Reduce denials with an outsourced Home Health Billing Company

Home health facilities face various complexities in both patient treatment and the reimbursement process. Home health facilities are different from other healthcare specialties because patients receive treatment in their homes. The payment depends on episode-based rules, patient eligibility, visit timing, and documentation of medical necessity. Due to these factors, claim denials have become a challenge for many home health providers. They not only delay payment but also impact patient care quality. Managing denials could be difficult for in-house billers with limited knowledge and expertise. This is where an outsourced home health billing company proves beneficial in handling the complexities of home health billing. However, before discovering the ways in which billing companies reduce claim denials, it is important to identify the reasons behind these denials. This would allow home health providers to follow the correct billing method and ensure accuracy.  

 The reasons behind home health claim denials 

1. Incomplete documentation – Like other healthcare specialties, documentation errors are among the reasons behind denials in home health reimbursement. These include misspelled patient names, incorrect dates of service, inaccurate use of medical codes, and incorrect insurance policy numbers. Several other discrepancies, such as missing physician notes, inadequate patient visit notes, and lack of medical necessity documentation, also contribute to claim denials in home health facilities.   

2. Coding errors – The incorrect use of ICD-10 diagnosis codes, HIPPS codes, place of service, and billing periods is major red flags in home health coding. Some of the common mistakes include the use of unspecified diagnosis codes, omitting secondary diagnoses, and incorrect sequencing of diagnoses. Claims are also denied due to incorrect laterality, expired codes, or failure to update coding changes every year.  

3. Delayed claim submission – Every insurance company has a specific timely filing limit for home health claims. Providers need to ensure that all claims are submitted within this time frame to confirm timely reimbursement. In many cases, claims are submitted after this deadline. Even if there are complete documentation and correct coding, payers can still reject the claims since they were not submitted within the timely filing limit.   

4. Missing prior authorization - Missing prior authorization is a common reason for claim denials in home health billing, particularly for commercial insurance plans and many Medicare advantage plans. A home health billing claim may be denied in the following scenarios:  

   
   

   - When no prior authorization was obtained before services began 

   - The authorization expired before services were delivered 

   - The number of billed visits exceeds the limit 

   - Services provided differ from those approved by the payer 

How a third-party home health billing company helps reduce denials 

An outsourced billing company adopts strategies to tackle the challenge of increasing claim denials in home health facilities. These include the following methods which are implemented for a better billing outcome: 

1. Integration of automation – It is evident that an automated workflow ensures that all claims are error-free before their submission. Automated claim scrubbing tools perform necessary checks that are difficult to perform through manual scrubbing. These tools evaluate claims according to specific criteria and industry regulations. Automation also helps to detect potential issues and improve the clean claim submission rate. It also improves denial management and reduces the time and resources involved in manual reviews.   

2. Improving documentation accuracy – The approval of claims depends heavily on accurate documentation. The outsourced companies review clinical documentation for completeness before the claims are submitted. They verify physician notes, certifications, and identify missing signatures, dates, or other supporting documentation. When the documentation is in place, home health providers are less likely to face denials.  

3. Adequate staff training – In the healthcare industry, change is the only constant. There are frequent changes in coding, payer, policies, and compliance regulations. It is important for the billing staff to stay updated on these modifications to ensure accuracy. An outsourced home health billing company conducts frequent training sessions so that the staff members are well informed of the latest updates. The billing team members are provided with the knowledge to effectively handle complex billing and claims processing tasks. With proper training, the staff are less likely to make errors while billing for home health services.   

4. Accurate coding – Most third-party billing companies have certified coders who are skilled at handling various coding complexities. These coders are updated on ICD-10-CM coding guidelines, payer policies, and reimbursement rules. With accuracy in the application of codes, errors such as incorrect diagnosis codes and missing modifiers are reduced. When the number of errors decreases, claim denial rates also fall significantly. 

Making the right choice before outsourcing home health billing 

It is evident by now that outsourcing offers the best strategies to reduce home health claim denials. However, what is more important is for providers to hire the right billing company to ensure proper reimbursement. In the healthcare industry, there are many companies that offer benefits such as access to CPC-certified coders and HIPAA-compliant services. It is recommended to go with these companies since they offer end-to-end revenue cycle management services. Submitting claims for home health facilities could be tricky since it involves complex payer requirements, extensive documentation, and frequent regulatory changes. Hiring the right home health billing company can make all the difference in profitability and patient satisfaction.