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

requirements including:

  • 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:

  • technology

  • documentation

  • coding

  • billing

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