It’s important that agencies understand home health billing basics to reduce errors. They can cost you a significant amount in penalties and fees. According to the OIG Fiscal Year 2017 Work Plan, the CERT contractor found improper payments were made for about $9.4 billion, or 51.4%, of home health claims in 2014. A large portion of these improper payments was likely due to mistakes. Thus, demonstrating a critical need for accurate billing.
Home Health Billing Basics: How to Reduce Errors
Let’s take a look at some home health billing basics that will help you reduce errors. For more detailed information on the most common claim denials, click here to view our claim denial guides for home health and hospice.
Duplicate Claims Were Submitted
According to CGS, many home health claims are rejected because they are duplicates of ones already submitted. This is typically a result of lack of organization on the agency’s part. Many agencies struggle with having a streamlined process that facilitates accurate billing.
Beneficiary Eligibility Was Not Verified
CGS also says that another reason for rejected claims is when the beneficiary information on the claim doesn’t match the eligibility record at the Common Working File (CWF). This is an important step in making sure that claims are paid, but can often be overlooked when there is a large batch of bills to be submitted.
Physician’s Orders Are Missing or Incorrect
This means that the physician’s orders did not include a physician signature dated prior to billing, or they did not cover the services to be billed. Accuracy is key to getting reimbursed for all of the services you provide.
Reduce Your Risk of Home Health Billing Errors
As you can see above, many home health billing errors stem from not having the resources necessary to efficiently and effectively manage the billing process. Here are some tips you can use to help your agency streamline your billing operation.
- Conduct a thorough analysis of your home health agency’s billing practices so no exposure goes uncovered. Take a close look at what your billing process is now, how well it is working for you, and what you need to do to improve. Ask yourself, “Are you getting paid for 100% of the services you provide? Are claims being rejected due to careless home health billing errors? What is your first time pass rate? Is your team able to handle the workload?” By answering these questions, you will have a clearer picture as to how you are truly performing.
- Establish compliance standards, and conduct internal monitoring and auditing of those standards. Once you have done your due diligence in determining how your billing practices are operating, it’s time to set up standards and processes to avoid home health billing errors. Do you need to establish a process to ensure that duplicate claims aren’t submitted? Do you need a way to submit all documentation in a timely, accurate manner? Continue to monitor these standards you have established, and modify when needed.
- Stay up-to-date on rules and federal regulations by reading current information on CMS Home Health Agency Center Many home health billing errors can occur simply because you aren’t aware of new regulations. Due to ever changing regulations, it’s important to train your staff on all new coding and billing rules and regulations as they happen. Don’t get behind. It might be difficult to catch up if you do.
- Identify billing problems, look for patterns, track denied claims, and avoid improper payments by taking the appropriate corrective action. Your billing is always changing. You should take the time to manage the process fully. Should you identify any home health billing errors, fix them. But don’t stop there! Make sure that you learn from your mistakes so you don’t continue to make the same ones over and over.
- Consider using a third party billing service to eliminate home health billing errors. Home health billing companies have the advantage of employing expert billers using proven billing processes that work. They work hard to submit error-free claims, collecting what you are owed. In addition, their knowledge goes well beyond home health billing basics, so they can really dig into your billing to maximize your reimbursements.
Home Health Billing Services from HEALTHCAREfirst
Whether you bill Medicare, Medicaid, private insurance, or all three, HEALTHCAREfirst’s billing experts have the experience needed for accurate claims and quick submission. Furthermore, we offer billing recovery services to resolve unfiled and rejected claims. As a result, you can experience fewer billing errors, faster turnaround time, and improved cash flow.
The HEALTHCAREfirst Difference
Struggling with home health billing basics at your agency? HEALTHCAREfirst can ease the headaches associated with billing and collect what you are owed for your services. Contact us for a free billing consultation, or call us at 800.841.6095 to speak with an expert about how we can help your agency improve revenue and help you get back to caring for patients.