This article is published in sponsorship with Elsevier.
Home healthcare is a burgeoning and besieged industry. Its growth is strongly connected to our aging population and increased competition; its challenges come from a variety of sectors. It all adds up to healthcare organizations that face financial, workforce and regulatory pressures on a daily basis that could threaten the quality of their service delivery and, for some, their overall viability.
The “graying of America” continues, with the number of persons age 65 and older expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030, according to the US Census Bureau. Since it has been estimated that more than 90 percent of persons over the age of 65 have expressed a desire to stay at home as long as possible, the surge in need for home health services is clear for this reason alone. Other factors play a role as well, as in-home services can be a matter of convenience and comfort for elderly persons or those with disabilities and their families.
With an overall goal of meeting the demands of healthcare reform and concomitant regulatory and payment requirements, these providers reportedly are looking at home health as a cost-effective means of achieving a wide variety of objectives. They include reduced admissions, readmissions, and emergency room visits as well as costs of care; improved chronic disease care management; and focus on concepts such as patient-centered care, population health management, personal choice, and effective transitions for coordinated care.
Reimbursement Changes and Regulatory Complexities
As part of a heavily regulated industry subject to the mandates of the Affordable Care Act, public home health agencies must keep up and comply with state and federal requirements and maintain viability in the midst of change. All home health providers must also deal with the uncertainties associated with reform, such as where they will fit in new delivery models. Other issues include:
- A shift toward value-based payments
- Bundled payments
- Errors, fraud, and abuse
- Staffing issues
All these recent mandates and conditions for payment add up to an industry that has to maximize its resources, doing as much as it can with what it has. At the heart of this pursuit is appropriate reimbursement, both in terms of merited recompense and legitimate charges, as well as achievement of monetary incentives. In other words, it requires effective revenue cycle management.
Home Health Revenue Cycle Management
In 2016, as part of its ongoing scrutiny of home health for fraud and abuse, the Office of the Inspector General (OIG) reported that the rate of improper coding in this healthcare sector continues to increase, up from 51 percent in 2014 to nearly 59 percent in 2015. The primary reason was listed as lack of documentation for medical necessity.
The issue of incorrect and improper documentation and coding must be addressed not only for the financial health of the agency or organization but also the potential impact on the care they provide. The straightest path is through staff training.
What to Look For in Revenue Cycle Training
There are many training vendors and many types of training. Thus, it makes sense to choose an organization that offers the full range of training—coding, clinical, and administrative—for both consistency and cost-effectiveness. Online access to training often is the best course of action, enabling anytime, anywhere education that allows users to learn at their own pace.
Coding and documentation education should include targeted curriculum that educates nursing and administrative staff on the information that must to be documented for accurate and compliant diagnosis coding on the home health claim form, OASIS form, and the care plan, as well as for performance improvement and quality reporting.
This coursework should not be generic healthcare instruction; rather it should address the complexities of home health and the specific needs of consumers with scenarios and examples applicable to that delivery model. The focus should be on key coding and documentation concerns noted by OIG. In this context, detailed training on the guidelines, conventions, and sequencing instructions for coding home health diagnoses in ICD-10-CM is critical to meeting today’s rigid requirements.
Additional features could include pre-approved continuing education credits, ongoing educational events such as webinars, and reporting updates to complement training and keep staff current.
Download the full white paper at ElsevierRevenueCycle.com to read more about the many challenges the home health industry faces and the focus it has put on efficient revenue cycle management. The white paper also addresses the widespread deficiencies in home health documentation and coding, and makes the case for targeted training to help ensure appropriate reimbursement, maximum incentives, and regulatory compliance.
About Elsevier Revenue Cycle
Elsevier offers a full suite of education solutions designed to help healthcare organizations optimize staff performance and data quality for value-based programs and financial health. Through education and training, staff can be confident in their coding and data abstraction skills, and be empowered to help obtain appropriate reimbursement, reduce risk, and improve performance.