If you want to outsource home health billing and coding, now is a great time. Not only can outsourcing provide you with high-quality services and more time to focus on your core competencies, but you’ll also be addressing other issues. Staffing challenges around coding, in particular, are well-known. We were receiving warnings almost ten years ago, and now, coders call the shots.

Today, home health providers are struggling with blows to their reimbursement — all because it’s challenging to find enough qualified professionals to get your claims out the door in an efficient, timely manner.

Outsourcing has been used by many home health providers to navigate this problem, but before you look for the same benefits, here are five things you need to know about outsourcing your home health coding and billing.

Expertise and Efficiency Matter
For coders especially, there’s a good reason that experienced professionals can come and go as they please — their expertise is incredibly valuable.

CMS’ rules and OASIS-D requirements are always changing and only becoming more complex, especially since ICD-10 exploded the number of codes, and in turn, potential mistakes. Even a small billing or coding error can cause big problems for your organization. Repeat it enough, and you could be missing out on huge amounts of revenue. On top of that, even simple, innocent mistakes could be considered fraud.

Efficiency works very similarly. Outsourcing organizations who staff experienced coders and auditors maintain the skills and understanding needed to review medical records and charts quickly and efficiently and catch issues for additional information and documentation. Maintaining the level of efficiency needed for true performance optimization in-house can be challenging.

Know Your Scores
Outsourcing home health coding and billing is a great option for many home health organizations, but figuring out whether it’s a good fit for you starts with identifying the results you expect.

Healthcare is shifting to an increasingly patient-centered perspective, and the home health space is no different. Your outcome scores matter more than ever, and many of them are directly related to the quality and accuracy of your billing. From Home Health Compare and Hospice Compare scores to OASIS-D assessments and value-based care contract incentives, your scores can heavily depend on patient encounters being accurately reported.

Making an optimal outsourcing decision starts with understanding which scores and assessments might be causing problems for you and identifying where you would like to make improvements.

HIPAA Still Applies
If you want to outsource home health billing and home health coding, you’re probably worried about the security of your patients, and you should be.

Healthcare is one of the most vulnerable industries when it comes to information security, with medical records selling for around $10 each [1]. That’s less than the high of $50, but if your organization does experience a breach, you can be fined tens of thousands of dollars and more, not to mention the blow you take to your reputation. The risk isn’t just about criminals, though. 58 percent of healthcare breaches are initiated by insiders, so you have to be able to trust the people you give access to your medical information [2].

All that said, any organization that you outsource your home health billing and coding services to will be subject to the same HIPAA standards and penalties that you will. According to HHS, HIPAA rules apply to covered entities but also business associates. According to the U.S. Department of Health & Human Services:
“Business associates are directly liable for compliance with certain provisions of the HIPAA Rules.” [3]

If you’re still worried about whether an outsourcing vendor meets business associate status, CMS’ Q&A tool will help you decide [4].

Know What Services You Want
One of the great things about considering outsourcing home health billing and coding is that you have options.

Depending on your needs, you might want to outsource just the billing part of your revenue cycle, or you might want to farm out revenue cycle management completely. If you decide only to hand off billing, you will still be responsible for managing coding as well as submitting and following up on claims. Depending on your history, successes, and areas in need of improvement, this may or may not be a good solution for you.

Another factor to consider is constantly changing regulations and policies. We’ve implemented ICD-10, but in a few years, ICD-11 will be coming down the pipeline. Are you prepared to navigate that successfully or would you rather focus on core competencies than go through another code set upgrade?

Sit down with your team to discuss what challenges you’ve had at your organization so you can decide which can be addressed with home health revenue cycle outsourcing.

Understand Your Hosting Needs
We live in the age of the tech-enabled revenue cycle, so technology will always come up in the billing and coding outsourcing discussion.

Most outsourcing partners will give you the option of hosting the software and your data on their servers; and these days, it’s becoming increasingly common to offer cloud hosting as well. The downside is that you will be handing off control of your data, but the pros might outweigh that for you.

Outsourcing partners are completely focused on managing data, and as we mentioned before, are subject to the same security standards that you are. This leaves you free to worry less about security and equipment management as well as frees you from the endless responsibility of updates and system maintenance.

Consider whether your staff is currently handling these obligations well so that you can build a clearer picture of what kind of hosting needs you’ll have in the future.

Most importantly, remember that outsourcing home health billing and coding is a decision that impacts many positions and roles in your organization. Sit down with representatives from multiple departments, including revenue cycle, IT, and executive leadership to make sure you’re choosing the outsourcing partner that works best for you. If you need help having those conversations, 3Gen has been providing these services since 2006 and we’d love to talk.

[1] M. Korolov, “Black market medical record prices drop to under $10, criminals switch to ransomware,” CSO, 23 December 2016. Available: https://www.csoonline.com/article/3152787/black-market-medical-record-prices-drop-to-under-10-criminals-switch-to-ransomware.html.
[2] L. Columbus, “58% Of All Healthcare Breaches Are Initiated By Insiders,” Forbes, 31 August 2018. Available: https://www.forbes.com/sites/louiscolumbus/2018/08/31/58-of-all-healthcare-breaches-are-initiated-by-insiders/?sh=7eee42ed601a.
[3] U.S. Department of Health & Human Services, “Covered Entities and Business Associates”. Available: https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html.
[4] U.S. Centers for Medicare & Medicaid Services, “Are You a Covered Entity?”. Available: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/AreYouaCoveredEntity.

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