Home health agencies are continually faced with challenges to receive appropriate payment for their claims. Face to Face (F2F) has been an exceptional burden since its inception in January 2011 with the constant changes in interpretation and documentation expectations. The denial rate based on inadequate or insufficient F2F documentation continues to average 59% of claims reviewed. Further, increased focus on documentation of home health certification and re-certifications in the last 2 years has added to the burden of denials for home health agencies.
As with nearly all aspects of home health, documentation is the key to successfully meeting home health requirements. That is especially true when home health agencies are confronted with Additional Documentation Requests (ADRs) related to Phase 2 of Probe and Educate or any medical review request. Under the Probe and Educate program mandate, there is no limit to the length of time a HHA can be subject to these reviews if greater than one denial is received in the claim sample.
States that are subject to pre-Claim Determination are required to submit documentation to support all home health episodes prior to billing services or experience a 25% reduction in payment for the episode even if the episode is determined to be covered. While this particular demonstration project is targeted to only a few designated states at the current time, it is expected that if the project results in significant savings to the Medicare program, it will be expanded to more states.
The primary focus of all of these projects is the certification/re-certification process since denial of those requirements results in a total claim denial. Home health agencies must be prepared to proactively avoid claim denials through effective, compliant documentation.
In this session, expert speaker Judy Adams, RN, BSN, HCS-D, HCS-O, will discuss the latest guidance for F2F and certification documentation to assist home health agencies to avoid denials and receive the reimbursement they are due for their claims. Get clarification and clear suggestions for proper documentation to ensure compliance with home health certification, including the face-to-face requirement.
The program will dispel incorrect rumors and provide samples of compliant documentation plus strategies to fully meet these requirements from the beginning. In addition, the program will discuss CMS guidance to its contractors regarding pre and post claim reviews and lessons learned from the first implementation of the Pre-Claim Determination Project. This session is especially important with the beginning of Phase 2 of Probe and Educate and the expansion of the Pre-Claim Determination Projects.
Everyone involved in home health must be knowledgeable about the Probe and Educate and Pre-Claim Demonstration Projects and work together to ensure home health documentation is meeting the requirements so claims are paid on first submission. Survival of the health agency is dependent on submitting compliant claims and documentation to support the provision of documentation that supports both eligibility and coverage criteria.
Who should attend?
Home health staff with administrative, supervisory, quality improvement and compliance responsibilities plus clinical visiting staff and billing staff.
Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.
Judy Adams, RN, BSN, HCS-D, HCS-O, has been involved in health care in numerous health care setting over the span of her career. She has been involved in nearly every aspect of home health care over the last three decades including direct clinical care, supervision, administration and quality improvement.