family Home Care and Care at Home found themselves in a much better position now to weather the complex pressures that homecare providers face, including thinning margins, rising costs, value-based payments, and increased payer diversity. “RCM Services plays a big role in that,” Maynard said. “They provide us with optimized revenue cycle performance while allowing management to focus on the challenges and execute on the opportunities in the market.”
Revenue Cycle Management refers to the entire financial process of managing claims, payments, and reimbursements from payers. It includes everything from claim creation and submission to denial resolution, accounts receivable follow-up, and final payment reconciliation.