The Smart Medical Practice

Expert Interview: Carter Smith of Complete Revenue Solutions on Medical Billing for Home Health and Hospice Providers


Practice management

Carter Smith is the CEO of Complete Revenue Solutions, which provides industry leading management and financial services for Home Health and Hospice providers.

We recently asked Carter for his insight on helping these niche practices with billing and Revenue Cycle Management. Here’s what he shared:

Tell us your story. How did you get into revenue cycle management?

My path to revenue cycle management was a bit untraditional. While I was attending The Ohio State University studying Accounting and Finance, my mother and father were looking for some help in their home health agency office with billing. I had always been good with numbers and problem solving so they saw it as a natural fit. I began learning the billing and accounts receivable processes and really engulfed myself into the detail of it all. I was able to recover over $250,000 in uncollected revenue within six months and knew I had found an industry I would enjoy.

Can you tell us the story behind Complete Revenue Solutions?

Complete Revenue Solutions was the result of many, many sleepless nights and countless hours working at home. While I was billing for my family home health agency I became more and more involved and ultimately became the CFO. I then realized that while I enjoyed the home health industry, the part of my job I enjoyed the most was managing the revenue cycle and being sure to collect every dollar our agency earned.

After considering it further I began working on starting my own company that would handle all the revenue cycle. Ironically, right around that same time a friend of mine from high school reached out and said his parents needed some help with their billing because they weren’t collecting enough to cover their payroll. I helped them turn their RCM around within two weeks and no paychecks bounced. This was the validation I needed to know my company could succeed.

What do you feel differentiates your service and sets you apart?

What really separates my company apart from other companies out there is what I call, “unrelenting attention to detail.” My employees go through a very intense training process in which they learn that phrase and what it means to CRS. We scrub every claim multiple times before sending it to make sure we submit clean claims the first time. We take a very militaristic approach to our culture at CRS, we demand excellence and reward it. All my employees are given military dog tags once they complete the training with the quote from the navy seals “The only easy day was yesterday” and that is the motto we try to live by.

Can you talk a little bit about the landscape and complexity of your billing?

Complete Revenue Solutions is a full-service billing company, meaning we do everything from generate the claim, scrub the claim for errors, submit the claim, and track the claim all the way until payment. We handle the entire Accounts Receivable process for our clients.

We have a variety of ways in which we can access the claim information from our providers, the easiest of which is by directly accessing our clients EMR and working within that. This gives both the client and CRS access to real time information always. However, if that is not an option we can export files from our client’s system and create claims outside of their software, or, of course, we can accept good old-fashioned faxes with the needed information and create claims that way. We attempt to be a truly versatile fit for any client’s needs.

Where some of the challenges specific to billing for home health care agencies?

There are many challenges to billing for home health care agencies. I believe home health care companies are some of the most undervalued and therefore scrutinized providers by the government and insurance agencies.

One of the biggest challenges is keeping up with all the constantly changing codes and regulations necessary to bill Medicare and Medicaid across the country. From the introduction of ICD-10 to the switch to G0299 and G0300, there is always something coming that providers must be ready for. That is one of the biggest benefits to utilizing a company like Complete Revenue Solutions, our only job is to be ready for these changes.

What should home health care agencies be doing to improve their reimbursement rate? What advice do you find yourself repeating to clients?

My first piece of advice to home health agencies is always to make sure they are collecting 95-100 percent of their revenue moving forward and get things fixed now before you attempt to fix the past.

This often seems counterintuitive because the oldest claims are the hardest to collect and the closest to those dreaded timely filing limits, however if you focus on fixing past issues constantly then you aren’t going to fix the problem and will be faced with more past issues going forward.

There are three main drivers of reimbursement: documentation, insurance and revenue cycle management. The one that will affect your bottom line the most is documentation and insurance, but the one that will impact your bank account the most is revenue cycle management. My two pieces of advice are always: collect what you earn and improve your documentation to earn more.

What would you like more of your clients to do to improve the speed of reimbursement?

The main killers of reimbursement time are documentation timeliness by clinicians and prior authorization timeliness of insurance companies. If my clients could decrease the amount of time it takes for an OASIS to be completed or an authorization to be returned, their reimbursement time would decrease exponentially. Additionally, oversight on insurance eligibility is a huge time waster when it comes to reimbursement. If you don’t have someone checking eligibility on an ongoing basis, you’re going to have trouble getting paid as patients often switch plans without notifying the provider.

What are the most common errors you see home healthcare agencies making in RCM? What can they do to avoid these errors?

There are three huge errors I often see when I am brought in to fix an agency’s RCM. The first is the agency isn’t actively tracking their accounts receivable and denials. This is like taking a road trip without a map or GPS, it is impossible to collect all your revenue and have a strong RCM if you aren’t paying attention to your accounts receivable and constantly working on denied claims.

The second error is not following through on insurance eligibility. Often, I will see denials for patients not covered by the health plan being billed and it will be a very simple fix of switching the patient’s billing to the correct health plan. This creates more problems than necessary, especially if the new health plan requires prior authorization.

Finally, agencies do not track rejected claims that never even made it to the health plan for processing. They wonder why these claims have never been paid and when they call they are told the claim isn’t on file, they go around and around with the health plan without ever checking to see if the claim was successfully transmitted to the health plan.

These errors are all very avoidable if you have an unrelenting attention to detail, our team posts remittances the day they are received and begins working on the denials directly from that remittance, additionally, we go through weekly and follow-up on all denied claims, this is just one example of how our attention to detail can ease some of these common issues.

What’s your plan to stay competitive with major players like Athenahealth, eClinicalWorks and McKesson?

The way we will stay competitive with large companies as mentioned is we will out hustle them every day of the week. We embrace the fact that we are a small player in this industry and focus on the fact that this gives us the advantage of better communication and better attention to detail. We have focused on our niche in the healthcare industry of Home Health and Hospice and we plan to be a very major player in that market. The one thing you can always count on from CRS is we will never stop fighting for every dollar, we may not be the biggest but we will be the toughest and work the hardest.

How has the Affordable Care Act affected your business? What about patient pay. What has been the impact on your work?

The ACA hasn’t been kind to too many providers in healthcare in general. Home care has really taken blow after blow from this legislation and the decrease in reimbursement has really affected some of our smaller clients that are struggling now. This has made our job even more important as every dollar is even more valuable to our clients now more than ever. Patient Pay is an increasing part of Home Care, we are more than happy to handle this.

What headlines or trends in the world of revenue cycle management are you following today? Why do they interest you?

One of the major trends that interests me the increased usage of technology in the RCM process. I believe that technology can make all processes of business easier and more advanced, given the right oversight. With the increased usage of EMRs and Electronic Claims Submissions, it’s only logical that most the RCM process will begin to become even more technologically driven. The problem with EMRs and Electronic Claims Submissions for many providers is the disconnect with the claim and information once you click submit. This has led to poor RCM management and is part of the reason my company exists. We understand the technology we use and we understand how much oversight is required to optimize its use.

What predictions do you have for the future of revenue cycle management? How will the field evolve?

The field of RCM will look very different in the future I believe. Technology will continue to automate some of this process and companies like Complete Revenue Solutions will become more and more valuable to our clients as the company to oversee the technology and be sure the RCM process stays strong. This field will continue to evolve just as all of healthcare will continue to evolve.

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