data analytics
How technology can overcome barriers
by Adrian Schauer

It’s no secret that in recent years, billing has become increasingly complicated for homecare agencies. The industry has watched as modified requirements and regulations have forced agencies to embrace new payment models and upgrade their processes in order to ensure accuracy, efficiency and reimbursement.

The pandemic brought additional complexities. The CARES Act Provider Relief Fund offered assistance, yet it also requires agencies to have a system to track how the funds are used over time. The Department of Health and Human Services is requiring providers who receive CARES Act funds to submit future reports on how they were used within the targeted allocations. (Such requirements can be found in the fund’s terms and conditions.)

This is only the latest reason for agencies to have a robust data collection system to manage billing. As health care costs have spiralled upward, driven by the needs of an aging population and escalating rates of chronic disease, homecare is becoming a bigger part of the picture. As a result, the annual growth rate for home health spending  was nearly 7% in 2019, an increase that outpaces that of hospitals, nursing care facilities and continuing care retirement communities, according to Healthcare Finance.

Newfound Payer Expectations

With such spending comes expectations, which marked the rise of new payment models such as value-based purchasing. Amidst all this, homecare organizations must grapple with how to manage bottom lines while continuing to deliver quality of care. To navigate these evolutions, there is an urgent need for robust billing processes—now more than ever.

Data, metrics, analytics: What seemed onerous and unnecessary as little as five years ago is now commonplace in homecare. While client care is based on individuals, the service of that care is underpinned by numbers. Fortunately, we exist in a new technological age of efficiency, even when it comes to navigating the weeds of complex payment systems.

Before COVID-19 turned the world upside down, the industry was shifting from fee-for-service models to value-based payment. This means payments are linked to performance, holding health care providers accountable for both the cost and the quality of the care they provide.

As payers and providers hunt for technology supports that can help them identify the origins of health care costs, homecare agencies must look ahead over the long term and set the foundation for effective and nimble billing. No matter who the third-party payers are, it is incumbent on agencies to have fast, detailed systems that not only meet requirements but also make the agencies themselves far more productive.

The Great Differentiator

In an ever-evolving billing landscape, agencies need flexible, modern software to track how clients are doing—and to demonstrate the value of the care delivered. Those who work with referring sources like hospitals and skilled nursing facilities will seek this information even more than before. There is an urgent need for a seamless flow of data and analytics linked to client outcomes and, needless to say, any paper-based methods of reporting will quickly curtail this mission.

Technology has always been, and continues to be, the great differentiator in homecare. Those agencies with forward-looking tech and with providers who serve as partners to their organization (rather than just vendors) are a step ahead. They’ll be better able to capture real-time data, build out new analytics, track performance management, have greater synergy with reporting needs and incorporate predictive analytics into planning.

Providers will have to figure out how to track quality depending on their value-based purchasing setup. Homecare agencies must be ready for any assortment of quality performance metrics that payers build into their payment system. These will include metrics related to health system usage, such asthe percentage of clients admitted to hospital in the past 90 days, as well as those related to a patient’s quality of life—loneliness, distress, uncontrolled pain, etc.

It’s important to deploy a strong e-billing module that relieves administrative headaches, performs tasks and updates in real time, and even predicts and sidesteps potential issues in the claims cycle. Advanced billing software allows users to submit and track claims in real time, while quality control elements reduce any potential errors that might delay payments. The software should be able to fluidly handle any file format, and ideally should have built-in Medicaid eligibility checks for forms 270 and 271.

It is also wise to hunt for a software solution with an automated banking function that includes the ability to “bank” units, a key aspect in many regions of the United States that can save agencies thousands of dollars a year by ensuring reimbursements are collected in full. Such a feature enables staff to bank time for each bill code or client and quickly assemble all fractional hours into whole units. Meanwhile, an agency can pull reports that analyze all potential units to bank, further defending against half or quarter units of reimbursement being lost to the ether.

Questions to Ask

Ultimately, technology saves time, frees staff and cuts costs when it comes to billing. E-billing systems will help process claims faster by trimming turnaround time from payer to agency and reducing risk for agencies via functions such as auto-checking client eligibility, flagging and resolving errors before submission, one-click uploads to clearinghouses, and electronic audit trails that allow staff to track any claim’s progress through the system.

It’s also important to find a tech provider that is knowledgeable about the particularities of homecare billing, because they can proactively offer solutions. The following questions will help unearth answers as to whether the provider’s software is right for one’s agency needs:

  • Does it integrate directly with my accounting software?
  • Do you offer flat file integration (a CSV or Excel export) or does data flow automatically?
  • Does it integrate with a desktop-based or online accounting software or both?
  • Is it capable of split billing?
  • Is it set up for long-term care billing?
  • Can I customize bill rates and pay codes?
  • Will it automatically check client eligibility?
  • How many steps does it take to get a claim to a clearinghouse?
  • Will it automatically search for potential errors before submission?
  • Does it generate billing reports that my agency can use to monitor trends and emerging issues?

Nothing is more critical to any business’s continuity and success than the flow of money. It is time to use the strength of technology to underpin operations to empower any agency to respond to unforeseen events, to operate with meticulous billing practices and to ultimately realize the enormous efficiency gains that can occur after a software upgrade. 

Adrian Schauer is the founder and CEO of AlayaCare, a home health software company founded in 2014. AlayaCare has provided the industry with innovative technology solutions to optimize the full care continuum for home and community care organizations around the globe.