Home Health Industry Structure And Documentation Requirements For Payments

The home health care industry is ever-changing in its structure, organizational and operational spheres and implementation of new care policies. On the other hand, the laws and regulations that govern these agencies are also constantly reformed by the powers that be to ensure that the rights of the care workers as well as that of the clients are well protected. 

It is for this reason the government is very strict with the documentation requirements of these agencies to form and perform as well. therefore, if you want to do well in this specific segment and ensure that you provide the best care services at all times you must know about these requirements as well as the home health industry structure and organization.

There has been a significant rise in the number of Home care agencies near mebut all of these are not eligible to avail the Medicare home health benefits. According to research report of CMS Data Compendium 2009, it is seen that:

  • The growth of the hole health care agencies has been even more after the implementation of the HH PPS
  • The Medicare payments for home health care has risen from $8.5 billion in 2001 to $16.9 billion in 2008 under the first full year of PPS
  • There is a trend that is restricting from both increase in episodes for each patient as well as in the number of home health care patients.

According to another survey report of MedPAC regarding the Medicare Payment Policy 2010, the number of home health care users for every 1,000 FFS beneficiaries grew from 71 to 90 between 2001 and 2008. It is also seen that, the average number of home health care visits increased from 31 to 38 within the same time period.

The report shows that during this period, the home health care agencies that are Medicare certified also grew in number. The report showed that it the number was 6,809 in 2001 and it increased to 10,422 in 2008.

The conflicting scenario

However, in spite of the significant growth in the number of home care agencies as well as in the available care providers, there are a few conflicts in the scenario. The policymakers have shown their concern on such situations because in this present landscape, there will be a few specific subgroups in the home healthcare industry that will face difficulty in accessing Medicare-covered home health benefits and services. 

In order to evaluate their claim, it is very important for a home health care agency to understand a few things such as:

  • The structure of payment 
  • The time and reasons a patient use home health care service
  • The thing that may substitute home health care services and 
  • The factors are affecting and may affect the availability of such services for a particular patient.

The home health care industry is known to be open to payment incentives to the home care agencies and their workers which is why knowledge of such industry structure, labor force, rules and organization is so important before evaluating the possible impediments to the accessibility of such care services. It will also help them to understand the ways in which they can improve the payment systems through revisions.

Physiognomies of Medicare home health patients

According to the Social Securities Act, there are a few requirements for a Medicare beneficiary to be eligible for the Medicare home health benefits. 

  • First, the beneficiary must be homebound or confined to the home
  • He or she must be under the care of a physician and a certified nurse
  • The plan of care must be established, certified, and reviewed periodically by the physician
  • The nursing care should be skilled and involve more than venipuncture only
  • The care requirement should be intermittent
  • Physical therapy or speech-language pathology may also be included along with a continual need for occupational therapy. 

According to the structure, the Medicare Home Health benefit also covers medical social services, durable medical equipment and supplies. These are provided with a 20% coinsurance. 

The documentation requirements

The home health care agency needs some specific documents that will keep a detail record of patient care. This will enable both the public and private insurers to know about every penny spent. On top of that, Medicare and the private insurance companies want the home care agencies to follow the Medicare standards to receive their payments.

The documents will not only let the Medicare know and review patient cases for repayment but in addition to that it will also make sure that the home health care agency gets their due paid. Apart from that, it will save them from getting sued in case of any allegations. These documents will help them to defend them during lawsuits.

Evaluate and plan

As an owner of a home health care agency you should keep your documents updated according to the ever-changing insurance and Medicare regulations. You will need to evaluate your documents from time to time to ensure that it complies with their requirements.

  • You will need to do a complete assessment of the patient and the care plan
  • Review the health status and functioning of the care plan and 
  • Establish the condition of the patient at the very beginning of the treatment. 

This will help the agency to plan of the care process, even if the patient has to see multiple clinicians. 

Be specific about your progress

Specificity is another essential need to recover payments and Medicare home health benefits. You will need to be very specific about the progress of the patient as well as your maintenance, the types of services delivered by your nurses, clinicians and therapists as well as how it relates to the plan of care for a particular patient.

In addition to that, your charting should be measurable as well. Keep written notes of everything including information on the patients. Instead of generalizing your goals, you should give it a figure that is achievable and measurable. It is only a measurable goal that will enable the patients as well as the players to know the progress and tolerance.

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