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Medicare Compliance & Reimbursement

Home Health Billing:

Keep Your Billing On Track With These Crucial Benchmarks

Published on Tue Jan 03, 2012

You should run this vital billing report weekly.

Home health agencies that fail to keep tabs on their billing stats are asking for billing errors, sluggish collections, and worse. Running brief weekly reports and more detailed monthly reports with vital billing stats "will change the collection life of your agency," pledged billing expert Melinda Gaboury in her presentation at the National Association for Home Care & Hospice annual meeting in Las Vegas. "Implement it tomorrow," she urged in her Oct. 3 session. The simple reports "will tell you volumes about what's going on in that [billing] department," Gaboury promised.

Using the reports is key to making billing staff accountable, explained Michael Horsley, therapist and owner of HHA All Coast Therapy Services Inc. in Lady Lake, Fla., in the presentation.

Here are the stats Gaboury and Horsley recommend should go into the weekly reports:
  • Average days in accounts receivable. You can calculate that by dividing total revenues by total days, Gaboury instructed. Horsley recommends separating the figure by payer type.

Tip: Figure out whether you're going to count AR from the day the patient is discharged, or the day the claim is billed, Horsley advised. For the former, a 40-day figure might be good. For the latter, seven to 14 days could be a rule of thumb.
  • Admissions and recertifications versus RAPs filed. If you do 50 admits and recerts but only bill 10 RAPs, "you've got a huge problem," Gaboury told attendees in the standing room-only presentation.

If your RAP figures go up and down wildly, so will your reimbursement, Horsley pointed out. "You want consistency from the billing staff."

Remember: If you aren't billing RAPs timely, you're going to be seeing people without getting paid for it, Horsley noted.
  • Number of days to transmit a RAP and final claim. This figure will be influenced by your internal deadlines for paperwork, Horsley said. Billing the final claim within one or two weeks of the episode's end would be ideal, Horsley said. But that's dependent on getting paperwork from both your own staff and referring physicians.

"The biggest problem is with physicians," Horsley lamented. Both the plan of care and face-to-face documentation can delay billing for weeks.
  • Cash receipts. Don't leave out this vital performance measurement. If your billing department can't collect enough money to keep clinicians working, "what's the point?" Gaboury asked. A monthly report also should include details of any claims older than 150 days, Gaboury recommended. It should include specifics like the last time someone called to collect, etc.

Typically, agencies who implement this reporting system find that after an initial period, collections improve so much that there are almost no claims that old, she reported. At that point, they can move the benchmark down to any claims older than 90 days.

How to use them: Billing managers should use these reports to examine goals in team meetings and address low performance issues, both with the team and individuals, Gaboury advised.

Plus: Make sure the reports aren't just internal billing department documents. They should go to the administrator, owner, director or whoever has ultimate responsibility, Gaboury recommended.

Someone in authority has to look at the report every week and, most importantly, analyze it, Horsley urged. The person analyzing it must have the authority to make changes based on the report.

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