I think if Drucker were the keynote speaker at Medtrade, his message might be:
The bulk of an HME provider's resources should be focused on effectively evaluating prospective patients and delivering appropriate products and services. Every effort after delivery and confirmation must be minimized.
- Preventing denials, not efficiently resolving a greater number of denials per revenue dollar earned.
- Building processes that enable CSRs and delivery techs to prevent billing errors instead of hiring more AR personnel to correct them.
- Obtaining favorable audit decisions from the initial response, as opposed to winning appeals and hearings.
For example, audits are a problem. That is, they never represent an opportunity to grow the business, provide better care to patients, or increase profitability. And yet, how many of our initial responses are not much more than copies of the entire patient file with an expectation that the auditor should and will figure it out? When that doesn’t happen, we are forced to spend even more time navigating complex, error-prone appeal options.
Because we cannot completely eliminate audits, our responsibility as good managers is to minimize the amount of resources they consume. We must focus our time and resources on favorable opinions in the initial response so as to avoid the low-yield, time-depleting endeavors of redeterminations, reconsiderations, and ALJ hearings.
To learn the practicalities of passing Medicare audits the first time, we invite you to join us April 6, 2017, for First Time's a Charm: Passing Audits without Appeals.