Do you have a bulldog on your staff? Melinda A. Gaboury believes that every home care billing agency department should have a true collections person who embodies the traits of a bulldog—tenacious, determined, relentless, charming, hard-core, knowledgeable and assertive.
For smaller agencies, where job titles often are combined, “You need to hire a collector who bills, and not the other way around,” says Gaboury, CEO at Healthcare Provider Solutions Inc. “This person has to have the personality and drive to do the job, because the people on the other end of the phone are getting paid to deny your claims.” Gaboury was a featured speaker at the 2012 McKesson Home Health and Hospice Executive Summit. In addition to aggressive hiring, she offered four more steps to improve an agency’s collection efforts.
Update job descriptions: In her company’s work with agencies and their home care billing departments, Gaboury often finds that the collections person is pulled in directions that have nothing to do with the billing function. In one instance, a billing manager also was in charge of intake and OASIS transmission. Job descriptions are important to ensure that every employee is working within his/her assigned area. The creation or review of job functions also will determine where your agency may be overstaffed or understaffed.
Collectors should be responsible for:
- Working Medicare “T” status claims
- Working denials/partial pays for all payers
- Tracking and following up on accounts receivable balances
- Issuing patient statements
- Tracking Medicare ADRs
Gaboury stresses that clinicians should not be responsible for tracking additional development requests (ADRs). Someone in the billing/collections department should track what happens with the ADR (partial pay/full denial, etc.) and communicate that to the clinical department. “Clinicians can’t fix what is causing the denials if they don’t know that there was a denial and why,” Gaboury says.
Review early and often: The collections process actually should begin at the time of referral, Gaboury says. Contracts should be checked every year or so, and reimbursement should be renegotiated often. Intake staff should be aware of current contract details, and any contracts that aren’t paying should be terminated.
Gather the right tools: In order to do a better job, the home care billing collections person must have the right tools:
- Accurate receivable reports
- Access to all contracts (including rate information)
- Timely copies of EOBs and remit information
- Accurate recording of authorizations and verifications
- Adequate time to perform duties (and not other assignments)
- Effective tracking system for follow-up
Monitor days outstanding: Finally, the collections person should have adequate oversight to make sure he/she is doing her job correctly, Gaboury says. Managers should monitor Medicare A/R, which ideally should be under 30 days, and non-Medicare A/R, which is more likely to be 60 days in a best-case scenario. If your agency’s numbers are out of line, find out why and take steps to improve the situation. Remember: if you don’t have a bulldog on staff, start looking for one.