Home health services are in high demand in the US, and it is increasing day by day. The home health market is expected to increase to $555.6 billion by 2032. Though the market is increasing, the home health services face several challenges due to higher patient volume. But before delving more into the challenges, let’s have a look at the services that come under home health care. These include physical and occupational therapy, nursing care, speech therapy, and medical social services. These services make home health billing and coding quite challenging as there are different rules.  

It has been observed that about 20% of medical claims get rejected by payers due to billing and coding errors. Hence, the hectic billing and coding process makes home health an extremely challenging job. However, the experienced personnel of the home health billing services know about all the complex billing intricacies. So, let's jump into the challenges of home health billing which the third-party billing companies solve. 

Challenges Faced by Home Health Services 

The home health challenges not only lead to billing inaccuracies but also leave many patients unsatisfied due to claims denials. These challenges include:

Problems with Regulatory Compliance  

The US healthcare sector is heavily regulated by several medical authorities. The home health staff need to stay updated about Medicare regulations, Medicaid state-specific rules as well as insurance policies. In addition to that, the experts of the home health services also need to follow the rules under the Medicare Patient-Driven Groupings Model. Moreover, they must follow the documentation requirements. But, as the home health staff almost perform all the home health operations, that’s why it becomes difficult for them to get updated with the billing regulations. Here, the experienced staff of the home health billing services get themselves updated about all recent and upcoming changes in healthcare, thereby streamlining the billing process which improves healthcare billing efficiency.  

Complex Medical Coding  

There is a requirement of ICD-10-CM, CPT, and HCPCS codes in home health. The ICD-10-CM codes represent the patient’s condition and diagnoses. CPT codes represent the services and procedures offered to the patients. Finally, the HCPCS codes represent the home health supplies required by the patient. These coding complexities make home health most challenging and prone to errors. On the contrary, the experts of the home health billing services have a thorough knowledge of all the medical codes needed to know the patient’s particular condition. So, as the billing experts have specialized coding knowledge, they eradicate claim denials to boost healthcare revenue.  

Prior Authorization  

The home health staff need to verify the treatment, medication, and supply requirements with insurance payers before rendering service to the patient. The payer will review whether the services have genuine medical necessity or not. Finally, if the treatment, services, and medications are deemed truly necessary, the insurance payers will pre-approve the treatment cost. That is why this process is highly complex and takes a lot of time to perform. On the contrary, the experts of the home health billing services initially verify the patient’s insurance coverage. Then they accurately submit all the patient’s medical records, diagnostic reports, treatment plans, and estimated treatment costs to streamline the prior authorization process. That is how they boost healthcare efficiency.  

Final Thoughts  

Home health is a very intricate process, and minor mistakes can lead to claim denials. That is why the home health services need to have top-notch experts to eradicate claim denials. However, as their staff perform almost all the healthcare operations, that's why they can't invest enough time to reduce claim denials. However, the experts of the home health billing services get updated with all the updated billing regulations to make sure no billing error occurs. Moreover, the home health billing services also provide dedicated experts that take care of only your billing process. Hence, with their help, you can focus on improving patient care rather than reducing billing errors.