Why There’s So Much Fuss About Home Health Billing Companies

Population Reference Bureau stated that Americans aged 65 years or older have risen from 58 million in 2022 to 82 million in 2050, which is a 47% increase. That is why the requirement for home health has also increased significantly because these people need care from the comfort of their home. So But the problem is that healthcare staff handle too many tasks. They manage almost everything and can’t focus fully on patient care. So, what can you do to fix this situation? Here, you can take the help of home health billing companies that know all the ins and outs of the claim submission process. 

These home health services provide a wide range of offerings, such as treatment, diagnosis, nursing care, occupational therapy, medical social service, physical therapy, and many more. So, billing for all these processes is highly complex, as it needs the usage of complex modifiers and coding procedures. However, a strong home health billing process ensures timely and correct payments. There are five main players in home health billing. They are home health agencies, patients, payers, billing staff, and clinicians. Each of them plays a key role in keeping billing accurate. This teamwork helps make the claim submission process smooth and fast.Now, before diving into how these companies help you, let’s find out how these services work.  

How Home Health Medical Billing Works  

The home health billing process is highly complex because it includes the use of complex modifiers and codes. The steps of this billing process are described below:  

Understanding Financial and Medical Eligibility for Home Health Care  

Initially, the physicians need to evaluate the patients to confirm if they meet the needed criteria to qualify for home health care. It includes homebound patients who have a medical condition. You can do this by reviewing the patient’s private insurance details. Private insurance usually covers part of the cost based on the plan. Then comes Medicare, which pays for skilled nursing and therapy services. The patient must meet the homebound rule to qualify for that. Always remember that understanding the financial and medical responsibility is important to ensure smooth access to home health care and reduce billing errors. That’s where you need the help of home health billing companies in this process.  

Insurance Eligibility Verification  

The next step is to verify the eligibility of patient’s insurance to ensure that their insurance covers the service. It incorporates verifying patient demographic information, active coverage, policy limitations, home health benefits, prior authorization requirements, whether the provider is in-network or out-of-network, and the financial responsibilities of the patients. Hence, the eligibility for the ongoing services needs to be verified as the patient’s insurance can change during the treatment procedure. Always remember that accurate verification is the key to making sure the services are covered, hence helping to avoid payment delays.  

Proper Documentation  

Detailed and accurate clinician documentation is key for every billable service. Factors like the patient’s medical condition must be clearly recorded. Homebound status, physician certification, and needed services also require careful documentation. Proper records ensure correct billing and reduce chances of claim denials. This documentation includes thorough visit notes, OASIS assessment for Medicare patients, care plans, physician orders, and records for any changes in the patient’s condition. Hence, capturing all the nuances of the patient’s condition establishes audit compliance.  

Coding and Claim Submission  

The CPT codes for the home health services and procedures include codes for the E/M home visits, home infusion procedures, and home visit services. There are several E/M home visit codes, such as 99341-99345, used for home E/M services for new patients. Moreover, 99347-99350 codes are used for home E/M services for established patients. You need to remember that claims must always be submitted correctly. This is usually done electronically via clearinghouses or direct payer portals. Proper submission prevents delays and helps secure faster reimbursement for services. The claims need to follow the correct format and be accurately submitted to ensure the providers can get proper reimbursement at the right time. The experts of the home health billing companies know all the complex coding nuances.  

Payment Posting and Reconciliation  

Once payment arrives, the system posts it to the correct services. It shows the amount applied and notes any adjustments or underpayments. The reconciliation process checks that total payment matches expected amounts. This follows the insurance contracts and the claims that were submitted.  

Follow-up and Denial Management  

After submitting claims, you need to contact payers when required to ensure the outstanding claims are addressed effectively. Hence, this strategy maintains correct revenue flow and helps to avoid payment delays. This medical billing process also includes denial management to identify and resolve problems that lead to claim denials.   

Collecting Patient Balances  

The patient’s financial responsibility has grown with high-deductible plans. Collecting balances means covering amounts not paid by insurance. This includes copayments, coinsurance, and deductibles that remain. Patients must be informed about their responsibilities through statements. Clear communication helps patients understand what they need to pay. However, an efficient collection process keeps the agency financially stable. It also reduces confusion and stress for patients during billing. 

Related Reading: Home Health Billing Services: Things You Should Know

How the Outsourced Experts Tackle Home Health Billing  

The home health billing companies stay updated with all the latest regulations. Their experts know all the complex nuances of the CPT, ICD, and HCPCS codes to make sure no claim denial occurs. These experts first verify patient eligibility, collect important patient documents, and then submit a prior authorization request to make sure no claim denial occurs. That is how they streamline the prior authorization service. They also know how to use the right technology to speed up the claim submission process. These experts also know how to store patient data inside the EHR system. They also know all the complex nuances of the prior authorization procedure for submitting claims electronically. So, as your healthcare staff tackles all the administrative hassles, it may be a good option to outsource home health billing companies.  

Now, you may have this question which is as there are so many RCM companies out there, how can you choose the right expert for your clinic? That’s where SunKnowledge comes in as your trusted ally.  

SunKnowledge: Your Complete RCM Expert  

We, as one of the best home health billing companies, provide all-inclusive home health billing services that encompass patient eligibility verification, proper documentation and coding, prior authorization, claim tracking and submission, denial management and appeals, accounts receivable management, and financial reporting and analytics. Our experts have high expertise and experience and provide a customized solution for your agency. We provide technology-driven efficiency, dedicated support, and partnership. With SunKnowledge, you can have a clear patient focus, improvement in cash flow, reduced operational costs, and risk management. We can reduce your operational costs by 80% and work with 99.9% accuracy.  

So, take the step today and grow your clinic.  

Related Reading: Common Mistakes in Home Health Billing Services That Cost Millions

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