North Consulting Solutions, LLC an independent consulting firm dedicated to developing and implementing innovative solutions for Home Healthcare Businesses.
The number one threat to a Home Health Agency regardless of the size is the current Medicare and not much different commercial insurance regulatory environment has seen tremendous increases in Administrative Document Reviews (ADRs), the forthcoming rise of CMS contracted collection agencies such as Recovery Audit Contractors (RACs), and serious, continuous Medicare Audit Contractors (MACs), Zone Program Integrity Contractors (ZPICs) audits and now the Pre-Claim Review Initiative (PCR), home healthcare business owners and leaders must invest in process improvement initiatives that has a laser focus on compliance.
To succeed in this perplexing environment agency leaders must focus on a holistic approach that
prepares for the changing reimbursement system in home health care, it is now more important
than ever for agencies to understand how to leverage their clinical, outcome and satisfaction data
in order to improve performance. This performance measurement in this ACA era will be closely
associated and identified with an agencies star rating.
One main compliance initiative that will be a characteristic of successful agencies in this
challenging environment is to have a laser focus on a Quality Revenue Cycle Management
(RCM) process. Compliance issues and lost revenue are closely related. The relationship
between the two permeates the internal operations of an agency in unison.
Revenue cycle management (RCM) is the process of managing claims, payment and revenue
generation. RCM encompasses everything from determining patient insurance eligibility and
collecting co-pays to properly coding claims.
An effective RCM program is the responsibility not just of the home health leaders, but all
agency team members. This includes the intake coordinator who receives the referral, the
Business Development personnel who helps educate the referral source on the proper
documentation needed to support the need for home health in the form of Face-to- face
F2F Encounter Dates
Correlation between the F2F encounter and the need for Home Health
Supporting Documentation for Homebound Status
Clinical responsibilities of completing a comprehensive assessment that connects the dots with
the physician, the acute facility and other continuum of care providers involved with the patients
care is no longer just responsible for their respective cases they are now responsible for ensuring
that the transitional aspect of the patients care from one setting to another are coordinated.
Gathering important clinical documentation are now becoming a part of the patient’s medical
record is more important than ever for ensuring quality care as well as ensuring proper
supporting documentation to help increase quality care and in case of an audit from all of the
entities involved with claims review and prepayment initiatives.
RCM processes must build in compliance as a priority. It should no longer be considered
something the larger agencies focus on, but an important process to ensure quality patient care is
at the forefront. Compliance is dependent on effective communication across the entire
coordination of care team that is part of a plan of care that manages a patient’s medical needs.
The four main areas of this process this is coordinated and geared toward the plan of care are:
These four areas of Home Health operations support RCM and form a high level of compliance
which will ultimately reduce errors.
North Consulting Can Help
North Consulting Solutions offers Revenue Cycle Management services supported by an
extensive knowledge and expertise in the Home Health Industry. We combine an in depth
knowledge of technology and Home Health Operational services with expert consultation to help
Home Health agencies successfully manage complicated day-to- day operational responsibilities
such as Commercial & Government billing, Coding overflow, billing recovery, regulatory
compliance and document review. How do you survive? You hire North Consulting as your