Accounts Receivable Case Study

A large hospital-affiliated home care agency with a 75% Medicare payer mix, was placed on a 35% Focused Medical Review as a result of recurrent clinical documentation and billing errors. They sought a solution which would facilitate their removal from Focused Medical Review, prevent a recurrence, and improve their operating cash flow.

Objectives:

• Facilitate removal of FMR status of their Medicare claims
• Educate and train management and clinical staff in Medicare Reimbursement Regulations and Documentation guidelines
• Monitor adherence of staff compliance to regulations and report deviations to clinical managers

Tactics:

• Created reporting mechanism to track ADRs and identify monthly trends
• Educated clinical field and management staff on Medicare Reimbursement Regulations and Documentation Guidelines
• Developed Pre-Invoice Edit process and policy and trained reimbursement staff on its use
• Wrote Corrective Action Plan and submitted to Fiscal Intermediary
• Established teleconference dialogues with Fiscal Intermediary regarding FMR status and corrective measures

Results

Agency was removed from FMR within 9 months resulting in:

• Increased Medicare billing release from 23% to 70% resulting in an accelerated average cash flow of >$300,000 per month
• Trained all reimbursement, clinical and management staff on Medicare regulations and reimbursement guidelines. Staff mastery of the regulations was measured by a written competency test.