HHAeXchange · Current-Practice Worksheet

How You Use the System Today

For each step of the revenue cycle, the reference shows how HHAeXchange is meant to be used. Tell us how your team actually does it today — gaps here are exactly what we'll work on together.

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One idea

In HHAeXchange a visit is not money until it has cleared every step. Each step either passes a visit forward or holds it until someone fixes the problem. Skipping a step never speeds things up — it just parks your revenue at a later gate, where it sits unpaid. Run the workflow in order and the system becomes the same audit an outside reviewer would run on you, for free.

Self-assessment at a glance

11 steps

Consistent

Inconsistent

Not yet

Not answered

Start with step 01 — your answers will appear here as you go.

Phase 1

Intake & Eligibility

Referral & Intake

How it should work — Enter every new prospect as a Referral first, before any payer approval. Track which payers/contracts the case went to, with a follow-up date.

Patient > Referral ManagementOwner · Intake

Common gap: people entered straight in as active patients, or referrals tracked in a side spreadsheet.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Authorization Received → Patient Activated

How it should work — On payer approval the referral becomes a Patient. Add the payer Contract — this activates them for scheduling — and confirm the contract's billing setup.

Patient > ContractOwner · Intake / Billing

Common gap: patients left as referrals, or activated with no/incorrect contract.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Phase 2

Authorize

Enter the Authorization

How it should work — Enter the auth exactly as the payer issued it: service code, units/hours, frequency, date window, and diagnosis (DX) codes. Use a TEMP auth if the payer is slow (visits will hold at billing until the real one arrives).

Patient > Authorizations/OrdersOwner · Authorization / Billing

Common gap: missing or "rough" auths, missing DX codes, or auths not updated when the payer changes units.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Phase 3

Schedule & Deliver

Caregiver Readiness

How it should work — Before being scheduled, a caregiver must be compliant for that contract (training current, no restrictions) and able to record EVV (mobile app or telephony).

Caregiver > Compliance / ProfileOwner · HR / Scheduling

Common gap: scheduling caregivers who are out of compliance or have no working EVV method.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Schedule the Visit

How it should work — Schedule from the Patient Calendar or a Master Week. The system checks each visit against the auth on save — a visit in pink is breaking the auth and must be fixed before the visit date.

Patient > CalendarMaster WeekOwner · Scheduler

Common gap: pink visits left unfixed, scheduling past authorized units, or scheduling with no auth.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Deliver & Confirm the Visit (EVV)

How it should work — The caregiver clocks in/out (mobile, telephony, or 3rd-party EVV). The visit must then be confirmed — EVV linked, clock in/out present, call exceptions cleared. An unconfirmed visit is not billable.

Visit > Visit MaintenanceCall DashboardOwner · Scheduling / Ops

Common gap: visits never confirmed, hand-confirming to force billing, or ignoring EVV exceptions.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Phase 4

Bill

Prebilling Review

How it should work — The system auto-audits confirmed visits and holds any with a problem (incomplete, unbalanced, not authorized, unapproved timesheet, missing DX). Nothing on the hold list bills — clearing it is the job. In aggregator/Medicaid states, get visits accepted in the EVV Transaction Manager first.

Billing > PrebillingOwner · Billing

Common gap: the hold list is ignored, or "Timesheet Approved" is checked without verifying times.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Create the Invoice Batch

How it should work — Cleared visits are compiled into an invoice batch by payer/contract. Only visits that passed Prebilling are eligible.

Billing > New InvoiceOwner · Billing

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Billing Review

How it should work — A second exception page checks each invoice against the payer's billing rules (DX, modifiers, required fields) before submission. Held invoices stay until corrected.

Billing > Billing ReviewOwner · Billing

Common gap: treating it as a rubber stamp and submitting invoices the payer will bounce.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Submit Claim → Clearinghouse → Payer

How it should work — 'Accepted 999' means the clearinghouse received the file — not that you were paid. The claim file is exported (EDI) to the clearinghouse, then the payer. Follow each claim through to actual payment.

Billing / EDI ClaimsOwner · Billing

Common gap: reading "Accepted 999" as "paid" and never tracking the claim to payment.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Phase 5

Collect & Reconcile

Remittance & Denials

How it should work — Post the remittance against claims, compare paid vs billed, and work every denial: unbill → fix → rebill. Denials are normal; speed of turnaround is the skill.

Remittance PostingUnbill / RebillOwner · Billing / AR

Common gap: remits not posted (so AR is fiction), denials left unworked, corrected claims never rebilled.

How consistently does your team do this today?

1 · Who does it?

2 · In what system?

3 · How often?

Notes / describe your actual process

Your Chief Advisors · we handle this

Reconciliation

Once the steps above run cleanly, we close the loop outside HHAeXchange three ways — hours vs ADP payroll, billings vs the QBO books, and claims billed vs remittance paid — to surface the dollars the day-to-day workflow hides. Nothing for you to fill in here.

On submit, you'll download a copy and we'll email it to Your Chief Advisors.