Addressing Home Health Denial Management Services in 2025 - 3Gen Consulting

1. Addressing Home Health Denial Management Services in 2025 Denials remain a significant challenge for providers, especially within home health organizations. Ineffective denial management services have left providers across the healthcare spectrum scrambling to regroup as we approach 2025, and for home health, the challenge will be especially difficult. To help you adapt and improve your revenue cycle outcomes, 3Gen Consulting has developed four critical guidelines to enhance AR and denial management processes. By following these insights, you will be better equipped to tackle denials and optimize your financial performance next year. Providers Have Wasted Significant Resources on Denial Management Services Providers have invested substantial resources into denial management services without seeing effective results. A report from earlier this year found that providers spent almost $20 billion dollars in 2022 on denials. This included addressing delays and countering denials across all payer types, but private plans stood out as the most expensive. On top of this, only around half of the total traces back to claims that were eventually paid. This means that around $10 billion was spent on claims that could have, and possibly should have been paid when they were submitted. Perhaps the most concerning part is that these totals did not factor in added clinical labor. The American Medical Association estimates that this factor adds $13.29 in adjudication costs for inpatient stays and $51.20 for inpatient surgery. It also doesn't include the indirect costs of delay and providers going back and forth with insurers. According to Home Health Care News, a similar dynamic is at play in home health denials. However, we’ve seen a few approaches that can be effective in mitigating these issues [1]. 1. Identify and Address Common Errors Even the best billing program makes mistakes, and it’s useful to know which are most likely in your home health care billing. This is because many of these errors can lead to significant denials, and by identifying and addressing the root causes, you can get ahead of denial challenges in 2025. While each program will have its own issues, it can be useful to start from a list of common errors. CMS analysis of Payment Error Rate Measurement (PERM) data has shared a leading source of improper payments for home health services [2]. Number of Units Error This error happens when a home health care provider bills the incorrect number of units under a procedure code. This can happen in multiple ways when billing for equipment, appliances, services, and supplies. Some of these issues include: ● When the units billed for a procedure code doesn’t align with the number of units documented.

2. ● ● When the units billed are more than the units authorized by a physician’s order. Cases where overnight services aren’t divided into units per day and do not exhibit the proper date span. Instances where the incorrect procedure code and units were billed. When units are incorrectly calculated for the code. ● ● Addressing these issues requires quality control on multiple levels, including a check that the person providing the service is authorized, control of beneficiary records, and control at the claims processing level. 2. Be Aware of Insufficient Documentation Another revelation of the CMS PERM data analysis was the prevalence of insufficient documentation errors in home health care billing. This error happens when a home health care provider submits documentation that does not provide full support of the procedure code billed. Some of the most common errors include [2]: ● Service logs missing essential details like dates of service, provider names, activities performed, time spent, or lacking validation by a beneficiary or provider signature ● Progress notes that fail to indicate whether the billed services were provided, that are not signed and that are missing a date of service. Progress notes that don’t confirm if the billed services were provided, lack a signature, or are missing the date of service ● Missing signatures from the written person-centered plan with physician authorization. 3. Be Vigilant About Clinical Notes Clinical notes are an issue that can be cut both ways. Get them right and your billing is functioning at its best. But if you’re lax in this area, you run the risk of myriad issues, including denials, unnecessary delays in payment, and audits. These issues can persist even if your clinicians are functioning at the highest level of service. Ideally, clinical notes are designed to provide highly accurate descriptions of a patient’s care, how they respond to clinical interventions, and outline treatment. They require a level of specificity that all your clinicians and revenue cycle leaders should understand to optimize AR and denial management services. This level of awareness will help you avoid clinical notes being a source of denials in 2025. 4. Be Specific in Understanding Top Denial Risks Documenting denial risk is important not only for your organization as a whole but also by payer. Creating specificity at the payer level will make addressing root causes not only easier, but more effective. Track denials by payer, and don’t hesitate to leverage their data. For example, Medicare administrative contractors publish top reasons for denials. Consider Outsourcing Home Health Care Billing

3. Identifying and addressing denials can be an extensive and resource-intensive initiative. If your team is already overworked with little room to address these issues, taking on an additional project could cause other areas of your home health coding and billing department to slip. In such cases, many providers choose to outsource healthcare denial management services in the USA to take advantage of the benefits. This is because outsourcing allows you to realize the benefits of improvements in your denials program without the disruption to your existing staff that is common with this kind of project. To explore where you can start incorporating outsourcing home health care billing solutions into your home health care billing denial improvement plan, contact us at 3Gen Consulting today. References [1] J. Famakinwa, "How Home Health Providers Can Avoid Payment Denials," 12 April 2024. Available: https://homehealthcarenews.com/2024/04/how-home-health-providers-can-avoid-payment-denials /. [2] "Common Errors That Lead to Improper Payments for Home Health Services and Agency-Provided Supplies, Equipment and Appliances," https://www.cms.gov/files/document/hcbs-common-errors-imppay-factsheet-102815pdf. October 2015. Available: Original Source - https://www.3genconsulting.com/addressing-home-health-denial-management-services-in-2 025/