Addressing the rise of home health billing

In recent news last month the pressure to continue the Acute Hospital Care at Home (AHCAH) waiver program for an additional five years intensified. With close to 100 stakeholders such as WellSky, AARP, and the Home Care Association of America pushing it to be included in the March government spending package makes the matter more complex and demanding. Moving Health Home (MHH) spearheaded the campaign, highlighting that the waiver program has been successful in enabling hospitals to provide patient-centered care at home, increasing access to and use of affordable healthcare. 

The Increasing Demand for Home Health Billing Solutions 

As home-based healthcare models grow, the need for smooth billing and reimbursement solutions is on the rise. The AHCAH waiver extension is likely to prompt more hospitals to implement home health programs, which will require an effective billing infrastructure. Yet, home health billing presents some special challenges, such as: 

• Complicated Medicare and Medicaid regulations 

• Prior authorization requirements 

• Timely claims submission and adjudication 

• Accurate documentation and coding for compliance 

These challenges may result in reimbursement delays, compliance issues, and financial losses for healthcare providers. To maintain effective home healthcare services, providers need to focus on optimized billing processes and revenue cycle management. 

Steps for Optimizing Home Health Billing 

To improve the efficiency and accuracy of home health billing, providers need to emphasize: 

1. Comprehensive Eligibility and Prior Authorization Management: 

• Verifying patients' eligibility for home health billing services under Medicare, Medicaid, and commercial payers. 

• Fast-tracking previous authorizations to avoid delays in patient treatment. 

2. Coding & Claims Submission Accuracy 

• Using ICD-10, CPT, and HCPCS coding to adhere to payer regulations. 

• Avoiding claim denials through real-time auditing and quality assurance. 

3. Denial Management and AR Recovery 

• Determining claim denials and implementing timely appeals. 

• Dealing with accounts receivable(AR) backlog through strategic follow-ups. 

 4. Regulatory Compliance & Audit Support 

• Staying current with CMS guidelines to make accurate reimbursement. 

• Delivering audit-ready documentation to facilitate hospital-at-home billing programs. 

The Future of Home-Based Healthcare & Effective Billing Practices 

As federal flexibilities fuel home healthcare adoption, providers need to prioritize patient care over administrative tasks. The AHCAH waiver's possible five year extension is a huge opportunity for providers, but effective billing will be key to long-term success. This is why many providers are also finding the outsourcing solution as a cost effective and convenient way out to manage their home health billing services. Being a game changer for many, outsourcing in short offer efficiency, better productivity metrics and cost effectiveness.   

Also, not to forget outsourcing allows providers to focus on patient care rather than complex billing processes. Of-course with access to cutting-edge technology and real-time reporting, outsourcing partners enhances transparency and efficiency in revenue cycle management. This strategic move can significantly reduce overhead costs while improving cash flow, making it an essential component for sustainable home health operations. 

Today with the healthcare environment changing towards patient-centered home care models, providers that actively manage billing inefficiencies, regulatory issues, and reimbursement delays with the help of outsourcing will be better suited for long-term growth. Investing in cutting-edge revenue cycle management techniques will guarantee timely reimbursement, compliance, and financial strength in the emerging home healthcare environment