The graying of America is here and in five years 20% of Americans will be eligible for Medicare services. This means that the number of people using home health services funded by Medicare is sure to rise, bolstering the continued growth of an already $82 billion market. But the rapidly growing space will face some hurdles in the coming years, as presented by stipulations within the 2015 Home Health Final Rule (Final Rule) recently released by the Center for Medicare and Medicaid Services (CMS) under the Patient Protection and Affordable Care Act (ACA).
The new regulations are making already challenging requirements faced by home health organizations more difficult and costly to implement year-over-year. This year alone will be particularly taxing for hospitals as they try to mitigate readmission penalties that are expected to reach $428 Million. And home health organizations will play a central role in aiding acute care providers tackle this challenge. This is a reason for all in the industry to monitor the fiscal burdens being faced by home health agencies and is precisely why home health agencies themselves should be prepared for the upcoming changes, like those enacted on Face-to- Face encounters and data submission.
Processes and Training for New Face-to-Face Guidelines
Behavioral Health, Interoperability and eConsent: Meeting the Demands of CMS Final Rule Compliance
In a webinar on April 16 at 1pm ET, Aneesh Chopra will moderate a discussion with executives from DocuSign, Velatura, and behavioral health providers on eConsent, health information exchange and compliance with the CMS Final Rule on interoperability.
Changes made to the Face-to-Face encounter procedures are mostly welcomed news, but still hold some snags for providers. The biggest change is the elimination of the narrative portion required of physicians in the Face-to-Face certification of eligibility. This is great news for agencies, especially those that have had to miss out on payments for services rendered to individuals that are in obvious need of skilled services but where a physician’s narrative was found to be inadequate by an auditor. On the other hand, CMS now expects that the records of a referring physician or the referring medical facility be parallel to the contents of home health agency records in relation to a patient’s need for home health care services and related documentation. Additionally, CMS expects that home health agencies should be able to produce the physician or facility records that prove that the encounter happened in a timely manner and supported the order for Medicare home health services. This new rule comes with a cost and home health agencies need to ensure that the information needed is at hand and compliant with Medicare reimbursement.
To deal with the change, there will be a need to review current procedures and provide staffing with training that will guarantee fulfillment of the new rules. This means refreshers on available software functions that are used to track information from Face-to-Face encounters to secure reimbursement. Also, be aware that the language of the rule allows agencies to prepare a summary of what’s required by the physician or facility in order to ensure a reflection in documentation.
Data Submission Requirements
With the new Final Rule, there also comes an expanded threshold for data submission, which includes qualified OASIS information that equate to 70% of an agency’s “Quality Assessment.” This aspect of the Final Rule will take effect this July. Although most agencies are most likely already meeting this requirement, it does add the burden of calculating and monitoring levels of compliance. And remember, it will most likely be used by CMS to further review and button up Medicare expenditures for home health services.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
To prepare, agencies should take advantage of their CASPER reports to monitor OASIS submission and compliance on regular basis. The earlier you get to addressing the issues the better off you’ll be come July, This will also safeguard an agency’s claim to full reimbursement.
As I mentioned above, being attuned to these changes is of paramount importance as post-acute care increases nationwide and the amount of those qualified for home health care increases. In order for home health care agencies to continue growing and building momentum, they need to be able to adapt both timely and efficiently. Luckily, there are tools that are ready to meet the growing complexity of the changes. Cloud-based technology is quickly pervading all industries and it has its benefits in the home health industry, as it provides the easy to use functions, real-time information laden dashboards and synced reports that make it easy to navigate highly detailed processes.
Russel Krengel is product manager for Kinnser Agency Manager, Kinnser’s web-based solution for home health agencies. With a history of business leadership that includes the acquisition, growth and sale of a home health agency to Vanguard Health, Krengel brings the mindset of the owner to the development of home health’s leading software.
