Process Outsourcing in Home Health and Hospice: Capture Value and Reduce Liabilities with a Trusted Business Partner

Posted Wednesday, May 17, 2023

Written by:
Melissa Kalinowski, Corridor’s Vice President of Coding Services and
Lorie Owens, Corridor’s Director of Strategic Client Management

Home health and hospice agencies are focused on their mission of providing exceptional patient care. However, challenges abound! Clinical and back-office staff need to be hired, maintained, and continually re-trained in new rules, regulations and processes that affect payment and reimbursement. The strain on personnel can be daunting. And even though we have emerged from the COVID-19 pandemic crisis that further strained limited resources, many of the ongoing problems facing home health and hospice agencies remain.

Outsourcing critical but repetitive business processes can take some of the pressure off staff while improving claims processing times and clinical staff performance. Some of the advantages of outsourcing your revenue cycle management tasks include the ability to streamline and standardize your processes across your organization and branches without relying on any one individual’s performance. Outsourcing can provide operational stability and allow clinicians to focus on their patients. Consider the ability to:

  • Leverage certified/trained staff with extensive back-office expertise
  • Rely on consistent reporting and tracking of key joint performance metrics
  • Benchmark key performance metrics against other organizations
  • Realize significant cost savings
  • Let us flex our capacity to adjust to your changing volume needs – you don’t need to worry about it
  • Most important – shift the skillsets and capabilities of your staff to best serve core patient and organizational needs!

Leverage the Three Critical Success Factors for Your Business

When you are assessing the need for an outsourced business partner, identify your organization’s weak points by analyzing the strength of the three critical success factors for business: people, process and technology. Ask yourself what you are trying to achieve with outsourcing, what are you currently doing well and where are opportunities for improvement.

People:

  • Is a tight labor market impacting hiring and retaining qualified staff?
  • Does complexity require ongoing and robust training and education programs?
  • Is your clinical staff required to manage a growing number of clinical denials?
  • Do you have adequate access to your data to conduct an accurate analysis of your claims denials and do you have the expertise to interpret it?

Process:

  • Do you face seasonal staffing challenges that expand denial backlogs due to untimely filings?
  • Do you focus on remediating individual denials versus analyzing root causes?
  • Do you have denial prevention strategies in place on the front end and mid-cycle?

Technology:

  • Do ongoing regulatory changes require a constant need for updating of Revenue Cycle Management and Health Information Systems?
  • Are your workflows automated to manage the highest priority denials?
  • Do you have an investment in modern analytics and artificial intelligence that can flag denials before you submit the claims to payers?

When you have identified the specific problems that you are trying to solve for your agency, you will be able to clearly focus on areas for improvement.

Maintaining Control and Decision Making

An outside expert business partner can bring a lot to improving everyday functioning, but roles need to be clearly defined and expectations discussed. After all, ultimately agencies want to retain control of their organization. A review of the agency’s infrastructure will not only identify which operations are best to outsource for optimal functioning, it will also help identify who will own the relationship with the business partner to ensure smooth operations.

An agency champion can provide guidance to the outsourced partner about the needs of the organization as well as work with internal owners and decision makers to ensure their goals are met. The agency champion will understand the specifics of what is outsourced and what needs to be managed internally, as well as provide oversight. For example, if your agency outsources billing, designated staff will need to continue to maintain understanding of payor requirements and changing guidelines, as well as monitor your held revenue to be released for billing.

Toward a Stronger Agency

A knowledgeable business partner can be the best ally as agencies adjust expectations to move forward and maintain profitability while providing quality patient care. Focus improvements on all three critical success factors: people, process and technology. And carefully select a business partner who can help you improve all the elements you have identified as you implement an outsourcing strategy.

In our next blog, we’ll discuss how to choose an outsourced business partner to bring your agency to the next level as you position yourself to meet future challenges.

About Corridor

For over 30 years, Corridor has partnered with home health and hospice providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operations executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face. Contact us today to learn how we can help you.

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