The COVID-19 pandemic has catapulted home health services to the forefront. According to estimates from a McKinsey study, $265 billion worth of care services for Medicare fee-for-service and Medicare Advantage beneficiaries could shift from traditional facilities to at-home care by 2025.
While this spells good news for your home health agency (HHA), it has never been more crucial for you to stay on top of the reimbursement process to maintain a healthy bottom line and revenue cycle.
To ensure you can receive timely reimbursements for your home health services, here are the important things you need to know about the home healthcare reimbursement process.
Who Qualifies for Home Health Reimbursement?
To qualify for a home health benefit from the US Center of Medicare & Medicaid Services (CMS), you need to consider the type of services your HHA provides to patients.
Medicare home health reimbursements cover two categories of services:
Part A Services
When patients under your care are confined to their home under the advice of a qualified healthcare professional, your HHA is eligible to apply for CMS’ Part A benefit.
Home health services listed under the Part A episode of the CMS benefit include:
- Skilled nursing
- Physical therapy
- Medical social services
- Speech & language pathology
- Occupational therapy
- Home health aide
Patients can only be classified as “homebound” by physicians if they are suffering from a condition, injury, or illness that puts them in need of special assistance from another person in order to leave their home.
Other criteria that need to be met in the care of a patient to qualify for the Part A home health services benefit include:
- An in-person patient visit by a medical professional
- A plan of care prepared by a certified physician
- A need for intermittent skilled nursing, physical therapy, or speech-language pathology services
Part B Services (Non-Homebound)
Should your agency not qualify for the Part A benefit nor meet the criteria above, reimbursements can still be made under the Part B benefit through the Medical Physician Fee Schedule.
If a patient is not confined to their home, services and supplies that are medically needed to treat your patient and follow accepted standards of medical practice can still be covered under this category.
Preventive services for early detection of illness are also included under the Part B episode of Medicare benefits.
How to Apply for Home Health Reimbursement
You will need to consistently provide all documentation and consolidated billing for Part A and Part B services to your Medicare Administrative Contractor (MAC) to receive efficient reimbursements.
Documentation you will need to provide during quarterly and annual updates will include:
- Invoice number
- HCPCS codes
- Patient name
- Description of services
- Dates of service
- Charges
Be sure to follow all CMS best practices and consolidated billing instructions to ensure your claims are processed efficiently with all supporting documents.
How Telehealth Helps with Your Capitation Reimbursement - Strategies for Capitation Success
Opting for a capitation payment model places a greater emphasis on waste cutting, which simply means eliminating inefficient care and processes that are contributing to healthcare spend. Telehealth and remote patient monitoring (RPM) solutions have proven results when it comes to cost savings and improving quality of care.
A 2014 study suggested that new capitation-based payment models when used with telehealth can maximize clinical outcomes and minimize costs. The areas of improvement cited include videoconferencing for outpatient visits and home telemonitoring.
Important CMS Updates
Recent changes to CMS benefit policies are important to keep in mind to ensure your reimbursement process goes smoothly. Here are the highlights:
Notice of Admission (NOA)
As of January 2022, HHAs now need to complete and submit a notice of admission (NOA) to their MAC within five days of starting a patient’s home health episode. Failure to do so will mean paying a non-timely submission fee.
The NOA has replaced the previous request for anticipated payment (RAP) system, which struggled with compliance issues from HHAs.
You can submit your NOA to your MAC by mail, electronic data interchange (EDI), or by using the Direct Data Entry system.
Home Health Value-Based Purchasing (HHVBP)
With the nationwide expansion of Home Health Value-Based Purchasing (HHVBP) in 2022, Medicare home health reimbursements will now be calculated on a value-based model.
Instead of focusing on volume of care given, HHAs will need to make the shift to prioritizing the value of patient care, with approval for reimbursements tied more closely to quality of care rather than quantity.
Patient-Driven Groupings Model (PDGM)
In 2021, an update to the Patient-Driven Groupings Model (PDGM) reduced payment periods from 60-day episodes to 30-day episodes to remove the incentive for unnecessary patient services and move towards a more value-based approach in patient care.
Reducing payment periods to 30 days is an effort to increase cost-efficiency and the quality of patient care in a shorter time span, encouraging HHAs to increase care coordination and patient oversight.
With this payment reform, a question of concern for many HHAs is “How do we continue to provide quality care without impacting our bottom line?”
Learn More About Navigating Home Health Reimbursements for Your HHA
Exploring telehealth and remote patient monitoring to provide the right care for the right patient at the right time is an example of how HHAs can keep patients engaged and healthy at home. Talk to one of our experts to learn more about home health reimbursements.
