Netsmart CareThreads
Netsmart CareThreads

Episode · 11 months ago

#hospice and #palliative Billing Strategies for Financially Tough Times


We were working on payment reform when life threw a giant curveball into post-acute care settings — and everywhere else — last March.

Organizations that hadn't yet bulked up on technology struggled at first, but industry wide, we should all be giving ourselves a big pat on the back for how well we handled the changes.

Now, how can organizations plan for 2021, stretch their budgets, maintain remote environments, and stay focused on our patients?

In this episode of Netsmart CareThreads, Jason Banks, vice president of post-acute at Netsmart, talked with Erica Gregory, vice president and general manager of revenue cycle operations.

Here's what Erica and Jason discussed:

- Revenue cycle and billing-related changes during COVID

- How post-acute care communities can improve operations and stretch budgets

- Recruiting and training billing staff in a remote-work environment

- How to run financial operations smoothly while staying focused on patient care

If you want to hear more episodes like this one, look for the Netsmart CareThreads podcast on Apple Podcasts, Google Podcasts, Spotify or Stitcher.

Welcome in that smart care, threads, apodcast, fere human services and postocute leaders across the healthcarecontinuum come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimprove the quality of care to the communities we serve? Let's get intothe show. Thank you for Joinin us. My name isJason Banks on the vice president of client, development for posecutedNetsmart, I'm joined by Erica Gregory, hi, Erca, Hi Jason. How are you I'mgood? I'm good! Thank you. So Much Ericas are Vice President GeneralManager of Revenue Cycle Operations at Netsmart. I ves Sarah could have joinedme, so she could share her expertise and leadership with you around billingstrategies. You know, I think it's needless to say, two thousand and wentsbeen a extremely challenging year for our clients, who have been greatlyimpacted by the COVID pandemic, and when you, you know, you add, on that,to all of the typical regulatory changes. You know it really has been astruggle this year. For many finances are tight needles to say so. Let's goahead and jump into our podcast and so cover some of the topics. So here,because you work with our senior living and homecare clients, what are some ofthe largest? You know, revenue cycle or billing related challenges, you're,seeing Gosh that tha great question Jason- and I think you said it bestchallenging- is the best word to describe this year. You know we startedout the year planning for Change. We were planning for our payment reformandand getting settled into what that meant for us and crosspost o cute withPDPM and PDGM, and then it's been the story of the year.For me, I feel like has been like it has been cur false. How do we deal withthe curve balls that have been thrown... us and professionally, as well aspersonally? All of our organizations and US are dealing with what this newnormal of the pandemic has met and meant for us, and with that I think it's been talked about a lot, butthere's some really specific items inside of revenut cycle that a pandemicand thus working virtually or having to not be close together, has createdchallenges as we approachd the payment reform, we were working on educatingall of our staff and getting our staff ready for their payment change bothinside of my organization, I know so many of my clients were were doing thesame, and so just as we were hitting our stride with that in the Spring Goshhere comes the big curvball, where many of us had to take a billing functionthat usually is very office based and requires a lot of good collaboration toa decentralize. How do we get everybody out of the caresetting if they don'tneed to be there, so that we can curb infection control? And how do we still allow thatcollaboration and training that is needed to be able to happen? So I thinkfor us, I'm so proud of my team, for how wewere we actually in twenty four hours, took all four of our central businessoffices virtual and so we're incredibly fortunate that we were positioned wellto do that. But I know for a lot of clients that was a big challenge, justtechnology wise being enable to send some folks home to do ir their workfrom home, an callenge and cout, and I think about you know as an organizationhaving been on the provider side. You know what I didn't realize Erica fromthe very start was that billing and...

...revenue cycle starts the moment you getthe referral and so not Tus t the billing teams being home, but theintake staff and the frontline plenitians and everybody beingdisconnected and have to orchestrate this. It is incredible, and I love thatyou say that chase. So one of my favorite statistics I share withclients as we're looking through denials management is over. Sixty percent of the informationthat goes on to your claims form comes from the upfront process before care isever provided, and so it's so important that you have those teams collaboratingwell and not that we didn't all in revenue cycle acrosspostecute rise to the challenge, but it was a challenge and something that I think is exciting andI think a lot of revenue cycle leaders across our industry soul really givethemselves a huge pat on the back, because this has been the year thatreally had to stretch us on how we could be creative and and find uniquesolutions to this absolutely. I would totally agree and applaud all of thoseat the provider level as well as your team. I mean they've really done anoutstanding job, but on the Post, O cute care communities. What advicewould you give to our postocte care communities to improve their operationsand to stretch their budgets in this incredibly difficult time? Yeah, that'sa good question! You know, I think, one of the biggest things that we see thatwe provide a lot of advice on- and I always think is an important part- ismaking sure that you're planning for the regulatory change in your budgetplan, so budgeting is, is a challenging time. It takes a lot of work and effort,but going that extra step to look at what regulatory and payment changes arecoming my way, and how am I going to...

Flex my budget so that I have realisticplans for how we're going to count for that? You know one of the greatexamples of that that were working with a lot of home care clients on right nowis the no pay raps that start in two thousand and twenty one. So you know nolonger. Are we going to get that upfront payment that we have, and sothat's a big change from a budgeting perspective? There's going to be atiming of our cash that is going to be changed and that we have to have thoseon file so quickly. So really looking at your days to wrap right now andthinking through what? If anything, do I need to change around my staffing sothat I'm going to meet that new timeline? If you don't, there could beso much money left on the table so yeah that is so good Arica, and you-and I talked earlier- it's not just Wein a regulatory changes that couldimpact your financials in the upcoming year. It's even things like NBI numberschanging. I know you and I had a conversation earlier today about thefact that the NBI numbers changed about a year ago. From being you know, asynonymous with your social security number to unique identifiers that causea huge change in the way that revenue cycle was impacted for hospice providerspecifically, and so it's regulatory changes hat. Maybe things like NBInumbers change in a couple of post of factors that will impact your revenueabsolutely, and you know that NBI one is a great example on how I would alsoencourage organizations to think about technology. So you know that thatchange of no longer accepting a subscriber or social security numbermeant that organizations that had clients and residents and patients thatthey had been seeing for a decent...

...amount of time. Now, all of youreligibility information that o you've had loaded is no longer accurate and sothere's a couple of Nice pieces of technology out there that really canmake this a seamless transition for your front and registration and intakestaff as well as then, really curbe those denials on the back end for yourrevenue cycle, none of us have extra hours to be working additional denialsthese days and so being a making sure that you get theright information on that claim with that switch overst. Just so important.Absolutely can you take a moment to share some examples of how your teamhas helped posteqte care clients with certain challenges that might be ofhelp to other organizations out there yeah absolutely I' love to one of thethings that we've seen a lot and goes to what I've been talking about earlieraround just the changes that we saw this year.A lot of our organizations found themselves shortstaffed, so whether itwas sending staff to work remotely meant that things weren't as efficient,and so they just weren't able to get through the normal inventory that theydo or they had individuals go out, sick or they lost billars and so recruitingand training. Right now is training, especially as I mentioned, is reallyhard in a remote environment, and so we've been able to help provide clientsome augmentation in their staff. We can quickly scale up and scale down forthem, and so that that is probably one of the biggest thing t at that. I'veseen this year is just helping folks bridge that time period and then several of our clients have beenlooking for enhanced reporting that they've needed in order to make planswith their budgeting as well as just...

...the day today management. So you know,as I mentioned, we've got all of these regulatory changes happening both theones we had at the beginning of the year and the ones that are comingreally understanding. What your key performance indicators are telling youabout. Your Business is important to know how am I doing with the changethat just happened as well as how do I plunt for the next one and the next one?So you know, if I don't know what my days to rap is, I have no idea if I'mready to have it on file under the new deadhline same thing is, if I, if Idon't know where I'm starting to see declines on my reimbursement, because Idon't have the right codes, I don't know how I'm I'm doing and h how muchrevenue I have at risk based on the payment rerforms. That's so good! Youknow at going back to your initial comment about you know just recruitingand training. These are really such highly specialized positions and manytimes the revenue cycle teams have such a wealth of knowledge about the entire.You know, organization or business that they're in and I've had the opportunity.I'll say where you know. One of my key billing folks is: Is Retired or gone omaternity or an extended leave for whatever reason and whow. Is it justhard to find somebody with that level of domain knowledge about the industry,the organization the billing requirements, the regulatoryrequirements? It's just so your point is absolutely well taken. I think it'sthe area where a lot of organizations really struggle is how am I going toreplace this key individual that is so so talented and so knowledgeable. Youknow and find another person just like him or her. It's really difficult to do it's true. It does end up being at somany organizations. I've worked with...

...their incept being so much tribalknowledge in the revenue cycle and a biller. That'sgotten comfortable with a payer or comfortable with e service line. Wehave a client that is one that immediately comes to mindwhen you say that they had a client, Delaware that we work with. That hasbeen just a really great success story with a partnership, their billarretired, and they thought they had a backfill and it just didn't work outand when we stepped in to help them, theyhad ninety five days worth of back home health bills to get out the door. Andso you know the just was a sense of panic in the organization right thatthat is a a rough spot to be in because they're, just every single day, you'refeeling a little bit more behind. And so we were able to move things aroundand get them staff ready to be logging in within twenty four hours and wereable to get all of those bills out and my favorite part about t is we reachedout to them the other day, because we had collected a hundred percent of thatback ar? And so it's just a wonderful story. there. Their president was justfeeling very good about how they're heading into the end of the year andjust not worried anymore, that we weren't going to. You know that theywere going to have these bills. That aged out to the point that they werejust going to have to write them off. That's so cool, because I know that formany organizations that money goes right back into the individuals thatare carrying for patients and families, and so it's so important not just forthe financial stability of the organization, but to continue theirmission of serving their communities. I'm goinna pivot a little bit in afinal question and ask got to get out your crystal balls. We Look Qickntwenty one. What advice would you give... our clients to help them stayfocused on carring for patients yet keep financially smooth operations? Ohthat's a good one! You know, I form my homehealth clients. I can't say enoughabout the change that's coming in January and it's going to be followedvery quickly with the NOA process the next year and so for those in that carevenue from a revenue cycle management standpoint. I can't stress enough ifyou haven't been already looking at both. You know: Managing a cash FLOperspective to get ready for this. What's GOINGTO feel like a cash rortarattraction for a while, as you you no longer get that payment on the rap andthen also really looking at how quickly you're getting them on file? Because ifyou don't, you will miss out on that reimbursement. For my hospice clients,we've been doing a lot of work since Medicare made that change around NBIand we've got some good technology to help clients, look and beyind numbersup automate that full process so as they are bringing additional clients onthat, they can quickly find that information and not have to have anoverly cumbersome eligibility process with a family and then with my seniorliving organizations. This has been a real roller coaster of a year andplanning for revenue for next year and that payr mix is really important. So,if you're not looking at what these changes have done to your payermix,it's really important that you do because flight changes in that payrmixcan make a big difference for your organizations, profitability and sokeeping an eye on those kpis are really important and something that we workreally closely with clients on, because it can just drastically change what youplan from a researcing perspective for...

...the next year Gush, and then, if I can't stress itenough, be thinking about what type of technology you need to deploy inside ofyour revenue cycle, the world of clearinghouses has so drasticallychanged in there', so much that can be automated, whether it's oasis, crubbingor Imdia, scrubbing or advanced eligibility lookups, or you know a lotof News, selfpay collection tools that areout there, so enhancing your payment portal or the look and feel of yourstatements and how you interact with clients on that collection process.There's there's a lot of technology out there that has tremendous Roy and sosomething to really think about. As you're approaching. What's likely goingto be another year full of change, I mean, I think, we're all hoping t a thevaccines going to come and that we're going to have our lives back right andour businesses back to where w were. We were before and even better, but Ithink you know my crystal ball says it's still going to be six to ninemonths of the world, we're living in and so thinking strategically about howtechnology and partners can help you and what your reports are telling youike is what is my advice that I would give such such great advice Erica, and Ican't echo that enough- I think you know, with high deductible health planson the rise and sort of were at almost a tipping point with Medicare advantagecoming close to fifty percent of in rollies. I think that you know makingsure that your technology and your people can support that is socritically important. Well, I want to thank you and your team andthe the organizations that you serve in all the post, secute caraganizationsout there who are going through this...

...incredibly difficult time. I appreciateyour time today and I hope that you and your family remain safe, this holidayseason and and we do as you pointit out, we have a vaccine in two thousand andtwenty one and and there's light at the end of this tunnel, and I do believethat will get there together. Absolutely Jason is same to you. I hopeyou have a great holiday season and to all of my revenue, cycl warriors outthere give yourself a pat on the back. It's been a year and we've made it anabsolutely. Thank you Erio. Thank you at net smart, we understand thechallenges facing provider organizations. Our team will help younavigate changing value, based care models with solutions and services thatmake person centered care or reality will equip you with technology andservices that provide holistic, real time. Views of Care Histories thatinform better decision making and better outcomes visit us today atntstcom Netsmart serving you. So you can serve others thanks for listeningto the Netsmart Care, threads podcast through collaboration and conversation,we can work together to make healthcare more connected than ever before andbetter support the communities we serve to ensure you never miss an episode.Please subscribe to the show in your favorite podcast player, if you useapple, podcast, we'd love for you to give us a quick rating for the show.Just have the number of stars that you think the podcast deserves until nexttime.

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