The purpose of home health consulting is to provide expert advice and guidance to home health agencies, helping them improve their operations, quality of patient care, financial stability, and compliance with regulations. Ultimately this allows agencies to deliver the best possible care to patients while ensuring efficient business operations for the home health setting. Key areas for home health consulting include clinical practice, billing, staffing, and regulatory compliance.
Why Do Home Health Agencies Need Expert Guidance?
Partnering with a home health consultant provides an agency with expert support for greater stability in a continuously changing environment. The consultant provides valuable support to maintain compliant operations and to ensure the continued success of the agency through the evolving regulatory environment and inevitable changes in internal leadership. Services from the home health consultants can be provided on an ongoing basis or on as needed basis with services customized to meet the needs of the agency.
Who Could Benefit from a Home Health Consultant Partnership?
- New home health agencies: Home Health consultants help to establish best practices from the start and guide new agencies in navigating the complexities of setting up a successful home health business.
- Struggling agencies: Home Health consultants help identify and address issues impacting the agency’s operations, such as low patient satisfaction, high staff turnover, or financial difficulties.
- Agencies facing regulatory concerns: Home Health consultants support agencies by addressing compliance issues and preventing potential monetary and regulatory penalties.
What Services are Available with Home Health Consulting?
- Mock Survey & Survey Management
- Mergers and Acquisition Support and Due Diligence
- Start-up and Expansion
- QAPI / Star Ratings / VBP / HHCAHPs
- OASIS Audit/Coding Services
- Medical Record Review
- Interim Management
- Strategic Planning & KPI
- Reimbursement / Finance
- Recruitment and Retention
- P&P Development
- Compliance
- Coaching and Leadership Development
Mock Survey & Survey Management
Home Health Consultants offer mock survey services to assist agencies in preparing for the annual survey process by identifying potential risk areas. An experienced mock survey team identifies potential deficiencies related to the agency’s systems, procedures and processes of care.
Home health consultants provide mock survey and survey management services which provide agencies with the following benefits:
- An opportunity to experience what the survey process will be like. Your team gains confidence in interacting with surveyors while working with our mock survey specialists.
- Comprehensive evaluation of your compliance risks and how to address them. You use this information to correct your deficiencies prior to your CMS survey.
- A summary of high-risk areas based on current survey trends. Your priorities are clarified in order to target resources toward corrective actions.
Areas of Focus for Home Health Consultants during mock survey include but are not limited to:
- Medical Record Review
- Staff/Patient Interviews
- Observation of Treatment (Home Visits)
- Review of Medication Reconciliation Process
- Review of Discharge Planning
- Review of Personnel Files
- Review of QAPI Program
- Review of Infection Control Practices
- Review of Emergency Preparedness Program
- Review of Patient Rights
Home Health Consultants offer agencies resources and guidance as needed in follow up to the mock survey visit including consultation on developing a plan of correction, policy and procedure development, follow-up compliance visits, staff training, and on-going regulatory compliance consultation services.
Mergers and Acquisition Support: Due Diligence
Home Health Consultants provide expert assistance and guidance for mergers and acquisitions including due diligence support. Expansion projects can be stressful not only for the seller, but also for the buyer. Through the experience and support of home health consultants, the process is defined with the outcomes of a smooth transition achieved.
Why is Clinical Due Diligence Important?
Clinical due diligence is important for a number of reasons. Here are the four main reasons your clinical due diligence is imperative:
- Identifying Potential Risks – Clinical due diligence can help your agency or organization identify potential risks or areas of concern with the agency’s clinical practices. Potential risks may include errors in the clinical documentation and/or billing process that could indicate potential overpayments or could impact the current and/or future census and revenue stream. Discovering this information early on can help to make an informed decision about whether to acquire or invest in a particular organization.
- Ensuring High-Quality Care – Clinical due diligence can help to ensure that the organization is providing high-quality care to its patients. Home health agencies provide essential services to some of the most vulnerable members of our society. Investors should seek clarification on the level to which the agency meets the highest quality standards.
- Identifying Potential Compliance Issues – Clinical due diligence can help to identify any potential compliance issues with the agency or organization. This is important because healthcare organizations are subject to a multitude of regulatory requirements. Failure to comply with these requirements can result in significant fines and penalties, as well as reputational damage.
- Identifying Opportunities – Clinical due diligence helps to uncover potential opportunities for improvement. For example, perhaps problems exist in retaining staff or the agency is operating with faulty IT systems. Clinical due diligence will help to spot these issues.
3 Key Areas of Focus for Clinical Due Diligence
There are three key areas of focus for clinical due diligence in home health, hospice, and behavioral health.
- Clinical documentation: This includes patient assessments, care plans, progress notes, and discharge summaries. The clinical documentation should be accurate, complete, and timely. In addition, clinical documentation should also be compliant with all regulatory requirements.
- Billing: The agency’s billing practices should be accurate and compliant with all regulatory requirements, and the agency or organization should be able to clearly justify the services it bills for. Have they optimized their EMR? Do they know how to track key performance metrics? Is their reporting concise?
- Compliance: The organization should be following all applicable regulatory requirement. This includes requirements related to patient safety, quality of care, human resources, and financial management. Are they up to date with survey readiness? Pre-bill audits? ADRs?
Home Health Consultants can integrate seamlessly with your team to review clinical documentation, compliance incentives, corrective plans, reporting programs, oversight procedures, the organization’s response to adverse events, and other risk indicators, carefully assessing and constructing a complete picture of potential clinical compliance risk.
Start-Ups and Expansion
Home Health Consultants provide expert level guidance, education, and auditing so your agency can become a successful Medicare Certified Home Health Agency. From the planning phase all the way through to certification, your home health consultant will be there every step of the way. Home Health Consultants can also conduct a mock survey to ensure your agency is fully prepared for anything that may come your way.
Once established Home Health Consultants are able to assist agencies with the areas below to ensure success.
- Policies and procedures – customization, implementation, maintenance processes
- Intake and admission process
- Clinical Documentation, OASIS and ICD-10 Coding Compliance
- Scheduling & On-call services
- Quality Assessment and Performance Improvement (QAPI) program
- Emergency Preparedness
- Personnel files
- Orientation and training program
- Clinical record review
QAPI / Star Ratings / VBP / HHCAHPs
Home health consultants provide agencies with expert guidance and education related to QAPI, Star Ratings, Value Based Purchasing and HHCAPSs. Quality performance is critical for operating a successful home health agency and home health consultants can provide agencies with the tools needed to successfully reach star rating goals, manage an effective QAPI program and avoid monetary penalties associated with Value Based Purchasing. Are you struggling with rehospitalization? Home health consultants can assist with drilling down to the root cause of repeat hospitalization in your agency and assist with developing a plan to combat rehospitalization and keep your patients safe in their homes.
Home Health Consultants can assist agencies in the development of a robust QAPI program to ensure all standards are met.
5 Standards of QAPI per the Conditions of Participation (COPs).
- Program Scope
- Program Data
- Program Activities
- Performance Improvement Projects
- Executive Responsibilities
In addition to QAPI home health consultants assist agencies with improving quality of care reflected by star rating, value-based purchasing and HHCAHPs. Home Health agencies are in the spotlight with providers and potential referrals sources based on quality measures and performance in patient care. If your agency is less than 3 stars on Care Compare, meaning that your agency is performing beneath other agencies, then home health consulting services could assist your agency with improving your overall star rating and quality of care.
Home health consultants can assist with Value-Based Purchasing (VBP) by analyzing current performance data, identifying areas for improvement, developing targeted strategies to optimize quality metrics, training staff on best practices for data collection and documentation, and providing ongoing monitoring to ensure compliance with VBP requirements, ultimately helping agencies maximize their reimbursement under the VBP model by delivering high-quality patient care.
Key ways home health consultants can support VBP:
- Data analysis and assessment: Reviewing existing patient data to identify strengths and weaknesses in quality measures, including OASIS data accuracy and clinical documentation.
- Quality measure optimization: Identifying which quality measures have the most significant impact on VBP scores and developing strategies to improve performance in those areas.
- Clinical practice improvement: Providing guidance on clinical interventions and care pathways to achieve better patient outcomes and improve quality metrics.
- Staff education and training: Educating clinicians and administrative staff on VBP concepts, quality measures, and proper documentation practices to ensure accurate data collection.
- Performance monitoring and reporting: Tracking progress on VBP metrics, identifying trends, and providing regular reports to leadership to make informed adjustments.
- OASIS optimization: Reviewing and refining OASIS assessments to ensure accuracy and completeness, maximizing the agency’s VBP score.
- Workflow optimization: Analyzing current workflows and suggesting improvements to streamline processes and enhance efficiency in delivering care.
- Regulatory compliance support: Staying up-to-date on CMS guidelines and ensuring the agency adheres to all VBP requirements.
OASIS Audit and Coding Services
Home health consultants assist agencies with OASIS audit and coding services. This allows agencies to ensure OASIS and coding efficiency without the need for hiring and training OASIS and coding staff. Home health consultants have OASIS and coding certified specialist who are assigned to the agency to provide these services.
What are the benefits of hiring home health consultants for OASIS and coding services?
- Cost Savings:
- Lowers agency personnel expenses and lowers FTE requirements
- Improved Reimbursement
- OASIS accuracy and Coding set agencies up for improvements in reimbursement with PDGM while ensuring quality and compliance is maintained
- Expertise and accuracy:
- Access to experienced coders and OASIS reviewers who stay updated on the latest coding guidelines, ensuring accurate billing and compliance.
- Improved efficiency:
- Allows clinical staff to focus on patient care instead of spending time on coding and OASIS documentation.
- Faster turnaround time:
- Outsourced providers can often process claims more quickly, leading to faster reimbursement.
- Reduced risk of errors:
- Professional coders can identify potential coding issues and minimize the risk of claim denials due to incorrect coding
- Compliance assurance:
- Expertise in navigating complex OASIS regulations and ensuring compliance with Medicare guidelines.
- Built-in Education
- Continuous education by expert reviews to improve clinician understand of OASIS and the importance of accuracy
- Improved Clinician Satisfaction
- Continuous education, communication and support from the expert auditors provides clinicians with the tools they need to be successful and fill more fulfilled in their roles
- Improved Star Ratings and VBP Scoring
- Improved Bottom Line
- Cost Savings:
Medical Record Review
Home health consultants provide expert review of medical records for purposes such as QAPI and Additional Documentation Request (ADR). Is your agency under Target Probe and Educate (TPE)? Home health consultants can assist agencies with medical record review to ensure accuracy, regulatory compliance and to also assist with areas of improvement. Home health consultants will customize training to meet the needs of your agency and to provide the education necessary to ensure documentation efficiency.
Key aspects of how home health consultants assist with medical record review:
- Clinical Expertise: Utilizing their clinical knowledge to interpret medical terminology and understanding the patient’s clinical picture based on the records.
- Documentation Review: Checking for completeness of documentation, including diagnoses, medications, treatments, assessments, progress notes, and any required forms.
- Compliance Assessment: Ensuring that the medical record reflects adherence to Medicare guidelines, including necessary face-to-face visits, skilled nursing needs, and appropriate treatment plans.
- Identifying Potential Issues: Flagging areas where documentation may be lacking, inconsistent, or could lead to claim denials due to missing information or unclear rationale for care provided.
- Providing Feedback and Education: Communicating findings to clinicians, offering recommendations on how to improve documentation practices to accurately reflect the patient’s condition and care provided.
- Claim Review Support: Assisting with the review of claims prior to submission to identify potential issues that may impact reimbursement.
Interim Management Services
A “Home Health Consulting Interim Manager” entails temporarily leading and overseeing the operations of a home health agency, focusing on stabilizing or improving service delivery, compliance, and financial performance during a transitional period, often when a permanent manager is absent, while also providing expert consulting on best practices and process improvements within the home health industry. Home health consultants employee industry experts capable of filling agency voids in key leadership roles as well as assisting with transitioning new leaders into their leadership roles.
Key Responsibilities of Interim Home Health Consulting Managers:
- Operational Management:
- Assess current home health operations, identifying areas for improvement in patient care, staffing, scheduling, and compliance with regulations.
- Manage clinical and administrative staff, including nurses, therapists, aides, and office personnel.
- Oversee patient admissions, care planning, and discharge processes to ensure quality standards are met.
- Monitor key performance indicators (KPIs) like patient satisfaction, re-admission rates, and financial performance.
- Compliance and Quality Assurance:
- Ensure adherence to all federal, state, and local regulations related to home health care, including Medicare and Medicaid guidelines.
- Conduct regular quality audits and reviews to identify areas for improvement and implement corrective actions.
- Monitor documentation practices and ensure accurate and timely reporting.
- Financial Oversight:
- Analyze financial data to identify cost-saving opportunities and manage budget effectively.
- Review billing practices and ensure timely submission of claims to maximize reimbursement.
- Develop strategies to optimize revenue cycle management.
- Strategic Consulting:
- Provide expert advice on industry trends, best practices, and potential challenges facing the home health agency.
- Develop short-term and long-term strategic plans to address identified issues and improve overall agency performance.
- Facilitate communication and collaboration between clinical and administrative teams to achieve goals.
- Transition Planning:
- Collaborate with the hiring manager to identify and onboard a permanent replacement for the interim role.
- Document processes and procedures to ensure smooth transition of responsibilities to the new leadership team.
Reimbursement and Finance
Home health consultants provide expert advice and services surrounding reimbursement and finance. From authorization to billing home health consultants work alongside your agency to ensure adequate reimbursement, timely reimbursement and reduced write-offs that negatively impact the agency’s cash flow. Home health consultants provide billing audit services to ensure all regulatory requirements are met prior to billing and can assist your agency with conducting billing audits or process development that includes the development of the tools necessary to properly conduct billing audits. Home health consultants also provide training to ensure agency success with Patient Driven Grouping Model (PDGM).
Recruitment and Retention
Home health consultants will assist agencies with recruiting and retention efforts. Ensuring that you have the right people on your team is key to running a successful and financially stable agency. If your agency is struggling with finding the right people or challenges with turnover, home health consultants can assist you with finding the solutions.
Following COVID, hiring and retaining staff is a challenge faced by many agencies. Home Health turnover has increased by more than 12% over the past two years. The current industry-wide turnover rate is 79.2%. With quality of patient care and patient outcomes being at the forefront for home health, hiring and retaining skilled staff is more important than ever.
Home health consultants are trained and experienced at
identifying the cause of turnover and implementing the processes or strategies necessary to stop the revolving door.
Policy and Procedure Development
Home health consultants are a great resource to assist agencies with developing policies and procedures. Policies and procedures are the heart of an agency and the road map to agency success. If you are struggling to establish and develop policies and procedures for your agency home health consultants can help. If you are looking to seek credentialing such a CHAP or The Joint Commission, home health consultants can assist you with establishing the policies and procedures required to meet survey expectations and to obtain credentialing.
Compliance
Home health consultants are experts at ensuring all around compliance within your agency whether its policy and procedure development, QAPI or medical record review. Compliance is a key to agency success and ensure not only smooth day-to-day operations but also survey. Home health consultants are skilled at compliance overviews to ensure all aspects of home health compliance is met and that your agency can rest easily. Don’t second guess whether or not your agency is survey ready. Enlist the assistance of a home health consult to review your compliance program and ensure efficiency.
Coaching and Leadership Development
Home health consultants assist agencies with leadership development and training to ensure that the agency’s key leadership has the tools necessary to run and manage a successful agency that provides high quality care.
With excessive staffing turnover comes management burnout and turnover. Turnover is not just isolated to field staff, therefore, leaving agencies without key leadership to ensure effective processes, oversight and field staff support. Instability in management creates a chaotic work environment and decreases employee satisfaction. Home health consultants are equipped to support agencies facing turnover in leadership and to assist leaders that are facing challenges with field staff turnover.
Home health consultants are experts at assisting agencies to empower their leaderships. Strong leadership is a crucial foundation for agency success. Whether a leader is in need of leadership skill development, onsite training for a specific role or strategics for reducing turnover and employee development, home health consultants are prepared to provide these services.
Is your agency in need of support from a home health consultant?
If your agency is facing challenges with day-to-day operations, staffing or any area that is holding your agency back do not hesitate to enlist the support of a home health consultant. Home health consultants offer a new perspective and fresh set of eyes on your day to day and are ready to help you take your agency to the next level.
Contact Proactive to begin your home health consulting partnership today.