The steady growth of home healthcare practices (HHP) in the US has been burdened by the intricacies of medical coding and billing regulations. Ever-stringent oversight and compliance measures mean that home health agencies (HHA) have begun to seek help from dedicated home healthcare coding services.
Let us get an overview of challenges that home health care agencies face before discussing how our dedicated coding support helps practices adapt and thrive.
Challenges Facing Home Care & Hospice
1. Coding Challenges facing Home Healthcare Practices
Home health practices play a vital role in the patient centric model that the AMA and various rights groups have fought so hard to implement. And yet, just one wrong coding modifier means that an HHA loses out on thousands of dollars worth of services rendered.
To keep this short, let us set aside the diagnostic codes (ICD-10) and focus on HCPCS level II and CPT codes. These codes that detail services come not only with relative value units (RVUs) but are constantly being updated.
Home Health HCPCS Codes
As can be seen here, these three similar services have the same home health revenue code but separate HCPCS G codes. The revenue code 042x comes with the following elements:
- 0 – General Classification
- 1 – Visit Charge
- On a 32X type of bill, report the date of service, the service units representing the number of 15-minute increments that comprised the visit, and a charge amount. You will also need to report an HCPCS that reflects the service for which the clinician spent most of his/her time during the visit.
- Multiple HCPCS codes should not be billed for a single physical therapy visit.
These codes are also subject to constant updates, such as the request to:
- Revise existing HCPCS Level II code R0070, “Transportation of portable x-ray equipment and personnel to home or nursing home…” to “Transportation of portable imaging equipment…”
- DispatchHealth Imaging, the applicant, urged CMS to expand the transportation component of HCPCS Level II code R0070 to include portable ultrasound, doppler, and echocardiogram procedures.
- CMS deferred to a subsequent coding cycle to consider any implications that might occur.
This application may result in an update to R0070 within the next few years.
2. Regulatory Churn
Home health care practices have been subjected to constant changes in billing and coding regulations.
For example, under section 4134 of the CAA, 2023, CMS proposed regulations to implement coverage and payment of items and services related to administration of Intravenous immune globulin (IVIG) in a patient’s home for a diagnosed primary immune deficiency disease (PIDD).
Here are some of the regulatory changes in CMS (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update (June 30, 2023):
- Focus on adjusting rates due to the Patient-Driven Groupings Model (PDGM) impact.
- Permanent adjustment planned to account for behavioral changes.
- Addresses differences in estimated vs. actual expenses from PDGM implementation.
- Aligns with the Bipartisan Budget Act of 2018, amending Social Security Act section 1895(b).
Additional Proposals for CY 2024:
- Rebasing and revising the home health market basket.
- Updating labor-related share and PDGM case-mix weights.
- Adjusting low utilization payment, functional impairment levels, and comorbidity subgroups.
- Codifying requirements for disposable negative pressure wound therapy (dNPWT).
- Introducing regulations for payment on new benefits like lymphedema compression treatment items.
- CMS estimates a 2.2% decrease in Medicare payments to HHAs for CY 2024
(approximately $375 million less than CY 2023).
- CMS proposes adding an extra chance to request reconsideration for the Total Performance Score (TPS) and payment adjustment under the Quality Reporting Program (QRP).
Our billing and coding experts keep up with regulatory changes constantly and are on the lookout for opportunities and risk to your home health agency.
If CMS finally replaces the OASIS-based Discharge to Community (DTC) measure with the claims-based Discharge to Community-Post Acute Care (PAC) Measure, your Home Health Agencies practice will be ready.
3. Pre-claim reviews
In 2016, CMS introduced the ‘Pre-Claim Review Demonstration of Home Health Services’ (CMS-6069-N), initially in five states—Illinois, Florida, Texas, Michigan, and Massachusetts—and later expanded it nationwide.
Key points of the system:
- If a claim isn’t approved during pre-claim review, the final payment claim will be denied, but the HHA can appeal.
- Failure to request pre-claim review leads to a pre-payment medical review.
- Claims submitted without pre-claim review, if determined payable, receive payment with a 25% reduction.
But there are many other challenges facing home healthcare practices in medical coding, such as:
- Lack of expertise: While HHPs are experts in Patient safety or infection control in the home environment, they lack the expertise for accurate coding and billing which ensures quick reimbursement.
- Coding errors are among the leading causes of missed payments for Home Healthcare Practices.
- Workforce shortages: Lack of skilled coding experts who specialize in HCPCS and CPT coding for Home Healthcare practices further increases the workload and increases coding errors.
- Recruitment and retention costs: High minimum wages and workforce turnover raises costs and further complicates the situation for HHAs.
- Burnout and stress: Home Health professionals tackle long hours and demanding schedules. Asking them to deal with prior authorization paperwork or medical coding tasks is too burdensome.
- Technology adoption – Most home healthcare practices lack the latest coding software or automated documentation management systems due to huge upfront investments.
- Communication and coordination – Lack of communication or in-depth knowledge of payer guidelines can lead to claim denials, eating away at the financial health of home healthcare practices.
- Data privacy and security – Expect further regulations and stricter requirements for data security in the future to raise operating costs in the medical RCM process.
- Emerging Trends: Capitalizing upon innovations like Telehealth and remote monitoring, chronic disease management, personalized medicine and AI in home care requires extensive IT infrastructure.
These factors combined have pushed home healthcare practices to outsource to dedicated coding services.
Why Choose Us Among Home Healthcare Coding Companies?
Outsourcing to our coding support for Home Healthcare has several benefits:
- Improved Accuracy and Reduced Errors
- Enhanced Efficiency and Productivity
- Reduced Costs and Resource Savings
- Compliance Expertise and Updates
- Scalability and Flexibility
- Data-Driven Insights and Reporting
We provide support at each step of the coding process:
- Collecting Comprehensive Client Information
- Checking for Codes and Billing Criteria
- Selecting Accurate Diagnoses
- Establishing Medical Necessity
- Verifying Eligibility and Benefits
- Submitting Claims
- Following Up with Payers
- EOB Accounting
- Handling Deductibles and Collecting Payments
But the real reasons why home healthcare practices across the US outsource to our coding services are:
- Proven track record
- 100’s of excellent client referrals
- Over two decades of domain expertise
- Immediate reduction in operational cost by 80%
- Error free patient entry
- Error-free charge sheets within agreed TAT
- We monitor, analyze and improve coding documentation to avoid denials and guarantee reimbursements
- ICD-10 certified (CPC) coders
- No binding contracts
- 99% accuracy
Our service lets you focus more on patient care and scales to your requirements. We deliver accurate billing and coding support for your home healthcare practice so that you can provide valuable care to many more patients.
Schedule a free, no-obligation consultation with our Home Healthcare billing & coding expert today to learn more about our tailored solutions.