Covisint – Advanced Home Care

Advanced Home Care met with Covisint’s implementation consultants to discover existing CMN workflows and identify best practices for the implementation. Because Internet access is the only requirement for implementing this easy to use system, a company can be fully trained and begin online transactions within a few weeks.

Situation

Advanced Home Care offers home medical and respiratory equipment (HME), home health care (HHA), and infusion services throughout the Mid-Atlantic. The company's central intake office manages referrals for over seventeen locations for all services. Thousands of HME referrals are received annually, which generates a large amount of paperwork. The challenge of handling this volume of paperwork is compounded by the fact that Medicare and Medicaid are financing the referrals. These payer programs require Certificates of Medical Necessity (CMN) and prior approvals (PA) in order to bill for the services performed. This CMN/PA form is lengthy and must be completed for every piece of equipment or supply needed by the patient in order to receive Medicaid reimbursement. The previous time-consuming process for obtaining prior approval for CMNs began with Advanced Home Care gathering all the patient information and mailing the CMN form to the doctor for signature. The doctor's office would mail the form with accompanying signature back to the company.

The completed form would then be mailed to the state's fiscal agent for prior approval. Next, the State Medicaid fiscal agent would review the form, post the prior approval, and mail the form back to Advanced Home Care. Finally, the company could bill for the equipment.

On average, 56 days would elapse between the time it took to deliver the equipment and begin billing. According to the 2004 financial performance survey by AA Homecare, the average DSO is 83 days. While Advanced Home Care stood ahead of the pack in DSO, company leadership knew that condensing this workflow was key to effective revenue cycle management. According to Kimberly Brummett, vice president at Advanced Home Care, "Our senior management recognized that improvements must be made in our paper process cycles in order to have positive effects on our cash flow. Our paper-based method of managing Medicaid CMN and prior approvals led to a high DSO and held revenue days."

Solution

Advanced Home Care met with implementation consultants to discover existing CMN workflows and identify best practices for the implementation. Because Internet access is the only requirement for implementing this easy to use system, a company can be fully trained and begin online transactions within one week.

Form Creator & Editor. The company also created their own special justification forms to accompany the CMN/PA. Now both online forms could be semi-populated with existing patient data and viewed by employees who have appropriate security levels. Unlike paper documents, the electronic CMN could not be misplaced as it traveled to the physician or fiscal agent.

Physician Signature Collection. Physician signatures are obtained and managed quickly and easily from a single screen. Physicians who use Covisint’s ProviderLink receive notification and view the form online. Physicians who are not yet Covisint ProviderLink users continue to receive the form via fax. Bar-code, fax-back technology assures that when the information is received online it is attached to the appropriate patient record. When the provider's office faxes back the physician's signature, the faxed document is attached to the electronic document and this image is put in an online queue for the company's billing representative. The solution works immediately for all physician's signature collection and is not limited to just the physicians who agree to sign CMNs electronically.

Online Medicaid Authorizations. Prior approval requests are sent to the state's fiscal agent through Covisint’s ProviderLink. If additional information is needed, Covisint’s ProviderLink is used for both the information request and fulfillment.

Better Health and Lower Costs

The company was able to drastically reduce the amount of time it took to gather physician signatures and to submit CMNs to the state's fiscal agent for prior approval authorization numbers. This had a direct and positive impact on the revenue management cycle. The average days of held revenue fell from 3.6 to 2.1 over a period of seven months. The company also saw a dramatic drop in their DSO, which measures the period of time between date of service and prior approval receipt from the state's fiscal agent. After implementing online CMNs, the company's average turnaround time for NC Medicaid workflows dropped to less than 10 days. Brummett commented, “Our financial business metrics have improved by converting our paper-based CMN workflow into an online environment. Covisint’s ProviderLink's Internet-based communication platform has enabled us to obtain physician signatures and prior approvals faster, which has had a direct correlation to revenue capture.”