Blog and Helpful Articles

Common Medicare Home Health Billing Errors and How to Avoid Them

Today’s home health care billing is more critical than ever. Shrinking reimbursement and increased regulations are forcing agencies to optimize their billing process. With many layers of complexity in the billing process, agencies have found that even a small number of billing errors have resulted in significant payment losses. Understanding common billing errors and how to avoid them can significantly increase your profitability. Here are some tips on common home health billing errors you can avoid:

1. Incorrect patient information- Inaccurate patient information will cause claim rejections or RTP claims. Incorrect patient address, zip codes, names and policy numbers are common and avoidable mistakes. Be sure your biller double checks patient demographics to avoid payment delays.

2. Incorrect source of admission- Determining whether a patient is being referred to your agency by a “physician referral” or “transferred” from another agency is one of the most misunderstood billing errors. Source of admission is determined by reviewing the patient’s eligibility documentation and must be accurately identified on the claim. Be sure your billers understand sources of admission to avoid payment delays.

3. Invalid diagnosis codes- Do not use codes that are marked “invalid”. Every October new diagnosis codes are published. Be sure your billers are keeping up to date with added, deleted and revised ICD-9-CM codes to avoid payment delays.

4. Incorrect or missing physician NPI- The physician’s full name and NPI must be entered on a claim correctly. Be sure your biller double checks this information to avoid payment delays.
The financial strength of your agency is directly related to timely billing and skilled billers. Use these tips and keep your eye on minimizing your rejected claims to maximize your productivity and provide your agency with a steady cash flow.

For more tips on Home Health Billing, contact Imark Consulting, Inc.

Read Full Post | Comments 1

Tagged , , , , , , , |

Why should I use a Consultant?

Question: Why should I use a Consultant?
Answer: The dictionary defines a consultant as a person referred to for expert or professional advice. At Coleman Consulting Group, we believe that using a consultant can be the best of both worlds: s/he can suggest or even make changes to your organization, while allowing you to focus on what you do best. In short, you can be as involved in the changes as your preference and schedule permit.

Question: How will the consultant interact with my staff?
Answer: Usually, the client selects his or her level of involvement. In some cases, the consultant fulfills an advisory role. In others, s/he is actually responsible for directly effecting change. Whatever the scenario, your Coleman Consultant is able to earn the respect and cooperation of your staff with his/her low-key, participative style.

Question: Consultants are expensive, aren’t they?
Answer: Not always. Small – what we call boutique – consulting firms, especially, offer flexibility in negotiating contract terms, leading to mutual satisfaction. Moreover, they are able to customize their services to your particular needs, rather than offering an “off-the-shelf” product. A consultant’s services should be offset by the greater value realized to your practice or business.

Question: What should I look for in evaluating a consultant?
Answer: We suggest that you apply the same criteria you use for any key member of your leadership team: proven knowledge, experience, flexibility and value for your investment. A consultant’s services should evolve with your business growth, so we encourage you to view a consultant as an informal, external and objective partner in your business.

Read Full Post | Comments Off on Why should I use a Consultant?

Tagged , , , , , |

The Dysfunctional Medical Practice – Part V of a Five Part Series

This is the last installment in our five-part series about the Dysfunctional Medical Practice. So far, we’ve seen that chaos can reign when there is lack of leadership, when office processes break down or are nonexistent, and when people are allowed to develop habits that impede smooth operations. The process of effecting change in a challenged environment requires buy-in from all the constituents (in this case, even the physician’s family) and the change must be led by a skilled and objective expert.

Our tardy, chatty, disorganized physician client didn’t change overnight, but he realized that his behaviors were the lynchpin to the problems. One issue that exacerbated the chaos was his tardiness in reviewing documents. Because he required charts to be pulled for all documents, he became overwhelmed when he couldn’t find his desk or credenza, and had to navigate through carts, piled high with work. Some short-term solutions included distinguishing between routine, maintenance meds and other prescriptions, foregoing charts on routine results (screened by a trained individual), enlisting the assistance of the practice-extender (PA or ARNP), and creating bite-size pockets of work to sign.

When last we saw this client, his office was a better-oiled machine. He experienced more satisfaction with his work, and was able to spend more quality time with his family; staff tenure increased, as did morale, due to organization which led to a normal work-day and less stress; patients experienced greater satisfaction as they re-established trust in their clinician, felt cared for and valued; and finally, quality of care improved.

Read Full Post | Comments Off on The Dysfunctional Medical Practice – Part V of a Five Part Series

Tagged , , , |

The Dysfunctional Medical Practice – Part IV of a Five Part Series

In Part IV of this five-part series, we tackle the last big issue of our dysfunctional medical practice revealed last week: the majority of calls to our client’s practice were repeated requests for prescriptions, referrals or test results.

Issue #4: Patients aren’t Always Patient, and Perception is Reality

This paper-based office had a huge challenge with patient test results. No process existed for the prompt and smooth handling of results from the fax machine or printer, to the clinician, and finally to the patient. Results were not proactively tracked so, many times, when the patient was in the exam room, staff members scrambled to request faxed results, which also prolonged the visit. External providers were becoming frustrated at sending documents several times because they got “lost” en route.

A visit to the Medical Records Department revealed a backlog of filing and no process for alphabetizing unfiled results for ease of retrieval. It was discovered that the same document was routed for review and signature and then filed multiple times, adding to the logjam. An overtime “filing party” quickly resolved the issue, and we revised the processes for the receipt/review/communication cycle which prevented a recurrence.

Finally, patient perceptions and expectations were addressed. People aren’t dumb. When they see staff flying around the office, and overhear conversations about “lost” charts and results, anxiety can run high. The patient’s typical reaction is to become hyper-vigilant when it comes to personal health documents. So if a test was conducted, patients will call right away and several times to obtain information, believing that if they lower their guard, something will slip through the cracks of the chaos.

The revised office processes were communicated to the patients to reassure them that the tide had turned. In addition, expected timeframes for results were explained, and the office increased proactive communication by contacting patients on normal results, when prescriptions were called in and referrals processed, thereby minimizing incoming calls.

Next week, we’ll summarize some final points about our chaotic medical practice.

Read Full Post | Comments Off on The Dysfunctional Medical Practice – Part IV of a Five Part Series

Tagged , , , , |

The Dysfunctional Medical Practice – Part III of a Five Part Series

We have been discussing a chaotic physician practice client with numerous issues impeding office success. So far, we’ve explored tardiness and chattiness. Of course, there is no magic bullet solution to physician practice problems, and the approach must be multi-faceted, but “Inch by inch, everything’s a cinch.”

Issue #3: Walk-ins

This practice experienced an unusually large number of walk-ins. As you know, an unscheduled patient – especially in a paper-chart practice – can wreak havoc in the work-day. When this becomes the norm, it’s an indication that something isn’t working right. Every practice experiences urgent visits; the solution is planning for them by building open slots into the schedule, developing criteria for their use, and – if necessary – an “approval” process.

Our physician client’s schedule had no urgent visit slots, so a total of four slots were created: two in the morning, and two in the afternoon. The next step was to determine the reason for so many walk-ins. Undoubtedly, people get sick without notice and prefer to see their physician rather than waiting in an urgent care center or ER. Our study, however, revealed that the majority of the unscheduled visits were routine in nature.

Drilling down to the root cause revealed a problem with the telephones! Because the phone lines were jammed, patients preferred a stop in the office, where they always received assistance, to the “eternal hold” of telephonic communication! Furthermore, the majority of calls were repeated requests for prescriptions, referrals or test results.

Next week, we’ll discuss the solution to this new wrinkle in Part IV of the series.

Read Full Post | Comments Off on The Dysfunctional Medical Practice – Part III of a Five Part Series

Tagged , , , , |

The Requirements to open a Nurse Registry in Florida

Nurse registries (NR) are – in our opinion – a less expensive and cumbersome mechanism for providing long-term care in Florida. In a nutshell, a NR is just like a home health agency. The only exceptions are they:

• Do not employ direct care providers; they are all independent contractors.
• Cannot be reimbursed by Medicare.

The requirements to open NR in Florida are fairly simple:

• An administrator is needed to run the NR’s daily operations, and a Financial Officer is needed to oversee the financial affairs of the company.
• The application requires financial projections which are consistent with the applicant’s business plan. The financial projections show evidence of sufficient funds for start up, working capital and funding contingencies. The financial schedules provide calculations to determine the capital requirements to sustain the start-up NR.
• Policies and procedures for operating within the State of Florida’s guidelines.

NRs do not require accreditation although this can be a competitive advantage in today’s crowded marketplace. And NRs have less marketing restrictions than HHAs.

Read Full Post | Comments Off on The Requirements to open a Nurse Registry in Florida

Tagged , , , , , |

The Dysfunctional Medical Practice – Part II of a Five Part Series

Last week, we discussed the dysfunctional office of a client where the provider and his staff rarely left until well into the evening because he was chronically late. The average tenure of an employee was less than six months because long days were untenable for most of the staff.

Issue #2: The Chatty Physician

After tracking the schedule for a few days, it became apparent that our sociable doctor was taking much longer with his patients than the time-slot allocated to the appointment. Variation in visit length is a fact of life but when it exceeds the estimates almost 100% of the time, there’s a problem. Another study revealed that the acuity of the patients was rarely the contributing factor. Instead, because patients vented their frustration about the long wait, the physician felt compelled to defend himself. He also was not skilled at managing the conversation to remain on track with the visit. Naturally, he loved his patients but a 15-minute chat about grandkids and vacations with a large number of patients only perpetuated the problem.

CCG’s solutions were multi-faceted: The Office Manager began to communicate frequently with the waiting patients to apologize and pre-empt the venting. She also monitored the patient flow – while training the physician’s assistant as well – and they developed code-words to extricate him from a room if the side conversations became too long. In addition, the physician’s habit was to escort patients to the exit window, where he charted and often continued conversing. The office flow was revised so patients were escorted by the Medical Assistant and the physician could chart and go on to the next waiting patient.

One final challenge was the physician’s frequent distractions with personal calls to his cell phone or personal visits to the practice that delayed him during and between appointments. CCG elicited his cooperation to limit calls to every two hours unless an emergency arose, and to discourage drop-ins from family and friends during the work-day. Visits from pharmaceutical reps were scheduled for slower days with specific time-slots for this purpose.

Read Part III of the series next week.

Read Full Post | Comments Off on The Dysfunctional Medical Practice – Part II of a Five Part Series

Tagged , , , , , , , |

The Dysfunctional Medical Practice – Part I of a Five-Part Series

Several years ago, we were engaged to transform a dysfunctional medical practice. No matter where we turned, there were issues, the largest of which was that the last patient appointment was set at 4:30 p.m. but the staff rarely left the office before 7:30 each night. Lunch was a juggling exercise because the morning patients were walking out as the afternoon patients were walking in. Understandably, patient frustration ran high and employee morale was almost nil. This series will explore four issues that contributed to the chaos and how they were resolved.

Issue #1: The Tardy Physician

Our client was a very affable, likable guy, and an excellent physician. No doubt that is what kept his practice full of patients. However, he was chronically late. The first patient was scheduled at 9:00 a.m. but he rarely walked in before 10:15. Seems like an obvious problem to fix, right? The short-term solution was, of course, to rearrange the patient schedule to better conform to the provider’s actual hours. But a wise man once said, “If you give a mouse a cookie, he’ll want a glass of milk.” Sure enough, once the schedule was revised, he felt less pressure to be on time, and slid further behind.

After a heart-to-heart, some “Tough Love” was in order. The schedule was scaled back by a half-hour, and the Front Desk operations revised to better track and act on patient arrival time. Medical Assistants were made accountable to fill the rooms, perform vitals, note the chief complaint and have patients ready for the clinician. The Office Manager gave the physician a reminder call 20 minutes before the first appointment so he could wrap up any hospital visits. And the physician’s wife was all too happy to help her husband out the door in the morning if it meant he’d be home for dinner with the family.

Read Part II of the series next week.

Read Full Post | Comments Off on The Dysfunctional Medical Practice – Part I of a Five-Part Series

Tagged , , , , , , , |

CCG Home Health Policy and Procedure Manuals

CCG has developed a set of policy and procedure manuals that are specifically written to satisfy the unique Florida statutes and rules regulating the operation of home health agencies, as well as Medicare Conditions of Participation. State-specific manuals for all other states are also available. Further, these materials are tailored to meet a specific accreditation organization’s standards. So, no matter which organization conducted or will conduct your accreditation, CCG has a manual to fit your needs. Our policy and procedure manuals are not “off the shelf” or sold as an individual item, but are a part of the overall consulting services that CCG provides to existing agencies or start-up agencies that need a workable, livable and concise program for operating efficiently and according to the numerous requirements.

Our consultants work directly with your key personnel in tailoring the CCG Policy and Procedure Manual to fit your concepts and ideas for the operation of your home health agency, within the parameters of the regulations and standards. If your Agency is already in existence, we can incorporate existing forms and processes in a manner that will minimize the disruption to your operations.

The important thing to remember is that there are no blanks left for you to fill in. When the process of creating your program is complete, your manual will reflect your agency’s reality, and your key personnel will know the operational processes, will be prepared for the operation of your agency, and will enter the accreditation survey process with confidence.

Read Full Post | Comments Off on CCG Home Health Policy and Procedure Manuals

Tagged , , , , , , , , , , , , |

Ask your Surveyor Q & A – Top Two Home Health Agency Citations

Q: What two items are found to be the most cited?

A: The coordination of care and aides following the plan of care are two of the most challenging standards to meet without fail. Communication and coordination between all of the entities that are caring for the patient are imperative when the goal is to help the patient return to their previous lifestyle. Not only do you have to do the coordination and communication, but these activities must be documented in the medical record. Being a home health aide is one of the most difficult jobs there is in home care. As an aide, you typically see the patient in a much more intimate environment than any of the other team members. Therefore, you will “see” things that could be done for the patient that would improve their day or even their circumstances. The problem is, the aide will quite often do the “extras” for the patient even if they are not on the care plan. Because of this, the aide is not following the plan of care and this leads to a deficiency being cited on survey. Training the aides to call the nurse for a change in the plan of care and documenting that conversation is part of the difficulty. Education to both the nurse and the aide to document those conversations would help reduce the number of citations for this
issue.

(ACHC newsletter – Spring 2011)

Read Full Post | Comments Off on Ask your Surveyor Q & A – Top Two Home Health Agency Citations

Tagged , , , , , |