Home health providers bring skilled medical care to patients’ doorsteps. This medical service is experiencing rising demand as more patients like to recover from diseases in the comfort of their homes. Moreover, it offers extreme satisfaction to the aging population and patients suffering from chronic diseases.  

Presently, the home healthcare industry is growing at a compound annual growth rate (CAGR) of 12.74%. It significantly increases the overall responsibilities of home health billing services. Before discussing the responsibilities, let’s take a look at the key drivers behind the rising demand for home healthcare. 

Reasons behind the Increasing Demand for Home Healthcare 

Aging Population: In the US, the population aged 65 and above observed a significant growth of about 16.8% in recent years. Mainly, aged individuals prefer home healthcare services. Hence, due to the growing aged population, the demand for home healthcare is continuously increasing. 

Chronic Disease Management: Chronic conditions generally require ongoing care and continuous management. These types of conditions mainly include cancer, diabetes, and cardiovascular diseases. People suffering from chronic diseases mostly prefer treatment in their homes. 

Comfortable Care Setting: Patients who received their treatment from hospitals or other healthcare facilities often choose home health for rehabilitation. They get convenient and personalized care at their homes to entirely recover from medical conditions. 

Cost-Effectiveness: Home healthcare is significantly more cost-effective than other in-patient settings for institutional care. Due to this budget-friendly feature both patients and payers prefer home healthcare.  

The Role of Home Health Billing Services 

Home health care covers a wide range of medical services provided in a patient’s residence. They offer the following services – 

• Nursing care 
• Physical therapy 
• Occupational therapy 
• Speech therapy 
• Personal care assistance 

In 2020, the Centers for Disease Control and Prevention (CDC) reported approximately 3 million patients opted for home healthcare from about 11,400 agencies across the US. Home health billing services ensure that healthcare providers receive accurate and timely reimbursement for the services rendered. These services involve a series of responsibilities. Hence, billing staff must have a thorough understanding of healthcare regulations, documentation, and coding. 

Patient Registration and Eligibility Verification 

The responsibility of home health billing specialists starts when a patient first approaches the facility for medical assistance. They need to collect accurate patient information that includes name, address, date of birth social security number (SSN), and insurance number. Moreover, they need to verify insurance coverage and determine eligibility for home health services.  

Obtaining Prior Authorizations 

Most home healthcare services and medical procedures necessitate prior authorization from insurance payers. One of the prime responsibilities of billing specialists is to secure approvals swiftly. Obtaining seamless pre-approval ensures the home health provider will be reimbursed for the rendered medical services. Failure to obtain necessary authorizations can result in denied claims. It will impact the provider’s revenue cycle. 

Accurate Medical Coding 

Precise coding is fundamental to the medical billing process. Home health coding professionals must assign appropriate codes to each service rendered. Moreover, they must adhere to the latest coding standards and guidelines as directed by CMS. Home health coders mainly use the following codes – 

• ICD-10-CM: These codes refer to diseases and diagnostic procedures.  
• CPT: These medical codes explain the rendered medical procedures and services.  
• HCPCS: These codes are used for services that cannot be defined using CPT codes. For example – HCPCS codes describe durable medical equipment, supplies, and other services.  
• OASIS: It is a standardized assessment tool widely used in home health billing. CMS uses OASIS to collect data about patients’ conditions and needs. 

Comprehensive Document Submission 

Documentation is a huge responsibility of home health billing professionals. About 10% of claims are denied due to documentation errors. Billing specialists must include all-inclusive documents that support the medical necessity of rendered home healthcare. These documents serve as evidence of the services provided and justify the amounts billed. Insurance payers have medical professionals who go through the documents to assess medical necessities before reimbursement.

Monitoring Claim Status and Addressing Denials 

Home health billing specialists must thoroughly monitor the status of the claim after submission. Moreover, they must put extra effort into identifying any issues that may arise. On average 20% of submitted claims are rejected by payers due to billing errors. Billing specialists must quickly investigate the reasons for the denied claim. After that, they must correct errors and resubmit the claims as quickly as possible. Denial management is one of the top-most responsibilities of home health billers. This way, they can efficiently maintain a steady cash flow and minimize revenue loss. 

The Impact of Outsourcing Home Health Billing 

Flawless billing directly empowers the financial stability and operational efficiency of home health providers. However, home health staff performs a wide range of tasks ranging from patient registration and offering healthcare to compliance adherence. These intricate workloads often make them exhausted. As a result, they often commit negligible billing errors that lead to denial and delayed reimbursement. 

Here, the best solution is employing outsourced home health billing services. They have specialized knowledge of billing, coding, documentation, and regulations. Moreover, they have an in-depth understanding of the payer policies. Hence, they can ensure the maximum reimbursement available in the patient’s insurance plans. 

Furthermore, keeping an in-house team is significantly more expensive than employing an outsourced billing team. It can save about 80% of operational costs for home health providers. Also, when specialist billing services take care of administrative responsibilities, the in-house staff can spend their time improving patient care.