Home health agencies today are feeling the pressure of reduced or delayed payments as well as increased expenses. It is more important than ever that billing is done right the first time, every time. Avoidable billing errors can lead to denials and reduced cash flow. By knowing how to reduce errors in advance, you realize the far reaching benefits of improved accuracy, accelerated reimbursement and better patient outcomes. Here are some things to keep in mind when billing CMS for home health care:
1. Be sure to have complete and correct patient information.
Missing or inaccurate patient information will cause claim denials. Ensure that the patients Medicare eligibility has been verified and valid before admitting the patient. FYI: The initial billing (RAP) claim the patient status is always 30. ‘30’ means active. The only time the patient status is anything other than 30, is if you have discharged the patient or the patient was transferred to another agency or facility.
2. The diagnosis code must be valid.
Do not use codes that are marked “invalid.” Billers should keep up to date on the new diagnosis codes* as they are released every October. It is also important to choose the correct code for the patient type. For example, you want to be sure you don’t use pediatric codes for adults.
- The correct address must be entered to calculate the correct CBSA (Core Based Statistical Area) for maximum reimbursement. You need to be sure the correct county and zip codes are entered. Please note the address date cannot be after the admission date.
- Axxess provides users of the Agencycore platform the most up to date ICD-9 codes as they are released. Axxess is ready for ICD-10 when implementation finally occurs.
3. The correct attending physician and NPI must be entered.
You must enter the physician’s full name and correct NPI number. The physician must be enrolled with PECOS in order to receive Medicare reimbursements. Every physician must have an NPI number. Users of Axxess’ agencycore home health software enjoy a built-in physician verification system that automatically confirms the PECOS status of their physicians before the physician can even be added to the system.
4. Review & log your Medicare billing denials.
One of the best ways to educate yourself is to review your denials, keeping track of your most common denial reasons. Use this list to create a checklist that you will use to review every claim submission.
5. Learn to use your DDE (Direct Data Entry) system.
Your fiscal intermediary (regional home health intermediary) such as Palmetto GBA,CIGNA, NGS or NHIC will provide you with a DDE Training manual. This is an extensive guide to the DDE system for proper data entry for billing.
Axxess has a team of experienced billing and claims consulting experts- if you have any issues regarding your billing; we are available to assist you.
Are You Experiencing Billing Errors? Axxess Can Help.
Billing is one of the greatest drains on home health agencies. It takes up valuable time and requires highly skilled employees that are often hard to find and even harder to keep.
Axxess’s home health billing experts can help relieve the administrative and technical burdens of in-house billing at a highly competitive price. Their sole focus is on home health billing and they receive continual education on regulations, rules and best practices. As a result of this experience and education, you will have fewer denied and rejected claims, allowing you to get paid more quickly and accurately. Many Highly Effective Home Health Agencies find that using Axxess billing services relieves their stress and maximizes their return on investment.
For more information about Axxess’ Billing Services click here or call us at 866-795-5990.
