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The Importance of Streamlining Order Management under PDGM

With PDGM set to take effect in January 2020, home health agencies need to make changes to their documentation and revenue cycle management processes. Optimizing cash flow starts with streamlining referral and intake management, order management, scheduling, and billing processes.

Order Management is a key component within the revenue cycle process, as the collection of physician documentation is required to initiate any billing process. A final claim cannot be generated without first obtaining all necessary orders. The turnaround time in receiving an order back from a physician plays a large part in the delay of cash flow.

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 timely manner in order to bill and not hinder cash flow.

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. Start by analyzing your agency’s current days to RAP and days to Final. You should be comparing to industry benchmarks:

  • RAP – 5 to 7 days
  • Final – 10 to 14 days

Look hard at areas within your billing process that you can optimize to lower your agency’s days to bill. Secondly, assess your order management process and evaluate:

  • How are orders going out?
  • How are orders sent out and received?
  • What is average turnaround time?
  • Who verifies the physician signed and dated the orders?
  • How are orders tracked and followed up on?
  • How are orders tracked and followed up on?

From an Order Managements Best Practice, the following timetable is recommended:

Day 1: Send Order
Day 5-7: Call and connect with key personnel for commitment of signed order
Day 10-14: Second call and connect with key personnel for commitment of signed order
Day 15-21: Escalate to clinical or health information manager and resend order
Day 20-28: Liaison visit to office

PointClickCare and Forcura have teamed up to help home health agencies prepare for PDGM. Working together, our two systems can eliminate time printing and faxing orders manually, monitor order statuses in Forcura through PointClickCare single sign on, view sent and signed orders from PointClickCare, and track Historical Order Statuses.

Reducing the time it takes to obtain clinical documentation will directly contribute to the timeframe in which payment is received.

To learn more, check out our recorder webinar, “Optimizing Intake and Orders for PDGM”.

July 11, 2019