5 Tactics to Maximize Your Authorizations

Are you one of the 55% of home care agencies that are estimated to have had a negative operating margin in 2019? The Home Care Association of New York State’s State of the Industry report says that chronic under-reimbursement is one key reason home care agencies are simply not making the money they should.

Patient authorizations should be the bread and butter of home care agencies, however, without intelligent systems in place, agencies are losing thousands each year to authorization under utilization.

It doesn’t have to be this way. We’ve put together five tips to help your agency better utilize your authorizations and maximize your bottom line.

Intelligent Staffing 

Caregivers are the backbone of successful homecare operations. In an ideal world, you would staff a caregiver on a case, they would clock in, complete their duties, and clock out. However, even if you plan meticulously, caregiver illness, family emergencies, compliance issues, or no-shows can create unexpected missed visits and affect authorization usage. You can minimize the impact by creating a caregiver fleet who are instantly alerted to new visits and staffed in real-time. Once a replacement caregiver accepts the case, an intelligent staffing solution will allow you to simply edit the caregiver’s name, the visit time and any other relevant information and have this feed directly to billing and payroll. This way caregiver absentee issues will have less of an impact on authorization usage.

Minimize EVV Errors

Electronic visit verification, or EVV, is a key part of your agency’s reimbursement plan via Medicaid or other secondary parties. However, EVV requires caregivers to document specific data points in order to submit valid claims. Unfortunately, many caregivers do not document these correctly or in a timely manner, leaving agency staff chasing caregivers to complete supplementary paperwork.

The key here is to work smarter, not harder. Maximize your authorizations and reduce your staff’s workload by using an app which sends caregivers helpful reminder notifications and allows requirements to be completed directly from their phone. When caregivers have the right tools, they’re 90% more likely to be EVV compliant. 

Automatically populate key Data and pay rate codes with an ecosystem approach

Use a system where EVERYTHING is connected, and updates occur instantly. For example, if you update authorizations or change billing rates, this should be automatically reflected in every aspect of your system in real-time. Using a system that automatically factors in EVV data, calculates billing units, banked minutes, and other key data points reduces workload and human error, meaning fewer claim rejections and more money in your pocket sooner. 

Double Check Your Claims

Avoid returned claims by generating clean claims the first time. Look for a system that automatically runs validations - including authorizations validations - in pre-billing and gives users a clear view of any potential issues before they become problems. Your system should have a handy dashboard that makes the process easy and gives staff members the chance to quickly track the progress of all outstanding claims.

Track how well your agency is using authorizations

How can you know if your agency is winning or losing the battle with authorizations? Make sure you select software that tracks this for you - your coordinators should know at the point of staffing whether they’re fully utilizing all available hours, through handy visualization features directly on the patient’s calendar. Moreover, the billing department should be able to filter for both authorization under and over allocation when viewing ‘visits with issues’ to spot agency-wide trends.  Move your business forward by finding a system that tracks all current authorizations simultaneously. Using AI and smart technology enables you to consistently maximize your available authorization hours, meaning this type of software often pays for itself. 

Automatic billing systems can help your agency maximize authorizations, eliminate errors, and generate clean claims. Be sure you find a system that is easy to use, features a dashboard to quickly track claims, and integrates with your agency’s EVV plan.