RCM Case Study: Cash Flow for Home Health Care

What was holding revenue back

Before working with us, the agency faced several ongoing challenges:

How Dilijent Systems Solved the Problem

Dilijent Systems deployed a special home health and hospice setup that enables the agency to continue its billing tasks with much efficiency. Here are some of the main solutions Dilijent Systems brought:

1. Complete RCM Assessment Process

   We commenced our analysis through an extensive examination, which covered six months of home health and hospice claims data to determine the exact causes of revenue losses. The process involved conducting a thorough examination of all OASIS submissions, together with physician certifications and billing procedures. We discovered compliance deficiencies, operational failures, and unidentified revenue loss areas through our analysis of the revenue cycle process.

2. OASIS and Documentation Optimization

   We established OASIS accuracy reviews, which operate before claims submission to achieve better compliance outcomes and decrease denial rates. The clinical documentation system received development to match current Medicare standards, thus maintaining consistency and audit readiness. We developed standard documentation checklists that enable clinicians to submit correct documentation without extra work.

3. Clean Claim and Billing Workflow

   We restructured the billing process to create an efficient system that enables clean claim processing from the beginning. The system enhancements for episode management and visit utilization tracking brought main improvements, which eliminated both timing issues and billing mistakes. The company assigned highly experienced billers from home health and hospice operations to manage the account and ensure that all claims reached their submission deadlines while following payer regulations.

4. Denial Management and Appeals

   The organization created a team that specializes in Medicare denial resolution to handle all rejected and denied claims with efficiency. The organization established a fast appeal system that relies on precise and comprehensive documentation. The organization used denial trend data to identify and fix root problems, which stopped future issues from happening again.

5. A/R Follow-Up and Cash Acceleration

   We found cash flow enhancement opportunities through our focus on Medicare claims and high-value claims, which needed follow-up. The organization established an A/R system that handles all claims that have remained unpaid for more than 30 days, thus decreasing the number of uncollected accounts.

Results Achieved (Within 120 Days)