The Centers for Medicare & Medicaid Services (CMS) and the Medicare Payment Advisory Commission (MedPAC) have been in the news lately with alerts and recommendations surrounding the new proposed rule that would bring back the controversial pre-claim review process for home health Medicare claims. They are looking at the possibilities of the post-claim review as well.
If that’s not enough, this week, MedPAC spoke to Congress about how rarely home health patients pick their neighborhood’s highest quality provider after being discharged from the hospital.
While we have our fair share of proposed regs to worry us about our futures, we have a plate full in the present. Current challenges like Zone Program Integrity Contractor (ZPIC) and Recovery Audit Contractor (RAC) audits as well as surveyors are already keeping us up at night.
All of these headlines force providers to the defensive. It’s understandable. You’re all looking for ways to protect your agencies financially.
To fend off a few gray hairs and ensure financial stability in your home health and hospice agencies, we recommend focusing on the collaboration between your financial and clinical teams.
While required reports are typically driven by the financial team, completed reports often require timely support from your clinical team. A great example is the Face-to-Face (F2F) document. Sure, if it’s not signed and dated it will result in a technical denial, but if the physician does not document the details related to the homecare diagnosis, it could be denied.
Other good examples are:
1. Oasis locked and submitted
2. First Billable Visit processed timely
3. Discharge Visit processed timely
4.Orders signed and dated by the physician
All of these items require joint processes from your financial and clinical teams to collect revenue and process payments. The more streamlined and efficient these concerted processes are, the faster you get paid.
Although Medicare is still the largest payor for most providers, there are just as many examples of the importance of collaboration that impact non-PPS (Commercial claims), Hospice Per Diem Claims and private duty billing.
Maxwell Healthcare Associates (MHA) has adopted a lean six sigma process to review each step in the provider’s payment path. We are not only looking at the timeliness of each step, but also documenting the requirements and supporting processes. Reducing errors, ensuring appropriate authorization and eliminating redundancy will ensure that all claims are paid and stand up to the auditors.
Please call on me directly or any of my amazing team members to help you review your processes. We have many templates to test each step and ensure they are working appropriately. From intake to payment posting, we can assist in all areas that impact financial and clinical outcomes. Please take care of each other and remember to be kind to everyone.