The Pre-Billing Issues That Hinder Your Revenue and How to Tackle Them Efficiently

Your home care agency relies on efficient and accurate reimbursement, so why is it that there are so many roadblocks in the billing process? The majority of frustrations are found in pre-billing issues, resulting in burdensome additional communication with payors, time-consuming clarification with caregivers, increased paperwork, and ultimately inefficient and inaccurate reimbursement for claims. 

Fortunately, most pre-billing issues can be fixed with a few tweaks to your agency’s routine as well as utilizing technology that automates the pre-billing process. Here are the most common pre-billing issues and how to eliminate them from your agency:

Under or Over-Utilization of Authorizations

All patients have a specified type and allocation of services they are eligible to receive. Anytime an agency doesn’t maximize a patient’s authorization they lose valuable revenue that can never be recovered. When staffing cases, ensure your coordinators have all the available information at hand. At a glance your staff member should be able to see the hours remaining in an authorization and allocate time for an exact match. You should also utilize a pre-billing system that will automatically alert you to over or under allocation of authorizations in real-time so that your revenue is always maximized and your patients always receive the correct amount of care. 

Caregiver Clock In/Out Issues

Most pre-billing issues begin when the caregiver clocks in to their shift. Or rather, when caregivers forget to clock in. The start of the shift is when services officially begin. Without that proper clock-in, agencies need to seek out the caregiver to complete paper documentation for their shift start time.

Manual paperwork further complicates matters when it comes to Electronic Visit Verification (EVV). Technology is the key to making the clock-in and out process easier for your caregivers. While telephony is still a viable option, many clients no longer have landlines to call from, and some are uncomfortable letting caregivers use their phone. Instead, give your caregivers the opportunity to clock in and out via a caregiver app right from their smartphone. A good app will record all relevant data, such as timestamps and GPS locations, it will send automated reminders on your behalf and reduce agency workload. You’ll find that EVV issues are reduced by up to 90% when caregivers can take care of clocking in and out right away, on their smartphone.

Caregiver Compliance Issues

Only eligible caregivers who have updated physicals, vaccinations, and tests are allowed to be working with clients on behalf of your agency. Unfortunately, one missed TB test or annual appointment can leave a caregiver unable to fill a shift, leading to missed revenue for your agency.

If your HR team could use a little help keeping compliance issues organized, or are spending too much time hounding caregivers for expiring items, find a platform that will empower caregivers to keep track of their own compliance documentation. 

Exceptional platforms give caregivers the opportunity to take a photo of their latest TB test, vaccination confirmation, or other paperwork and upload them straight from their phones. Even better, caregivers are automatically reminded when expiry dates are approaching so they can always stay in compliance, meaning more caregivers in the workforce and better, more reliable revenue for your agency. 

Unstaffed or Missed Visits

Your agency can’t be reimbursed for visits and services you didn’t provide. While most home care agencies struggle with caregiver retention, you can make finding caregivers easier by using a platform that makes staffing more convenient. Utilizing a caregiver-centric platform has been shown to improve caregiver retention by over 30%.

Your scheduling team can simply enter in the information for available shifts and use an automated platform that will push out notifications to all available caregivers who have expressed interest in that neighborhood and time frame. Eligible caregivers can respond to the case in real-time, so your team doesn’t have to call your entire roster to find someone who will cover an empty shift.

Missing Visit Duties and Personal Care Tasks

It’s not just clocking in and out that caregivers are responsible for. Their documentation of services and patient observations are crucial for the billing process. We’ve all heard the healthcare mantra  “if it wasn’t documented, it didn’t happen”, and it’s especially true when it comes to billing for services that were not marked as completed. Utilizing an app that allows for documentation in real-time leads not just to better revenue, but also better health outcomes for your patients. We suggest using a system that prompts caregivers to complete all required tasks before clock-out. 

Stop the pre-billing frustration by leveraging technology to make your agency more efficient and more profitable.