Home Health Medical Billing Outsourcing Myths

Outsourcing is changing — possibly more in home health billing services than anywhere else.

The assumptions and practices that were true a few years ago have shifted thanks to technology and general changes in the industry. This means that any home health agency that isn’t taking a fresh look at the potential outsourcing has to address some of today’s most pressing billing challenges stands to lose big as the industry evolves.

That’s why we want to help you address some misconceptions you might have and rethink outsourcing so you can make the best decisions possible around your medical billing services.

Myth #1: We can think about it later.
You haven’t had to think seriously about outsourcing in the past, so why worry about it now?

The answer is that home health is getting a lot more complicated. Review Choice Demonstration (RCD) is rolling out in states across the country, and the Patient-Driven Groupings Model (PDGM) promises to turn home health billing on its head. Home health is entering a period of change, and this is the exact time that most agencies should rethink their position on outsourcing.

As time passes, it will become increasingly difficult to maintain the in-house competence and expertise required to keep up with changing billing requirements, legislation, and technological demands.

Myth #2: We already know outsourcing.
You might think you’re already familiar with outsourcing after years of experience, but remember that past performance is not an indicator of future results. Think of the role technology played in healthcare just a few short years ago. It used to augment revenue cycle processes, but now changes like AI mean that leaders have had to completely rethink the role it plays in their organization.

The same goes for outsourcing. Yesterday’s outsourcing was a question of efficiency and ROI, and while that’s still true today, outsourcing is now a key decision point in maintaining a competitive advantage, adapting to change, and even organizational survival.

Myth #3: Every billing company is the same.
Have you had a negative experience with a billing company or heard rumors that sound like horror stories? They’re most likely true, but it’s a myth that they’re indicative of every outsource medical billing company.

Every company is different, and that’s especially true when you consider the level of specialization required for home health. A company that focuses on hospital or primary care outsourcing won’t understand the particulars of home health billing. Outsourcing home health billing services should start with finding a partner that fits your needs, understands your goals, and is willing to talk to you to make sure you’re both aligned on the results you expect from the partnership.

Myth #4: We’re doing fine the way we are.
One of the biggest dangers of the status quo in the home health revenue cycle is that you could easily be hemorrhaging cash and not know it. Your ‘normal’ could be riddled with clinical documentation issues, denial management problems, and unnecessarily inefficient processes.

Consider that, according to the Medical Group Management Association (MGMA), the cost to rework a claim after it’s been denied is around $25 and that a good number of those denials are probably preventable [1]. Ask yourself if you’re struggling with these common home health denials and what internal steps haven’t been taken to address them.

  • The physician certification was invalid since the required face-to-face encounter was missing/incomplete/untimely.
  • The initial certification was missing/incomplete/invalid; therefore the recertification episode is denied.
  • The medical documentation submitted did not show that the therapy services were reasonable and necessary and at a level of complexity which requires the skills of a therapist.
  • Requested documentation not received/received untimely
  • Physician’s plan of care and/or certification present-no signature

If you’re skipping the advantage that objective input from a competent outsource partner can provide, chances are you might not be as healthy as you think.

Myth #5: Hiring In-house is better.
In some cases, hiring in-house staff is a better option, but in a time of change, the decision is more complex. There are numerous drawbacks to hiring internally including:

  • The investment required to attract, hire, train, and retain candidates.
  • The risk to productivity of bringing on staff that will interact with your existing team and distract them as they work on different projects.
  • The drag in achieving short-term goals since outsourcing options will be up and running faster than in-house solutions.
  • Take time to evaluate your expectations and the objective costs of bringing on in-house talent.

Myth #6: Outsourcing is a security risk.
Every week in healthcare we see new organizations that are dealing with hacking, phishing scams, and data breaches. You have every reason to be concerned with security in your outsource agreements.

That said, know that your business partners are subject to the same standards as you when it comes to privacy and security. According to CMS’ explanation of HIPAA rules and business associates:
“If a covered entity engages a business associate to help it carry out its health care activities and functions, the covered entity must have a written business associate contract or other arrangement with the business associate that establishes specifically what the business associate has been engaged to do and requires the business associate to comply with the Rules’ requirements to protect the privacy and security of protected health information. In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules.” [2]

If you’re still concerned, talk with them about your security standards and ask to speak with whomever is responsible for security at their organization so that you can have your concerns addressed directly.

We encourage all of our partners to talk with us about our perspective on outsourcing and whether we’re the best fit for their needs. If you’re considering us to outsource medical billing, we’d love to talk and answer any questions you have.

[1] L. Zindl, “What’s Eating Your Bottom Line: The True Cost of Denials,” EfficientC, 17 April 2017. Available: https://www.os-healthcare.com/news-and-blog/whats-eating-your-bottom-line-true-cost-of-denials.
[2] U.S. Department of Health & Human Services, “Covered Entities and Business Associates”. Available: https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html.

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