8 Red Flags that Signal You Need Help with Medicare Revenue Recovery

Did you know that Medicare allows home health agencies (HHA) and other healthcare facilities up to 12 months to recoup payment for services rendered? This means that even if you have claims that are several months old or claims which have been denied, you can still submit them now. For a comprehensive look at Medicare’s claim procedures refer to the manual here.

Like many HHAs, you depend on a reliable stream of revenue to operate—so you can’t afford to leave money on the table at Medicare. However, many HHAs are missing out on the money they are owed by Medicare because they overlook the red flags indicating they need help with revenue recovery. This can happen even if a third-party billing service is being used.

Here are the red flags you should look for which may indicate your agency has money sitting on the table at Medicare and needs outside help to recover it:

1. Your Medicare revenue is down, and you can’t figure out why. If you know your Medicare revenue is lower than last year, yet your billings are about the same, this is a big signal that you need to examine your revenue recovery practices. Chances are, you have denied or rejected claims that you need to attend to—asap!
2. Your agency doesn’t regularly re-bill denied or rejected claims. Medicare allows 12 months to re-bill denied or rejected claims to recover revenue—if your billing department or third-party biller isn’t regularly resubmitting these claims your agency is likely losing out on revenue.
3. Your in-house billing staff are overextended or lack experience. If your billing staff are always behind, chances are your Medicare billing is, too. It also means they probably aren’t able to place a high priority on Medicare revenue recovery. This is also true when you have staff that is relatively new to billing, they may simply not be experienced enough to make sure your agency gets all of the money it is due.
4.  You have had high turnover of billing staff or staff on sick leave this year. When jobs change hands, it’s easy for things to fall through the cracks—this is especially true for billing. If you have had multiple billers this year, it is worthwhile getting an external partner to help you catch up on billing and capture all of the potential Medicare revenue you are due this year.
5.  You don’t have any billing support—you do all the billing. Does everything fall on your shoulders? If you are the owner, DON, administrator and biller it is understandable that billing sometimes has to take a backseat—but this scenario may be costing you money! Taking action now is the only way to recover the funds your agency is owed.
6.  The third-party billing party company you use is on autopilot. If you’ve used the same billing company for many years, chances are you have all become comfortable. Often, HHAs who outsource billing aren’t even aware of what is happening because billing is “being taken care of.” It’s not until they decide to take a closer look and give their biller a “report card” that they see money is literally being left on the table.
7.  You have had EMR software problems or changes. If you have encountered technological issues this year, you may have claim batches which have failed and gone unnoticed. This is a situation where having an external audit of your Medicare billing can deliver a significant return on investment by identifying unsubmitted claim batches.

Dominion Revenue Solutions can help you collect the money Medicare owes you. The end of the year is here, which means recovering as much Medicare revenue as possible should be a priority. As an experienced, affordable and trusted partner to HHAs, we are dedicated to helping agencies find and collect the money they are owed. We can help your agency, too! With thousands of dollars potentially on the line, now’s the time to contact us at 888-471-9333 for a complimentary revenue recovery consultation.