Best practices to go from payor to patient to paid

The HME industry is complex and constantly changing. That’s why it’s important to have efficient workflows around processing claims and collecting patient payments to keep your business healthy. We’ll explore some best practices that can help you maximize your collection process and minimize your staff’s workload.

For your payors:

Develop a foolproof intake process. Having a clear, well documented intake process can help your staff work smarter, not harder. What that really means is making sure everyone is on the same page: documenting your intake guidelines and requirements; making clear who is responsible for which parts of the process; aligning intake with other business processes and expectations; and having metrics so you can track your success.

Intake is challenging because of the complexity of our industry. We have fee-for-service models, Medicare, capitated plans, managed care plans—and they all have their own rules and frequent changes. And while many of these changes provide clarity and make HME work easier, it’s still a good idea to organize your team according to those different products or payors so they can become expert on the details plan requires.

Update your system configurations. It’s important not only to document guideline changes, but also to leverage your software to manage the updates. Take time to update your software systems when things change, such as prior authorization rules or new forms. Using your existing technology to manage updates streamlines workflows and helps reduce errors. You should also look into digitizing incoming orders as much as possible. There are tools that allow data elements from EHR system to be pushed into an order system and auto-create the order, perform the initial verification, check for errors and even author the order. Digitizing and automating processes like this get you out of the business of chasing paper and can reduce costs.

Define your insurance verification processes. Because many payors offer multiple insurance plans, it’s important to have accurate and complete insurance and product eligibility verification. This helps make sure the product the patient needs is covered and adheres to all guidelines. Streamline the process by being clear about when team members should gather more detailed information versus when a quick check will do. For example, after a complete initial verification, you might do a less in-depth verification check if the patient still has the same insurance three months later.

For the patient:

Collect payment information up front. There is no other realm of healthcare where a patient can receive care without having provided a form of payment, even if the service will be 100% covered. This has been a major challenge in HME because our organizations aren’t used to collecting that information. It should begin with making sure your intake staff understands why they need to collect this information and giving them the talking points to be successful. Keep the message to your patients simple: We’ve changed our policy and now require a form of payment on file for the type of service or equipment they’re getting. This is especially important for the segment of your patients who have recurring rentals and supplies.

Communicate payment policies with staff and patients. Your staff should fully understand why you’re making this change, such as previously writing off a large amount of debt and needing to reduce that for the organization’s financial health. And while getting existing patients to comply is ideal, it may be easier to start fresh and apply this policy to new patients. You can go back to gather payment information on those patients later, but starting with new patients can be an effective way to begin turning around a challenging financial situation.

Get financial authorization. Develop a financial authorization policy that is given to a patient at intake with all of your other required paperwork. This will make clear that if the patient is receiving recurring rental equipment, they will be required to put a form of payment on file. Train your staff to communicate this information and help patients understand why it’s required.

How technology tools can help

There are tools to help with these payment processes. A good first step is to enhance your system configuration. Make sure fee schedules from payors are properly loaded into your system so you can quickly and accurately tell patients what their total cost will be. When you add a new insurance payor into your system, make sure you gather all the background you need so your system knows what kind of payor it is—for example, managed care or Medicare—and all the requirements they follow, including whether they offer electronic connections for claims.

In resupply, keeping in touch with your patients is a key success factor. There are tools that allow you to track when patients are eligible for replacement supplies and the volume of supplies approved. Patients can be proactively notified with the information, reducing the number of calls your staff needs to handle. Some options even support automated text messages that keep patients updated on product orders and deliver electronic forms.

Another way to leverage technology is by using autopay and eDelivery tools. These require some up-front effort to set up a new process and train staff, but we’ve seen organizations who use these tools go from collecting about 50% of patient balances to nearly 90%. Using electronic billing via a patient portal is another game-changer, since it’s faster and less expensive than printing and mailing bills each month. The work it takes to initiate these processes is well worth the effort.

Touch base with your staff

Fostering an environment where team members can come to you with challenges or new ideas can be a great way to encourage open discussions about how to improve processes that affect your ability to process claims, collect from patients and run a successful HME business. I believe it’s more powerful to have the information come from the bottom up rather than from managers badgering staff about challenges. In the end, this is a great way for individuals to be accountable and contribute to your organization’s success.

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Ashley Brown

Ashley brings 12 years of experience in the healthcare service industry to her role leading a team of payer analysts and intake specialists who help Brightree customers manage their businesses. Her extensive background includes operations, account management and process integration.