Common Mistakes in Home Health Billing Services That Cost Millions

You always take care of patients, manage your staff members and handle the other crucial administrative tasks in your home health agency: however, you can only expect to provide your patients with the quality  home care only when your financial side remains strong. Billing errors are the primary reason why most healthcare practices face losses as almost 80% of claims contain mistakes, thus already causing the loss of $125 billion almost every year. The concerning thing is that the low payment rate of 7.66% from Medicare’s side contributed to the additional loss of $31.70 billion, while the amount caused by Medicaid was $31.10 billion. Coding errors alone itself caused almost 10-15% claims to face rejections, leading practices to encounter payment delays and revenue loss. Healthcare providers, including home health agencies, had to spend almost $10.6 billion in 2022 where each denied claim had taken almost $25-$118 per claim to be reworked. You should be more careful as home health agencies usually run with low margin and these leakages can be really costly for you.  

You can find some revenue leakages like claim denials easily, but mistakes like underbilling, missed documentation, or missing authorization are often. Small issues always get accumulated fast, making it hard for you to pay staff members and keep your organization running smoothly. It is really important to understand the reasons why revenue leaks happen in home health billing services so that you can take the right measures.  

Know why revenue leaks happen in home health billing: 

Home health billing itself is a complex area as you often deal with the insurance payers like Medicare, Medicaid and commercial companies and each payer has its strict set of guidelines. You can typically face revenue loss because of providing incomplete documentation, wrongly coded claims, missing PA approvals, overworked staff members who often make mistakes and ignore denials. You find those issues as trivial at the beginning but they pile up fast overtime and cost agencies thousands in revenue loss. A small number of mistakes can also cause your agency to face serious cash flow problems, making it really hard for you to run your practice smoothly.  

The following are the vital reasons that often lead your home health agency to lose money.  

Related Reading: Home Health Billing Services: Your Partner in Overcoming Prior Authorization Obstacles

Vital reasons behind revenue loss in home health billing services: 

Incomplete or missing documentation: 

Each service provided by your home health agency needs to be supported by proper documentation or else, you won’t be able to bill for it. Your claims can get denied if the administrative staff has not recorded the nurse visit or due to incomplete documentation. Another major reason is missing physician signatures that cause many claims to be denied. Here is an example- you often need a face-to-face physician encounter note as per Medicare guidelines and the entire claim can be denied if you are unable to provide the physician notes, causing your practice to face major revenue loss, staff burnout and wasted hours. You have to acknowledge the fact that proper documentation is always more than just paperwork as it directly safeguards your revenue and ensures prompt payments for the work done.  

Inaccurate coding: 

You can consider coding as the language of billing and you can face claim denials or be underpaid if you assign wrong codes. Practices often face billing errors because of outdated codes, mixing up similar ones or committing silly mistakes in HCPCS, CPT and ICD-10 codes. You can face claim denials if your staff members confuse a skilled nursing visit with a non-skilled one. The way how a payer process a claim can also be affected because of using a wrong modifier. You can always make your claims clean and get paid fast by assigning the correct codes.  

Missing PA approval: 

The majority of your home health services like skilled nursing therapies, extended home health services, occupational therapies require PA approvals from patients’ insurance providers. Claims are denied immediately if you have performed home health services without PA approvals. Agencies often lack enough resources to get PA done or keep proper track of requests that are about to be expired. You can be left with unpaid claims even after the provided care because of missing or wrong process of getting PA approvals.  

Ignored denials: 

No wonder denials are one of the vital reasons behind revenue leaks but still, most home health agencies are unable to stay on top of their denial game because of lacking skilled resources. It is true that many denials can be fixed with the proper measures but ignoring them means leaving a chunk amount of money on the table.  

Incorrect posting of payments: 

Home health agencies often cannot realize when they are missing money because of not posting payments promptly. Let’s walk through an example here-you received fewer amounts from Medicare but your administrative team has not checked it carefully. So what’s the result? You will end up losing money because payers never fix the mistakes until they are notified about it. The only way to make sure that you get paid optimally is by posting your payments correctly. 

Overlooking the secondary payers: 

A lot of patients often have multiple insurance plans and you can miss out on extra amounts if you don’t bill the secondary payer after the primary one. Many home health agencies face a huge economic loss because of forgetting to follow up and assuming the first payment as the final one. 

Most medium and small-sized home health agencies now outsource home health billing services to professional RCM partners to close revenue leaks. Professional billing experts always know how to meticulously handle coding, check documentation and submit accurate claims. A dedicated third-party billing company also uses advanced mechanisms to handle PA and other billing components to avoid the major pitfalls. You have to understand one thing clearly that outsourcing never means that you would lose control over your billing process; rather it’s about gaining expertise, experience and advanced workflow that your agency may not have.  

Related Reading: The Future of Home Health Billing Services in an Aging America

SunKnowledge: Ideal home health billing service partner by your side 

Our highly skilled team of billing experts posses significant years of experience handling home health billing services and know how to stay aligned with the industry and payer rules. What makes us a unique home health service provider in the market is that we are the only RCM company that works for both payers and providers. We know what it takes to cater to the unique requirements of all sizes of home health agencies. So, it’s high-time you automate each billing task, reduce errors and enjoy a dedicated account manager with us at SunKnowledge.  

So, don’t waste your precious time and give your revenue a strong boost with our end-to-end billing service at $7/hour only!