Demand for home health care is growing — recent data reports a total market value of more than $181 billion in 2020 and predicts a compound annual growth rate of at least 8 percent through 2025.1 As noted by Home Health Care News, increasing interest in home-based services will lead to the expansion of franchise efforts in 2021 along with the prioritization of care management technologies capable of streamlining operations without sacrificing patient-centric care.2
For many home care providers, however, expansion into new markets and adoption of new approaches is often tempered by the more familiar challenges of accurate and efficient billing. Let’s break down four of the top billing challenges, and how the right software solutions can help bridge the gap.
Challenge 1: Evolving Payer Expectations
Payer expectations for healthcare providers are on the rise. According to a recent Deloitte whitepaper, both patients and their families now “expect care to be available when and how it’s most convenient and safe for them.”3 In some cases this means telemedicine visits, while in others it may be flexible in-home appointment scheduling. But no matter the type of service delivered, clients now expect detailed, on-demand invoicing. The solution? Software solutions capable of creating visit-based invoices that assign different billing rates based on service and employee type.
Challenge 2: Managing Home Health Metrics
As noted by HomeCare, a business magazine for home health professionals, home health metrics are now a critical component of both care delivery and billing rates — information about total number of visits, services provided and outcomes achieved are critical to developing long-term billing strategies.4 The result? Providers need business intelligence tools capable of collecting and reporting these metrics on-demand to improve decision-making.
Challenge 3: Tracking Payment Processes
According to a recent analysis of home health trends, traditional Medicare programs made it “relatively easy to track how much that public insurance pays for various types of services, including home health care.”5 As many beneficiaries move into capitated plans, however, it has become increasingly difficult to manage these invoices at scale. Home health companies can be best-served by software solutions that offer flexible billing frameworks capable of assigning different rates and setting individual contracts as needed.
Challenge 4: Ensuring Reliable Reimbursement
A study by the U.S. National Library of Medicine National Institutes of Health reports that many home health providers are now facing challenges with low-utilization payment adjustments (LUPAs), which occur when the number of in-person caregiver visits falls below a specific threshold each month.6 This causes health care agencies to be paid per visit rather than per period of care, in turn reducing their total payment volumes.
Recent adjustments to LUPA thresholds have made this scenario more likely. Under previous payment models, four or fewer visits in a 60-day period would trigger LUPA frameworks. Meanwhile, with the payment-driven groupings model (PDGM), LUPA occurs in cases of two to six visits within a 30-day period, making it much easier for home health providers to face revenue shortfalls.
The solution? Streamlined schedule and service management software solutions that allow home health providers to easily track upcoming visits and ensure they limit their risk of LUPA-related payment loss.
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1 Markets and Markets, “Home Healthcare Market by Product (Dialysis Equipment, Ventilators, ECG, Canes, Wheelchairs, Activity Monitors, Nebulizers, BP Monitors), Service (Infusion Therapy, Skilled Nursing, Hospice), Indication, Region – Global Forecast to 2025,” October 2020.
2 Home Health Care News, “Top Home Care Trends for 2021,” February 4, 2021.
3 Deloitte, “2021 Global Health Care Outlook,” January 2021.
4 HomeCare, “Streamline the Challenges of Home Health Billing,” November 10, 2020.
5 NCBI, “The Future of Home Health Care: Workshop Summary,” August 4, 2015.
6 NCBI, “Emerging Challenges and Opportunities for Home Health Care in the Time of COVID-19,” November 2020.