Conquering Home Health Billing Reimbursement Challenges

Posted by William Jones on September 17th, 2024

Home health agencies often grapple with the unique challenges of medical billing and coding.

The intricacies of navigating insurance guidelines and optimizing home health billing and coding processes can be overwhelming for providers like you.

Therefore, it is essential to strike a balance between clinical and administrative responsibilities.

The financial aspect of your practice is completely dependent upon the effective revenue cycle management process.

However, due to a lack of expertise in billing and coding processes, your staff can make mistakes in the process which can lead you to claim denials.

Significant Errors in Home Health Billing

Improper payments for home health agencies can occur when the Medicare funds are paid to the wrong entity, in the wrong amounts, and are not supported by the documentation policies.

A number of units error occurs when you bill for an incorrect number of units for a procedure code.

For instance, if you bill for 144 units for the procedure code S9122-Home Health Aide or Certified Nurse Assistant providing care in the home, per hour, for the services offered over 4 weeks.

The insurance plan authorizes 9 weeks, and the documentation indicates a time of 36 hours. The number of units billed was calculated for 15 minutes per unit instead of 1 hour.

Insufficient documentation is a common yet significant mistake in home health billing. Inadequate service logs, missing progress notes, and insufficient treatment plans all are parts of inaccurate documentation.

Also, inadequate or missing patient information, medical history of the patient, and lack of medical necessity can lead you to claim denials and revenue loss.

On top of these mistakes, there is always a trepidation of policy changes, changes in coding regulations, and overwhelming patient volume and workload.

It is difficult for you to maintain an in-house billing team with consistent labor shortages, increasing wages, and the costs and time required to sustain an in-house staff.

Take a Step Ahead with Outsourcing

An outsourced healthcare revenue cycle management organization is a plausible and strategic answer to your home health billing coding challenges.

These companies have a team of professional medical billers and coders who can eliminate even the smallest mistakes within the process and ensure accurate and timely reimbursements.

Always look for a home health billing company that improves your practice’s efficiency, and productivity and improves revenue in the long run.