5 Reasons Why Your Home Health Agency Needs a Home Health Consultant

A report from the Centers for Disease Control and Prevention (CDC) shared that approximately 4.5 million people received care from a home health agency, and that was in 2015. Home Health services continue to increase every year and with every Baby Boomer being 65 or older by 2030, it is anticipated that home health services will continue to increase in need.

For home health agencies, delivering exceptional care is priority one, but quality documentation and appropriate utilization of resources is also needed in order to receive optimal Medicare reimbursements. With the level of reimbursement complexity and the potential ramifications if processes are not followed correctly, having a resource for your team to turn to when they have questions or need guidance is critical. Below we discuss how utilizing a knowledgeable home health consultant can provide the needed education, teaching, training, auditing, and mentoring that will help put your agency in a position to be successful.

When it comes to reimbursement, staying up to date with new regulations and changes can be a challenge. A home health consultant understands the key drivers for Medicare payment including accurate OASIS documentation, visit volume, and appropriate billing processes. They can educate your home health team on the factors affecting reimbursement and identify steps needed to meet requirements.

Home health agencies must sustain clinical reimbursement at its highest level, protecting the company’s financial bottom line so the best services to patients can continue. A home health consultant can help your team identify the following considerations:

• An understanding of specific reimbursement opportunities
• Identification of at-risk patients
• A financial forecast via historical reimbursements
• Profit protection by lessening potential audit risks
• Growth and/or maintenance of Medicare business
  
  

3. Notice Payment Trends

Medicare’s payment system is based on PDGM (Patient-Driven Group Models). It’s a complex multi-level methodology that is the basis for reimbursement, yet home health agencies may not see the need to seek assistance until they notice a decreasing trend in reimbursements or declines in quality measures with subsequent effect on revenue. Investing in a home health consultant will help your team be able to identify the potential for decreases and work to correct issues before they become a financial problem.


4. Assess Performance

At LeaderStat, our consultants work with agency personnel to assess the organization’s performance and identify opportunities to enhance both financial and clinical outcomes by— 

• Ensuring accurate OASIS assessments, including functional scoring 
• Making sure reimbursement rates correctly reflect patient acuity levels
• Reviewing visit utilization and volume
• Assessing revenue cycle management processes

Consultants also provide the training, tools, and support that allow healthcare organizations to put clinical reimbursement worries to rest. These services include— 

• Offsite and on-site support and training for patient selection using PDGM criteria
• Case-mix and reimbursement review
• Evaluation of documentation systems to measure compliance
• Benchmarking tools and quality measurement analysis
• Operational support for staffing, productivity, and other clinical functions

4. Ongoing Partnership

Hiring a home health consultant provides the opportunity to establish an ongoing partnership with a highly specialized professional who can provide knowledge and assistance in navigating Medicare rules and regulations for home health. This allows for your organization to have the ability to contact a consultant before a situation causes concern, or worse, results in a financial crisis, which provides a safety net warding off issues that may harm your agency or result in anything but the best possible care provided to your patients.

With rapid growth and changes in the home health care industry, being prepared is the best way forward.