As we approach the new year, home health agencies need to prepare for the annual insurance changes that impact patient care and reimbursement. Staying ahead of these shifts can significantly reduce billing issues, prevent care delays and ensure smoother operations. Here are the top 10 tips for home health agencies to successfully navigate insurance changes:
Be proactive! Most insurance companies allow benefit verification in the final two weeks of December. By running your client census early, you can verify benefits ahead of the new year, reducing the risk of service interruptions due to policy changes.
Most electronic medical record (EMR) systems allow you to send mass texts or emails. Use these features at the start of December to notify your patients or their families and ask if they plan to make any changes to their insurance coverage. Early communication helps you adjust to any potential insurance shifts before they impact care.
Understanding the nuances of insurance plans is critical. Deductibles, out-of-pocket expenses and coinsurances can vary significantly. Ensure your staff is well-trained and regularly updated on the latest verification procedures and technologies to maintain accuracy and efficiency in the verification process. Clear communication with your team is key to staying on top of these details.
Not all insurance plans cover home health services—particularly commercial plans. It’s essential to verify each policy and ensure that all required services are covered before providing care. This step can prevent denials and ensure timely reimbursement.
Different payers may have varying authorization requirements for home health services or Private Duty Nursing (PDN) care. Make sure your team verifies any necessary authorizations for services and confirms that they’re in place before services begin.
Clarify the yearly visit limit for home health benefits with each payer. Some plans may limit the number of visits per year, while others may have separate limits for different disciplines (e.g., physical therapy, nursing or speech therapy). Understanding these limits will help you manage patient care without exceeding insurance coverage.
Be cautious when checking Medicare eligibility. More than 53% of Medicare beneficiaries are either already enrolled or will be enrolling in a Medicare Advantage plan. Always check the "other or additional payer" section of the eligibility return, and make sure your team thoroughly understands the Common Working File (CWF) process to avoid surprises.
If your client has switched to an out-of-network insurance plan, check if the plan offers out-of-network benefits. If it doesn’t, consider negotiating a Single Case Agreement (SCA) with the payer to ensure continuity of care for your patients.
Always verify any changes to a patient’s group number or policy number. These seemingly minor updates can lead to unnecessary denials if missed during the verification process.
Thorough documentation is your best defense against denials. Keep a record of all insurance verifications, and, if possible, attach a copy of the insurance card or printout from the payer portal to the patient’s chart. This will help your billing team resolve denials more efficiently, ensuring you receive payment for the services provided.
Navigating insurance changes at the start of the new year can be a challenge, but with the right approach, you can avoid costly errors and ensure uninterrupted care for your patients. By staying organized, communicating effectively with your team and patients and verifying insurance details early, you’ll set your home health agency up for success in the coming year.
If navigating insurance changes feels overwhelming, Prochant is here to help. Our team of experts specializes in revenue cycle management, ensuring your home health agency stays on top of benefit verifications, authorizations and billing processes.
Let us streamline your operations so you can focus on delivering quality care. Contact Prochant today!
Prochant is the only AI-driven reimbursement service provider in the home-based care industry. We deliver focused revenue cycle management (RCM) solutions to healthcare providers with 7 wholly-owned global delivery centers. Our expertise lies in providing end-to-end RCM for home-based care, infusion, and specialty pharmacies, consistently delivering exceptional results to some of the leading healthcare providers in the country. We harness specialized automation technology and deep industry knowledge to streamline the time-consuming and expensive reimbursement process. As a result, we help healthcare providers accelerate their collections, increase revenue, and reduce operational costs while managing risk. Prochant is HITRUST certified, the gold standard for HIPAA security. For more information, please visit prochant.com.