PDGM: Expedite Turnaround to Bill Accurate Claims by Optimizing Order Management Process

Home health organizations depend on their staff and tracking systems for a quick and efficient order management process. Order management is a key component within the revenue cycle process, as the collection of physician documentation is required to initiate any medical billing process. A bill cannot be generated without first obtaining all necessary orders.

The turnaround time in receiving an order back from a physician plays a large impact on the delay in cash flow. Episodes still awaiting signed orders increases the unbilled amount currently sitting in an organization’s EMR, delaying the payment received for each claim. The unbilled amount directly affects an organization’s accounts receivable days, as the longer it takes to bill a claim the greater aged that claim will be. Reducing the time to obtain clinical documentation will directly contribute to the timeframe in which payment is received. Assessing the current order management process to view potential gaps and to refine processes for greater efficiency will be vital to maintaining the current cash flow of an organization. This blog will dive deeper into the processes to better manage order tracking.

Order Management and PDGM

Home health organizations will be required to obtain physician signatures and dates prior to the submission of the 30-day claim. Shorter billing periods require expedited turn around to bill compliant and timely claims. Under the PPS billing method, all orders are due back by the end of episode — under PDGM, orders will be required by the end of each 30-day billing period. PDGM places increased pressure on providers to obtain all clinical documentation in a timelier manner in order to bill and not hinder cash flow.

Monitor: Billing periods are much shorter under PDGM than they are in PPS, resulting in a quicker turnaround time to bill claims. Monitor your collection process of obtaining clinical documents and identify which stages are the most time consuming.

Processes/Management 

The initial Plan of Care (485 orders) is sent to a physician after locking the OASIS. Reducing the time to lock the OASIS will get the initial plan of care sent to physicians sooner. Therefore, resulting in a quicker return time to allow the final claim to be billed by the end of the 30-day billing period. It is crucial to acquire signed verbal orders and any additional orders, as they are required to bill the corresponding 30-day episode.

Home health organizations need to assess their current processes of obtaining orders to ensure the most efficient and successful methods are utilized. Using modernized tracking systems can reduce the manual hours spent on order tracking. Through enhanced functionality or usage of external document management systems, orders can be automatically sent, tracked, reviewed, and processed. This allows for greater efficiency and optimization. Utilizing document management systems to house all documentation necessary for billing will reduce the time employees spend on conducting these tasks, increase organization of documentation, and decrease the unbilled through use of technology and streamlined processes.

Balance: While home health organizations were built on methods like faxing and mailing to obtain orders, they are quickly becoming outdated. Organizations should be willing to invest in more advanced technology for tracking orders to adapt to the new changes and see long-term success.

It’s important to evaluate the turnaround time from when orders are sent/received back compliantly for billing. Conducting this review at the organization level and at the referral source level will determine where there are areas for improvement in communication and processes. Developing strong relationships with referral sources will be crucial for obtaining orders back within a timely fashion. Best practice is within 14 days from the initial send date. Working closely with liaisons or office managers at high referral sources will reduce turnaround time for receiving these orders and allow for timely billing.

Key take-aways:

• What is your organization’s current turnaround time on locking the OASIS to allow the initial send of the plan of care to the physician?
• Have you conducted reviews on order turnaround time at the organizational and referral source level?
• Does your organization have a modernized order management process via your EMR or external document management system to effectively track and monitor outstanding documents?

Want to learn more on PDGM’s impacts? Our ebook “Soaring to Success Under PDGM” gives a deep-dive into the clinical, financial, and operational impacts PDGM will have on home health providers and what they can do to prepare.