AAHCM HCCI Pre-Conference Session: Level Up! Take Your House Call Operations to New Heights-Core Compoents of HBPC Success Revenue Cycle

Core Compoents of HBPC Success Revenue Cycle
Pdf Summary
The core components contributing to the success of a Home-Based Primary Care (HBPC) practice encompass contracting, intake, documentation, coding, billing, accounts receivable (A/R) report management, denials management, productivity management, new payment models, and audit/compliance.<br /><br />1. **Contracting**: Ensure your practice is contracted at a minimum of 100% Medicare rate and all practitioners are credentialed with payers. Maintain up-to-date contracts and manage patient distribution across care types. Implement strategies for negotiating better rates and improving payer metrics.<br /><br />2. **Intake**: Staff should fully understand insurance plans, including authorizations and eligibility requirements, to prevent delayed reimbursements or write-offs due to lack of prior authorization.<br /><br />3. **Documentation**: Accurate and timely (within 24-72 hours) documentation is crucial for timely claim processing. Providers should be trained on medical necessity and compliance standards to avoid unfavorable audits and ensure claims support the complexity of patient conditions.<br /><br />4. **Coding**: Ongoing training in documentation and coding is essential. Use highest specificity in coding and appropriate modifiers, with a pre-submission review process to ensure clean claims and avoid denials. Accurate coding enhances revenue and protects against non-compliant audits.<br /><br />5. **Billing**: Timely submission within 24 hours of a signed note is necessary. Bill for all services, including care management, and implement strategies to collect copays/deductibles upfront to avoid delays.<br /><br />6. **A/R Report Management**: Regularly review dashboard and A/R reports to identify and address denials promptly, preventing write-offs and ensuring compliance.<br /><br />7. **Denials Management**: Establish processes for timely remediation of A/R denials and conduct regular reviews with billing departments to mitigate issues.<br /><br />8. **Productivity Management**: Monitor provider visits, patient census, and other productivity metrics. Setting standards and assessing performance ensures sustained practice operations and identifies growth opportunities.<br /><br />9. **New Payment Models**: Keep updated on evolving payment models like value-based contracting and MIPS participation, transitioning towards reimbursement based on outcomes rather than service volume for sustainability.<br /><br />10. **Audit/Compliance**: Implement a compliance program/plan to mitigate risks associated with Medicare/Medicaid participation and regularly conduct internal audits to avoid repayment penalties and ensure adherence to E/M benchmarks.<br /><br />Each component strategically impacts both cash flow and profitability, necessitating careful management to maximize financial stability and operational effectiveness in HBPC.