Healthcare providers are dropping major insurers – and home health leaders should consider following suit when looking at their home health care billing service strategy.
Denials have always been an issue in hospital billing, physician medical billing, and home health billing, but in the last few years, the burden on providers has worsened rapidly. Denial rates have increased, and the time, effort, and resources required to collect on claims (many of which never should have been denied in the first place) have skyrocketed. Some providers have reached their breaking point. Huntsville Hospital Health System recently announced termination of its contract with UnitedHealthcare. The 14-hospital system has called an end to both its commercial and Medicare Advantage contracts, citing a denial rate that is 75% higher than other comparable payers [1].
But this isn’t a one-off or even local issue. The Senate Homeland Security Permanent Subcommittee on Investigations (PSI) released a report accusing some of the largest Medicare Advantage Insurers (UnitedHealth, Aetna, and Humana) of denying seniors access to post-acute care through their denial practices [2]. And the Federation of American Hospitals (FAH) has weighed in, saying that “patients are being hung out to dry” and that plans need to be held accountable by the government [3].
Many home health providers are caught up in the same web of prior authorization issues, denials, and resource-intensive appeal processes. This can make dropping some payers seem like a logical choice when reviewing strategy and the use of home health billing services. And for many it can be, but it should be a decision that leadership makes with very careful consideration. For example, Huntsville Hospital Health System flagged UnitedHealth because they had information on denial rates by payer – meaning they could make an informed comparison. Your denial program should be in excellent shape so that your leadership has the most complete and accurate information possible when making a decision that will directly impact so many of your patients.
If your leadership is considering dropping a payer in light of the shift of the winds of denial management, make sure to start with solid use of audits and payer contract review. We offer both at 3Gen Consulting and are proud to support our home health clients during this time of change.
References
[1] R. Wilson, “14-hospital system splits with UnitedHealthcare,” Becker’s Healthcare, 10 October 2024. Available: https://www.beckerspayer.com/contracting/14-hospital-system-splits-with-unitedhealthcare.html.
[2] U.S. Senate Permanent Subcommitteeon Investigations, “Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care,” 17 October 2024. Available: https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf.
[3] A. Martin, “‘Patients Hung Out To Dry’: Report Shows Insurers Significantly Increase Rate Of Denials For Post-Acute Care,” Home Health Care News, 18 October 2024. Available: https://homehealthcarenews.com/2024/10/patients-hung-out-to-dry-report-shows-insurers-significantly-increase-rate-of-denials-for-post-acute-care/?itm_source=parsely-api.
Hemant Apte, Chief Executive Officer in
Hemant Apte, Founder & Chief Executive Officer of 3Gen Consulting, is a seasoned executive leader with deep domain expertise in US healthcare management practices. He founded 3Gen Consulting in 2006 and has been instrumental in offering thought leadership to his clients and providing services and solutions that are unique in the market.
