If you’ve been in the business of delivering home health and/or hospice care for quite some time like our conference attendees last April 21-22, 2022 during the NGS 2022 Update for Home Health and Hospice, then you’re well aware that denied claims deplete not only your resources, but they also put a strain on your agency’s cash flow. Consider the costs of reworking or appealing a rejected claim: phone calls, additional workload, and more reviews. It’s even more aggravating if the revised claim is under-reimbursed or, worse, denied for a second time. You not only incurred more costs, but you also did not recoup the initial cash you spent, resulting in a considerable decrease in your agency’s revenues.

Missing physician signatures, insufficient notes to establish eligibility, documents that do not meet medical necessity requirements, and incomplete physician initial certifications and recertifications are among the most common errors made by providers when submitting claims. All these can be resolved, corrected, and avoided – but how so? Here are some ideas you might want to take note of.

  1. Be in the loop

As a result of technological and medical developments, the healthcare industry is continually evolving and changing. Given this, policies and regulations are always updated to reflect these changes. There is no better way to comprehend how they will influence your agency’s operations than to hear them directly from regulators. In addition to subscribing to emails and reading online instructional articles, your team should join CMS, NGS/CGS/Palmetto GBA, HHS, and other regulatory agencies’ webinars, seminars, info sessions, and conferences to know the latest policies and regulations. Ignorance is not bliss when it comes to billing. To avoid having your claims denied, you must be aware of and fully informed about the most recent Medicare rules. When you understand which rules are frequently interpreted too narrowly by Medicare, you can take steps to guarantee your claims do not end up in the rejected pile.

  1. Get an EMR

The most common reason for claim denials is human error. Healthcare providers have long recognized this and, as a result, the majority have switched to using an Electronic Medical Record (EMR) system. You can reduce or even eliminate human errors by automating your processes, particularly the paperwork and administrative functions. You can properly and comprehensively record the patient’s condition, the services offered by your healthcare practitioners, and all supporting documents using quick and reliable software, removing questions or doubts about your patients’ eligibility and the necessity of their treatments.

  1. Identify risk areas

Being proactive pays off. If you already have an EMR, use the report features to examine and pinpoint the areas where you make the most mistakes. Measure and evaluate your present data against industry standards on a regular basis. Knowing why your claims keep getting denied will help you devise a strategy to avoid them from happening again, whether through process improvements, training programs, or other means.

  1. Respect deadlines. 

Late filings are probably the most undesirable mistake when it comes to claim denials. When Medicare requires organizations to submit Additional Documentation Requests (ADRs), which must be completed within 45 days, strict adherence to timelines must always be respected. A good EMR system where you can simply extract and download relevant documents can help you manage your timelines.

  1. Invest in your people.

This relates to the fact that the majority of errors are caused by human error. As a result, your employees should be adequately trained and oriented to properly fill out and complete forms on a regular basis. The devil is always in the details, thus they should be trained to pay close attention to even the tiniest of details in claim filings. If your agency is subjected to a medical review, a thorough understanding of Medicare requirements, as well as the various types of probes (e.g., TPE), will help them draft a better response. Most significantly, a robust communication culture between medical and office employees should be created, allowing for information sharing and eliminating any errors caused by misunderstanding.

All of these actions have one thing in common: a proactive approach to billing and claim submission. It’s advisable to make use of technological solutions that will make your billing processes more efficient and cost-effective.

With our intelligent and innovative software solutions specifically designed for home health care and hospice care, Data Soft Logic (DSL) can lend a hand. We make everything simple and convenient for you, from patient intake to claim submissions. Schedule a demo with us now to learn more. Join us too on July 13 – 14, 2022 for the NGS Update for 2022 – Home Health and Hospice Conference in Sacramento, CA, to know the latest developments in the industry and get more tips on how to avoid claim denials.