CHARLOTTE, North Carolina—As the home medical equipment (HME) market continues to expand, providers face growing challenges in revenue collection, impacting profit margins. Increased regulation and complexity in navigating payer reimbursement requirements, particularly with Medicare Advantage (MA) and commercial payers, are driving reimbursement down, while the challenges of recruiting and retaining skilled billing and collections staff have escalated costs. Consequently, a highly effective revenue cycle management (RCM) strategy has become the most crucial factor for an HME provider's success.
As 25-year veterans in the home-based care industry, Prochant recognizes the critical importance of an optimized RCM strategy. As a result, Prochant sponsored an in-depth survey from in90, an independent third-party consulting firm, interviewing 100 HME executives—40% of whom were CEOs or owners—directly involved in revenue cycle management. The survey included major HME providers, with a quarter of respondents representing organizations generating more than $25 million in revenue. These organizations had a payer mix that encompassed private, commercial, Medicaid and Medicare.
Key findings from the report reveal:
- The biggest billing and RCM challenge identified was reducing/preventing denials and appeals with 63% citing it as a top pain point.
- The second biggest challenge was hiring, training and retaining qualified intake, billing and collections staff.
- More than 80% of survey respondents reported dissatisfaction with their current RCM approach, citing accounts receivable (A/R) over 90 days overdue and excessive write-offs due to billing errors and complexities as primary reasons.
The report highlights significant business impacts resulting from inadequate RCM strategies. Sixty-two percent of respondents reported lower than desired revenue capture, while almost 50% found their revenue cycle and billing management too costly.
In response to these challenges, 60% of respondents have outsourced at least one RCM function in the past year, with more than 70% attributing this decision to resource limitations and cost concerns. The difficulty in managing RCM effectively, coupled with the high cost and scarcity of local talent, drives many to seek external expertise. For those that have chosen to outsource, about 50% of respondents reported that they were likely to outsource payment posting, claims scrubbing and denials and appeals. For those choosing an outsourcing partner, respondents value revenue capture and real-time performance tracking/visibility.
For all findings, HME providers and industry stakeholders can read the full report here.
