CASE STUDY:Select Data Provides Cash Flow Solution for Addus Healthcare

It was a mystery as perplexing as it was frustrating. But, to the management team of Chicago-based Addus Healthcare, the problem required a rapid and permanent solution. For some unexplained reason, cash flow had slowed to a crawl at its Alabama home care agency. To meet the challenge head-on, management called upon the expertise of Donna McNally, a home health nurse leader and Director of the Addus’ education and training department. Ms McNally was process driven and charged with the mission of uncovering the reasons for the cash flow slowdown and recommending a viable solution. She assembled a team: another experienced process-oriented nurse and a Medicare billing expert.

The team immediately launched a company-wide root-cause analysis, seeking indicators that would help them uncover the cause of the cash flow snag. Their efforts ultimately led them to the elusive problem:  in-boxes were overflowing with completed OASIS assessments awaiting data entry into the company’s computer system. Clearly, the stalled forms were the root of the financial bottleneck. The task force tallied a total of 208 unprocessed assessments stuck in the boxes.

To put the situation in another perspective, Addus Healthcare regards any more than 10 assessments in an in-box a serious matter. The astronomical total of 208 assessments awaiting data entry explained the excessive delays of the Alabama agency in converting Requests for Anticipated Payment (RAP) to actual payments. In some cases, the time to reimbursement dragged out to 59 days.

Determined to find a viable solution, Addus reassigned a large contingent of personnel to the task of addressing the cash flow catastrophe. This intensive team effort uncovered a set of problems commonly identified at Medicare home health care agencies.

  1. Assessments were often incomplete necessitating contacting the clinician, resulting in major data entry delays. Forms were also not cueing clinicians for details necessary for coding to the highest level of specificity.
  2. In cases involving missing signatures or other information requiring completion by a clinician, delays in data entry would continue until the nurse’s next office visit.
  3. While stalled OASIS assessments awaited action, new ones came in on a daily basis, incessantly adding to the overflow. To worsen the situation, the number of OASIS arrivals typically increased on paydays.

The problems triggered by this inadequate system were unacceptable to the Alabama agency.
Select Data Provides Scanning Solution

Prior to uncovering the hidden cause of the cash flow bottleneck, Select Data had been conducting ongoing discussions with Addus Healthcare, having had recently developed an interface between its Optical Mark Recognition (OMR) scanning system and the Addus’ back office clinical and financial software application. The Alabama agency had agreed to serve as one of two pilot implementation sites.

Once the Select Data interface was implemented, crucial processes at both pilot agencies improved immediately. The primary areas of improvement included:

  1. Clinicians are now completing OASIS assessments on clinically organized and highly efficient OMR forms. These forms were designed by homecare experts with the input from nearly a 100 homecare clinicians and agency leaders designed to capture necessary data, and still provide assistance to the busy clinician through format cues; having logical flow not only through body system but through care planning functionality also. In addition, the forms are scanned and have data software recognized and made available to office personnel.
  2. Scanning has eliminated problems that otherwise would inhibit management’s ability to meet the one to four day delivery schedule.
  3. No longer required to enter data, office personnel process OASIS forms through a high-speed scanner.  OASIS logic and skip patterns are detected by a software-driven system. Corrected patient information speed through the Select Data interface to the patient record and billing system. An assigned supervisor provides a final quality check prior to submitting information for payment.
  4. Communication has accelerated. Since scanning is completed in a matter of seconds, a clinician can provide any missing signatures or answers instantly.
  5. Because data entry is no longer an issue, office personnel now have the time to focus on the transmission of information from the field to the billing and payroll department. The entire process has been dramatically expedited.

Powerful Results on Several Levels

Select Data’s cutting edge system has had a powerful impact on the cash flow of the Alabama Addus Healthcare Agency. The Alabama facility currently is experiencing an average of five to seven days between episode start of care date and the day the episode’s RAP is submitted for payment. This represents a cash flow acceleration of as much as forty-nine days or seven weeks!

Equally fast is the training process. Addus personnel typically can learn the Select Data OMR forms quickly and with ease. Additionally, both nurses and therapists rate the new, high-efficiency forms superior to those used previously by the company. Overwhelmingly pleased by the results of the system, Ms McNally and other Addus leadership are planning to expand the Select Data system into the company’s other 23 branches.

Ed Buckley, CEO of Select Data, stresses the significance of his company’s involvement with Addus. According to the chief executive, the recent implementation represents a collaborative effort between Select Data,  Addus Healthcare, and that agency’s billing system vendor who wrote an application interface at the request of Addus Healthcare. The results speak for themselves.

Additional Boost

Encouraged by this initial success, Addus Healthcare also began using Select Data ICD-9-CM services, finding the benefits of a third party group of experts. For Addus Healthcare, the welcome result was an average $500.00 episodic increase. Third party billing expertise coupled with the clinically driven scannable OASIS tools has further solidified the highly productive partnership between the two industry leaders.