Background

The smooth functioning of the Authorization process and AR management is vital for the financial stability of any home Health Agency. When the internal staff member responsible for managing these tasks resigns unexpectedly, it can create a lot of chaos and disrupt the operations of the agency. This is exactly what happened to a home health agency with collections of around 250k in June 2022.

The agency was struggling to manage the authorization process and AR management after their internal staff member responsible for these tasks resigned unexpectedly due to personal reasons. The agency found it challenging to process around 50-60 authorizations per day, which made it a cumbersome process for the remaining staff. The situation became worse when the agency started facing revenue losses due to delayed authorizations and billing.

Identification of Issues

The first step taken by BellMedEx was to identify the issues faced by the home health agency. Through careful analysis and examination of their billing and authorization processes, BellMedEx was able to pinpoint the root cause of the difficulties.

Streamlining Authorization Process 

BellMedEx streamlined the authorization process by developing a system that allowed for the efficient processing of authorization requests. This involved creating a centralized system for managing and tracking authorizations, as well as implementing an automated process for authorizations that met specific criteria. This helped to significantly reduce the time and resources needed for authorization processing.

AR Management

 BellMedEx developed a comprehensive AR management system for the home health agency, which involved a thorough review of outstanding claims and the implementation of a system for follow-up on unpaid claims. This included developing a process for resubmitting denied claims and tracking the status of all claims until they were paid in full.

Staff Training and Support

 BellMedEx provided training and support to the remaining staff of the home health agency to ensure that they were equipped with the knowledge and skills needed to effectively manage the new authorization and AR processes. This involved training on the new centralized authorization management system and AR management processes.

Ongoing Monitoring and Improvement

 BellMedEx implemented ongoing monitoring and improvement processes to ensure that the authorization and AR management systems were operating efficiently and effectively. This included regular review of reports and metrics related to the authorization and AR processes, as well as regular communication with the home health agency to identify areas for improvement.

The Result 

With the help of BellMedEx, the home health agency was able to overcome the challenges they faced with authorization and AR management. The new processes and systems implemented by BellMedEx not only streamlined the authorization process, but also improved the overall revenue cycle management of the agency. The agency was able to increase their collections, reduce their average claims time in aging, and improve their cash flow, leading to increased profitability and sustainability for the business.

Conclusion

This case study highlights the importance of outsourcing medical billing and coding services to a reliable and experienced company. By doing so, healthcare providers can streamline their operations, reduce administrative burdens, and improve their financial performance. BellMedEx’s expertise and proactive approach helped the home health agency overcome its challenges and achieve success.

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