HME Terminology for Creating Excellence in Your Revenue Cycle Processes and Procedures

Revenue Cycle Team Members

Amie Barone
ACU-Serve

Ronda Buhrmester
VGM

Bruce Gehring
Allegiance Group

Joey Graham
Prochant

John Stalnaker
ACU-Serve

If you participated in either the Front Office or Back Office Sessions, here is the terminology we used during the presentation:

• A/R management – the process of managing open A/R balances in the billing system once they have met certain parameters, such as aged or denied.
• Back office – all post-fulfillment revenue-cycle processes, including (definitions below): order confirmation, claims transmissions & front-end rejections, hold management, cash posting, and A/R management.
• Billing system – this is the business management platform that the HME provider has adopted as their primary information system for HME orders and receivables. Most common choices are: HDMS, TIMS, Brightree, Bonafide, NikoHealth, and WellSky.
• Cash posting – the process of applying reimbursement in the form of cash, adjustments, and balance transfers to open A/R balances in the billing system.
• Claims transmissions – the process of sending claims to payers for reimbursement, either electronically or on paper.
• Patient pay collections – the process of pursuing payments of outstanding balances owed by patients.
  CMN – catch-all for physician-signed written orders/prescriptions. This includes “true” Medicare CMNs such as the 484 for Oxygen as well as generic prescriptions and written orders.
• Documentation – the process of chasing down medical records and CMNs in support of an HME order.
• Fax wrangling – the process of receiving inbound HME orders/referrals, as well as other documents, and routing them to the appropriate place. For new orders, a “work-flow” is created and assigned to the Intake & eligibility team for processing.
• Fulfillment – the process of providing the HME that was ordered to the patient and obtaining proof of delivery as well as other required paperwork/signatures.
• Front-end rejections – the process of resolving issues/error on electronic claims that are rejected from processing by the clearinghouse or payer.
• Front office – all pre-fulfillment revenue-cycle processes, including (definitions below): managing the phone queue, fax wrangling, intake & eligibility, documentation, prior authorizations and scheduling/dispatch.
• Hold management – the process of managing an HME provider’s on-hold and stopped revenue primarily due to CMN and prior authorization issues.
• Intake & eligibility – the process of performing data entry into the billing system and verifying the patient’s health insurance eligibility via phone or website to determine benefits for the HME order.
• Order confirmation – the process of marking the order as completed in the billing system thereby causing the order to “bill” and create invoices/AR/claims.
• Patient-pay balance – account balance owed by patient after insurance reimbursement or cash purchase.
• Payment gateway — merchant service provided by an e-commerce application service provider that authorizes credit card or direct payments processing.
• Patient payment portal – website that enables providers to securely accept credit, debit, ACH/e-check payments, and can store invoices, manage patient accounts, and payment history.
• Patient payment pre-authorization – documented approval from responsible party for recurring or auto-payments via accepted payment method (credit, debit, ACH/e-check payments)
• Prior authorizations – the process of requesting and following up on prior authorizations with insurance payers.
• Recurring charge — a charge set to recur automatically on the billing cycle you select (i.e. monthly, quarterly, annually)
• Scheduling/Dispatch – the process of scheduling an HME order’s fulfillment by contacting the patient, determining the date/time, and assigning the task to the appropriate fulfillment team (i.e. drop ship vs. RT vs. delivery tech)

Flow of the DME Order

Patient Invoice Workflow

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