Home Health News: Preventing Home Health Denials

Preventing Home Health Denials

A proactive approach to Home Health claim denial prevention is crucial. Areas of focus should include supportive documentation accuracy, thorough verification of patient coverage, and understanding payer-specific requirements. This includes verifying insurance before services are initiated, communicating clearly with patients about coverage, and using technology effectively to streamline the claims process.

Let’s take a look at key action items to prevent denials and ensure proper reimbursement for your agency.

Accurate and Thorough Documentation:

• • Standardized documentation:
    • Develop clear, standardized documentation protocols that meet payer requirements, using checklists and templates to stay on track.
  • Be specific and objective:
    • Avoid vague descriptions and provide concrete evidence of the patient’s condition and need for care.
  • Document medical necessity:
    • Demonstrate why the patient requires skilled nursing, therapy, or other home health services.
  • Maintain accurate records:
    • Ensure all documentation, including both billing and medical records, is properly recorded and legible.

Verify Insurance Coverage and Eligibility:

• • Pre-service verification:
    • Use real-time eligibility verification tools to confirm patient coverage before services are rendered.
  • Stay updated:
    • Regularly verify and update patient information as needed to ensure accurate insurance details.
    • Train clinicians to routinely ask patients if there have been any changes with their insurance coverage. Specifically, “have you recently received a new insurance card?”
  • Communicate with patients:
    • Educate patients about their coverage and any limitations.
    • Provide transparency related to payor requirements and coverage with patients and their caregivers to reduce confusion and misunderstandings that can lead to patient concerns/complaints.

Understand Payer-Specific Requirements:

• • Know your payers:
    • Familiarize yourself with the specific guidelines and requirements of each insurance payer.
    • Ensure proper access to payor portals and understand the steps required to obtain proper authorization.
  • Understand non-covered items:
    • Develop a process for managing claims for non-covered items.

Leverage Technology and Streamline Processes:

• • Utilize home health-specific billing software to streamline claims and track denials.
  • Set up automated eligibility verification systems and tracking tools for prior authorizations.
  • Monitor claim status and identify/addresss trends in denials to prevent future issues.

Manage Prior Authorizations Effectively:

• • Strong system for prior authorizations:
    • Implement a robust system for managing prior authorizations, including automated reminders and tracking tools.
    • Ensure that your agency has someone specifically dedicated to managing authorization to prevent breakdown in the system.
  • Timely submissions:
    • Ensure prior authorizations are submitted and renewed promptly

If your agency is facing challenges with insurance denials and needs assistance navigating payor challenges, contact Proactive Home Health consulting today for support.

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