Complications in Home Health Billing

Revenue cycle mistakes have always been costly for home health agencies, but the stakes are about to get even higher.

Review Choice Demonstration (RCD) has been rolled out in Illinois and will soon launch in Florida, North Carolina, Texas, and Ohio. While most agencies remain confident under the CMS initiative, there’s a bigger concern. How will it play out after the Patient-Driven Groupings Model (PDGM) hits the ground? Peter Miska, who owns Phoenix Home Care in Burr Ridge, IL, isn’t optimistic. “It’s going to blow up the revenue cycle of businesses…There’s going to be cash-flow issues everywhere.” [1]

While it’s impossible to tell for sure how the two initiatives will play out, especially for home health agencies that are subject to both, it’s become increasingly clear that now is the time to focus on avoiding home health revenue cycle mistakes. Here are a few tips to get started.

Keep up with VBC Developments
Value-based care has been disrupting the status quo all across healthcare, but a recent announcement from the Centers for Medicare & Medicaid (CMS) promises big changes for home health [2].

The Primary Cares Initiative comprises five payment model options, all of which incentivize primary care providers to cut back on hospitalization and keep the cost of care low. These goals align neatly with the outlook of at-home care providers. This means that home care agencies and home health are almost guaranteed to have prominent roles in these value-based models in the future.

The models fall under two pathways, the experimental, Primary Care First (PCF) route, and a direct-contracting option. PCF has two dedicated payment model, and direct-contracting has three. Home health revenue cycle professionals will benefit from keeping up with developments on the entire value-based front.

Be Proactive About Referral Management
Understanding how growth is managed in your agency is more important than ever, and that starts with referral management. Too many agencies fall short with it comes to tracking and analyzing referral data, leaving them with little visibility into the impact referral practices have on their business.

For example, take inquiry calls. For various reasons, some agencies don’t keep track of call notes, creating a black box when it comes to reasons why a patient might not have been accepted. This means the agency never builds a complete picture of conversion rates, leaving them in a position where they can’t identify referral issues — either through better processes or a new approach to communication with partners. It’s also a missed chance to discover new areas of growth and revenue opportunities. If a large number of non-converting inquiries are coming up around a specific need, an agency might want to consider expanding its services and specializing in a specific type of patient.

There are many good reasons why referral tracking might not be happening — sometimes referrals are managed with highly-manual methods like spreadsheets or paper. This though, is a good opportunity to consider referral management technology that can help automate less efficient tasks.

Track the Clinical Data that Affects Payment
In the age of value-based care, making good use of clinical data will be more important than ever. When you aren’t, you’re at risk for decreased cash flows, but also alerting CMS and risking an audit and possibly fines. You are even taking a chance at lower rates on Home Health Compare, meaning consumers in your area will have direct insight into shortcomings at your agency.

Don’t wait until billing red flags show up to catch clinical documentation issues. Not breaking down silos between clinical documentation and billing is one of the biggest revenue cycle mistakes home health agencies can make. HomeCare Mag recommends first steps including [3]:

  • Streamlining QA processes
  • Supporting clinicians at the point of care
  • Educating your clinicians on completion of Outcome and Assessment Information Set (OASIS)

If you need support, you might also consider outsourcing home health billing service to leverage the expertise of a highly-specialized revenue cycle provider.

Leverage Data to Make Smart Financial Decisions
Considering the complexity of the revenue cycle that home health agencies now face, using data to enable your financial decisions is essentially a requirement.

While this hasn’t necessarily been a standard of the homecare space, the revenue cycle environment is changing rapidly, and technology is essentially a requirement in keeping up, especially as greater scrutiny is being placed on agency practices.

It’s time to move beyond a metrics orientation and into a perspective where you’re looking at the vast amount of operational, clinical, and financial data as sources of opportunity to improve care, boost cash flows, and increase productivity.

Pay Attention to Staffing Issues
Staffing shortages around coding are well known, but they aren’t the only challenges in the home health revenue cycle.

Scheduling and patient management can present their own, unique, but still impactful issues. These issues include too many clinicians missing their visits, or high numbers of staff working overtime, as well as excessive turnover. On the patient management front, staff might lack education. Resolving these might take a solution such as regular meetings to discuss cases with clinicians as well as improvements to your continuing education programs.

Ultimately, tackling revenue cycle mistakes requires a perspective that sees the home health revenue cycle as a holistic process and invests in end-to-end improvements. Connecting with the right vendor partner is a strong step toward gaining that perspective. Make sure to look for a vendor that’s focused on quality and scalability, meaning they value coding accuracy and can quickly adapt to increasing and fluctuating claim volumes that cause so many revenue cycle issues. If you’re interested in finding that kind of partner, it’s time to talk to 3Gen Consulting.

[1] R. Holly, “This Critical Combo Could ‘Blow Up’ Home Health Agency Revenue Cycles,” 2 June 2019. Available:
[2] R. Holly, “Home Health Industry Reacts to CMS Value-Based Primary Care Initiative,” Home Health Care News, 23 April 2019. Available:
[3] A. Brandwein, “3 Revenue Cycle Management Mistakes to Avoid,” 1 May 2018. Available:

Leave a Reply

Your email address will not be published.

You may use these <abbr title="HyperText Markup Language">HTML</abbr> tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

Get In Touch!
close slider

    Get In Touch!