Crisis in Home Health

Home health agencies are under intense pressure from numerous federal rules and regulations.  Actual Medicare episode reimbursement has increased less than 2% since home Heath began PPS in 2000, while inflation for the same period has increased over 35%.  The face-to-face encounter rules have caused friction between the referring physicians and home health agencies. Most if not all of the education regarding the face-to-face encounters has been left to the home health agencies and their staff.  Several of the Medicare Administrative Contractors (MACs) have initiated special audit steps to review home health claims to ensure the home health agencies have the proper documentation.  They claim there is a high level of non-compliance to the face-to-face encounter documentation.  CMS is even planning to educate the physicians this fall.  That is like closing the barn door after the horses have escaped.

Many home health agencies have been audited by Zone Program Integrity Contractors (ZPICs) and Recovery (RACs) for various claim issues. Always remember that ZPICs and RACs are bounty hunters.  They get paid for what they deny.  In my opinion auditors should not be paid bounties.  This creates a need to find problems whether they exist or not.  A very large percentage of these denials are overturned when they are taken through the appeal process.  Unfortunately many home health agencies do not have the funds or the expertise to complete the appeals process.

There are proposed cuts in home health reimbursement again this year.  They have also proposed additional cuts for 2015, 2016, and 2017.  They are proposing to remove 170 codes from obtaining points in the HIPPA Grouper software.  The impact of removing these codes will impact every home health agency differently bases on the makeup of their patients.

Home health has to comply with revised HIPAA rules.  Failure to comply can lead the excessive fines and penalties.  Home health survey deficiencies could lead to fines, penalties, and removal from Medicare program.   The Healthcare Reform Bill will eventually cost home health agencies cash and will require additional administration expense.  There are also fines for home health agencies that fail to comply.  Have you noticed all of the various fines and penalties?  This appears to be a new found revenue source for Medicare and other government programs.

Home Health Agencies are at a crossroads.  They must either learn to comply with the new rules, regulations, and reduced payment rates or they will be forced out of business.  Successful home health agencies will know the rules, regulations, and will implement plans to ensure they are complying.

We are having an excellent seminar on September 23 to 25 that will discuss all of the above issues and much more.  It will be held at the Hilton Waikoloa Village on the Big Island of Hawaii.  The room block will be released on August 15, be sure to make your reservations before that date.