Health plans play a big role in dictating home healthcare billing requirements. For example, with Medicare plans, home health centers get more time to submit claims. However, with Medicare Advantage plans there may also be a greater burden of prior auth requirements on the provider.
Apart from these discrepancies, there are numerous other ways home healthcare billing differs based on whether the patient is enrolled in Medicare or Medicare Advantage. These discrepancies in billing processes include differences in terms of financial liabilities, coverage, reimbursement, and even denials.
If not handled by experienced billers, these plan-specific billing requirements can result in serious errors and delays for both providers & patients. In fact, industry reports suggest that denials are significantly higher for MA plans in comparison to Medicare.
So, how exactly do home healthcare billing requirements vary for both Medicare and MA plans?
1) Financial liabilities and coverage
For home health patients, their medical services are covered by Medicare Part A, whereas DMEs are covered under Part B. But with MA plans, financial liabilities are more for patients, as these plans are offered by private insurers with varying coverage guidelines. Because of this, home healthcare billing teams must be fluent in communicating financial liabilities to patients.
2) Authorization requirements
Some home health services like physical therapy or aide services are covered under Medicare. However, MA plans offered by private plans often require PA for these services. A KFF survey found that 80% of MA enrollees’ plans required authorization for at least one Medicare-covered service. And so, home healthcare billing should take these nuances into account to reduce errors and delays.
3) Reimbursements
Reimbursements are fixed for everyone under Medicare plans. As a result, providers know how much they will be reimbursed for their services. However, with MA plans, reimbursement rates vary significantly. This is because rates are fixed by private payers after negotiation with the home health provider.
4) Claim denials
Home health agencies report higher denial rates on Medicare Advantage plans as compared to the original Medicare. Denial rates on MA plans also have great discrepancies based on the insurer offering them. This is because of plan-specific home healthcare billing requirements. Although there is little clarity on MA plans’ adjudication process, providers must submit claims as per the health plans’ submission format and standards to reduce denials on MA claims.
Improve Practice Management with Home Healthcare Billing Services
Home health agencies in most US states have been closing down due to shrinking margins and rising costs. On the other hand, there are providers who are able to cover their expenses and expand their offerings. These are two starkly different outcomes. And in most cases, the differentiator is an expert home healthcare billing service or company.
Although, there are various factors responsible for profitability, losses due to home healthcare billing inefficiencies cannot be justified. By minimizing errors at their end, providers can cut down costs and improve their bottom line. These home health billing experts do exactly that for the providers.
An expert home healthcare billing company’s streamlined processes and workflows can help providers minimize billing errors, delays, and practice management costs. To learn more about our flexible pricing solutions and how our best practices are enabling providers to improve their bottom line despite industry-wide challenges, please contact Sunknowledge Services Inc., a HIPPA-compliant RCM organization serving US providers and payers since 2007.
Sign in to leave a comment.