One of the biggest areas within the revenue cycle that has been impacted with the switch from PPS to PDGM has been orders tracking. With billing increments cut in half from 60 days to 30 days, the importance of obtaining signed orders timely has increased significantly. COVID has proven to be a disruptor and further added to the challenge of obtaining timely signatures. This panel discussion will feature insight from Worldview, one of the technology leaders in the home health and hospice industry, as well as Amy Smith of Alternate Solutions Health Network, and BlackTree’s resident orders tracking expert Samantha Soulas.

Key Takeaways

Agencies are now seeing the value in adopting technology to obtain quicker turnaround in physician signatures

  • Expedite submission of orders so that team can focus on following up with physicians
    • COVID has made it more difficult to get in front of physicians, and providers need more technology options than auto-faxing
      • Worldview leveraging an eSignature platform, including notifications to remind physicians a signature needed
    • Under COVID, physicians are often not in the office to receive and sign orders.
      • Resulted in a lot of voicemails being left when attempting to call physicians
      • Escalation process harmed due to lack of ability to leverage liaisons/couriers.
      • COVID has pushed some of the more stubborn physicians away from hard-copy mail.
    • BlackTree developed benchmark of 10% for unbilled revenue aged over 30 days
      • When reviewing days to RAP, focus on days to internal orders approval.
        • Able to peel back and find other issues such as delay in getting the start of care visit completed and locked.
      • Days to final success focuses on turnaround on orders signatures
        • Strive for average 7 days for physician signature
      • Look at volume of interim orders being generated per episode. Are all of those orders necessary, or can some of them be included on the plan of care?
      • Look at incomplete orders. If your faxing is backed up by a few weeks, you could be sending out orders thinking they are unsigned, when they are actually signed but not checked in.
    • This is not a one-size-fits-all approach
    • The initial investment of onboarding a new technology is going to be worth the ROI you will get after adopting.
    • On F2F side, have seen a complete separation of those tasks vs orders tasks. Need to make sure those teams still collaborate on overlap in physicians.
    • Most common question was regarding physician push back
      • Develop a cohesive, planned out education program for your physicians; leverage an easy one-pager (BT developed one for PDGM)
      • Provide education which key representatives at physician offices too; approach at both marketer and staff level
      • Create an ease of doing business between the physician’s office and your agency
      • Don’t force physicians to rely on remembering usernames and passwords; Worldview leverages multi-factor authentication



    • Put in place additional escalation processes if your agency is an RCD state to achieve higher acceptance rates
    • Try to balance building positive relationship with physicians while looking out for your own agency’s needs.
    • Weight productivity based on automation and manual touches needed.
      • Set goal of staying within 1.5 day threshold of processing documents.
    • Make sure staff are assigned specific physicians so that they can form those relationships
      • Most important thing is having very clear staff assignments.
      • Make sure staff are not handling too many separate duties. This will help drive accountability.
    • Encourage staff to look in medical record prior to calling physician to confirm that the physician is appropriate and identify any potential issues
    • Aim to perform all orders work prior to the final claim dropping, rather than having to face held claims
    • Process older orders before an order that went out two days ago
    • We recommend a centralize model to achieve standardization and a greater level of efficiency.

    Having more people will allow you spread out duties rather than having 1 person at an individual branch own everything.  Branch employees could be pulled in different directions on top of just orders.