Home health agencies differ from physicians’ offices or hospitals in that medical billing is usually handled outside the business office and handled separately from its daily tasks. Instead, home health billing requires highly specialized knowledge from within their own staff members who specialize in this particular function of running the agency.
First are providers such as registered nurses, physical therapists, occupational therapists and speech therapists. They work directly with patients to meet their home healthcare needs before documenting it all for submission to Medicare, Medicaid or private insurers for reimbursement.
Medicare
Home healthcare services are typically covered by Medicare, Medicaid, private insurance or VA benefits. Medicare only pays for medically necessary services recommended by your doctor – for instance if an SLP is necessary to treat you for a specific medical condition at home, Medicare will cover that service as part of its coverage.
Home health agencies must submit a Medicare Plan of Care in order to get reimbursed for services they offer, with certification requirements being updated every 60 days or when patient needs change.
Agencies must follow Medicare’s OASIS guidelines when documenting each service they provide, which includes using a unique coding system for every type of treatment and verifying that OASIS data submitted is accurate. Therefore, agencies need software solutions that support such requirements for accurate coding submission.
Software should allow SLPs to quickly enter a patient’s plan of care and generate and submit an electronic claim form, helping ensure all information is entered correctly and on time. In addition, claims should be sent directly to insurance companies without having to upload them into a clearinghouse first.
Finally, it’s essential that your agency have a robust system for tracking each claim throughout its progression, in order to avoid mistakes which might lead to denied or rejected claims – this is particularly crucial if multiple individuals are handling billing duties at your agency.
If your current software solution does not fulfill all these needs, now might be an opportune time to upgrade and meet all regulatory guidelines required by payers more easily. These solutions make meeting these guidelines simpler for both you and your team.
Alongside an all-encompassing software solution, it is also wise to partner with an insurance agency familiar with home health care services. Doing so can expedite payment for home health services rendered. BAYADA Home Health Care can help find an ideal solution tailored specifically to your situation – contact us now and learn more – our experts are more than willing to discuss all possible payment terms that best suit you!
Medicaid
Medicare offers home health care services for people whose needs cannot be met at a doctor’s office or hospital. These include physical therapy, occupational therapy, speech therapy and nursing services as well as social services and durable medical equipment such as walkers and wheelchairs.
Medicare-certified home health agencies (HHAs) must abide by federal guidelines in order to be reimbursed by this program, such as performing eligibility checks and submitting claims directly to payers for payment.
Medicaid is a joint state and federal health care program for low-income patients and their families, designed to cover most costs related to home health services and equipment, although not 24/7 support such as shopping or cooking assistance. Rules and requirements may differ by state; typically though it provides coverage of most home healthcare services and equipment costs associated with home healthcare needs.
Home health agencies looking to be paid by Medicaid must first secure approval from their state department of health and human services before billing for its services – this process is known as receiving a Certificate of Approval (COA).
Documenting Need. An agency will need to submit documentation such as patient diagnoses and a plan of care for review by the state. They may also examine quality-of-care records as well as financial documents to make sure that their agency meets guidelines.
Once a home health agency is licensed, it can register with individual payers in order to get reimbursed for its services. Each payer will require them to create a contract outlining which services will be covered as well as how much payment will be due per service provided by the agency.
Understanding the roles played in home health billing is critical. A payer refers to any third-party that pays for care for a patient – this could include private insurers or government programs like Medicare or Medicaid. A home health agency hires trained healthcare providers such as nurses, therapists, aides or other experts as needed and arranges visits from these skilled individuals directly to the patient for care provision – these may include nurses, therapists or aides as appropriate.
Home health agencies face a complex billing process, making revenue cycle management crucial in providing fast and quality patient care. By having the appropriate tools in place, medical billing will become much less time consuming and complex a process for your home health agency.
Commercial Insurance
Home health agencies rely on multiple revenue streams, including Medicare/Medicaid, private insurance and self-pay. As Medicare has reduced its percentage payouts in recent years, home health agencies need to diversify their payment sources by forming relationships with commercial insurance companies as well as contracting with managed care organizations.
Step one in managing commercial insurance involves identifying which insurers operate locally. While large players like Aetna and Blue Cross Blue Shield might be an easy fit, smaller local insurers might be better suited. Agencies should ask these insurers questions such as whether or not electronic claims can be filed electronically; when are timely filing deadlines; what form should be used; etc.
Additionally, commercial insurance policies usually require pre-approval of care before an agency can start seeing patients. This process typically only requires filling out a few documents; all agencies should make this step to ensure they’re billing only eligible services and ensure patients’ needs are being met.
Home health agencies should take extra steps when setting up their insurance portfolios to address workers’ compensation, general liability and professional liability policies. Workers’ comp policies cover medical expenses for injured employees at work; general liability policies cover property damage or bodily injuries caused by home healthcare workers to clients; professional liability coverage (often called errors and omissions insurance) can help cover legal defense costs in cases against home healthcare agencies which result in financial losses for clients.
Learning the rules of each payer makes establishing strong relationships easier and avoiding reimbursement issues down the line. While this process will take some time, its payoff for home health agencies aiming to expand their reach and secure additional income streams is enormously rewarding.
Private Pay
Home health agencies have often shied away from exploring managed care and commercial insurance as possible sources of revenue, yet doing so can result in significant gains, according to Labarta. “Agencies should identify revenue drivers and pursue them aggressively,” she advises, noting that some agencies with diversified payer mixes have experienced 20% to 30% more income as a result.
Home healthcare billing specialists can help your agency take advantage of new payment opportunities by employing best practices and specialized software that streamline the process. Such software keeps all claims organized on one platform for easier tracking; errors can also be reduced significantly and payment turn around times decreased significantly with this tool.
Some Medicare beneficiaries may qualify for a private Medicare Advantage plan, also referred to as Medicare+Choice or Medicare Advantage plans, which typically provides more choices and flexibility than Original Medicare does. Plans such as these often provide Medicare prescription drug coverage or vision and hearing supplementary insurance policies as part of the package.
Consolidated billing presents SLPs in private practice who treat Medicare beneficiaries at home with particular challenges. Therapy services provided are often covered by their home health agency rather than separately billed by an SLP in private practice, leading to unintended double billing when one uses the wrong Current Procedural Terminology code (CPT) for services provided.
No matter whether the client has selected a private Medicare Advantage or Traditional plan, home healthcare agencies should always submit claims with an accurate CPT code for every service provided to ensure accurate billing without risk of rejection. Home healthcare agencies should ensure timely follow-up on submitted claims within two weeks of submission; many denials occur due to billing errors that can easily be resolved with timely follow-up. Home healthcare agencies that experience claims rejection should take steps to understand why, in order to correct and resubmit their claim. By following these simple steps, home healthcare agencies can increase revenue from Medicare and commercial insurers alike.