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5 ways providers can solve their most common Medicare billing challenges

5 ways providers can solve their most common Medicare billing challenges

According to recent research, the number of adults over the age of 65 is growing at a rate of about 3% per year. At the same time, recent analysis illustrates the federal government is facing the possible insolvency of the Medicare Trust Fund, which could create unprecedented financial pressure for home health, hospice, home therapy, skilled nursing, and other elder care providers. Further compounding financial matters, the billing and claim requirements from the Centers for Medicare and Medicaid Services become more complicated and confusing every year.

The future of Medicare is in flux

One way CMS has attempted to address the possibility of insolvency has been to enact stringent rules and requirements around chronic care management that have shown to reduce costs to both the government and the patient. The 2020 Medicare Physician Fee Schedule Final Rule notes that chronic care management is “increasing patient and practitioner satisfaction, saving costs, and enabling solo practitioners to remain in independent practice.”

While your organization may not classify as an independent practice, you may be an independent facility, one of a small number of practices, or an independently operational provider in a larger entity. No matter your organizational status, Medicare billing is likely a large portion of your operational expense and significant changes will continue to increase the complexity of Medicare billing:

  • The No-Pay RAP that began in 2021 has forced home health services into payment for services rendered, rather than up-front payments
  • CMS has relaxed requirements for RAP submission, but has added a late-submission penalty
  • Beginning Jan. 1, 2022, CMS will align the No-Pay RAP with the one-time Notice of Admission for home health and Notice of Election for hospice organizations

Five steps to better Medicare claim management

The good news is there are easy and efficient ways to address your most common billing challenges.

  1. Automate eligibility checks: Verify discharge dates with eligibility results to avoid overlapping services with other providers to make sure you’re getting paid.
  2. Use analytics that meet your specific needs: Stay on top of timely filing, notifications of admissions, and notification of elections using a robust reporting system.
  3. Make sure all of your billers understand Medicare: An intuitive and simple system makes it easy to cross-train staff so anyone in your billing office can submit claims to Medicare or any commercial payer, using the same system.
  4. Fix your denial problem: Understand your top denial, rejected, and return-to-provider reason codes — and fix them on the front end to prevent recurrences to get claims paid upon first submission and slash A/R days.
  5. Monitor regulatory changes: Use a software vendor that keeps up with constantly changing requirements for you so your staff can focus on more important tasks that improve patient care and improve your bottom line.

Wrapping it up: the future of Medicare billing starts here

Waystar is here to help with proactive reporting, a simple user interface with a direct connection to FISS, and a continuously updated Medicare rules engine. Learn how Waystar can help your organization simplify and unify your revenue cycle just as they’re helping nine of the top ten home health and hospice providers in the U.S.

“It’s great to use a product that is so straightforward and takes all the guesswork out for you.”

-Nicole Caffall, Lead Biller for Medicare, Harbors Home Health and Hospice

Find this helpful? Check out our video, specifically addressing the challenges facing home health and hospice organizations, and read about how Bayada Home Health Care was able to grow revenue by 60% without adding additional staff.

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