Ghazal Vahora

Associate

ghazal@jmsmithlaw.com

The home health industry is one of the fastest growing and most lucrative businesses in America. In fact, the $81 billion industry will likely grow even larger in the coming years due to an aging population who prefer to receive healthcare at home. However, to remain competitive, home health care employers must prepare early for new healthcare regulations to avoid business disruptions and legal hurdles.

This article highlights three main issues home healthcare firms should consider as a result of policy changes from the Affordable Care Act (ACA).

  1. Code Changes

In October, the Center for Medicare & Medicaid Services (CMS) announced it will implement a new medical code set, the ICD-10, for all claims covered by HIPAA, Medicare and Medicaid. Not only is the ICD-10 more detailed, it will require more time to process documents and claims accurately. Therefore, employers must begin to train employees to code effectively and precisely. Furthermore, employers should consider investing in software that can accommodate the new code set and allow for as seamless a transition as possible.

  1. Value Based Purchasing Program

Similar to the changes made in hospital programs, CMS will begin to test a pay-for-performance program for home health providers—a shift away from the fee-for-service program. The value-based purchasing program is meant to keep healthcare costs down and resulting in better patient care and outcome. To successfully transition, home health agencies should ideally have an electronic health record system that performs several tasks including charting, scheduling, billing, payroll, communication, and other day-to-day features while complying with legal regulations such as HIPAA. Furthermore, the system should be able to securely transmit health records to other providers to achieve coordinated, effective and efficient patient care.

  1. Be Ready for Audits

CMS is also increasing its scrutiny of documentation through audits to reduce improper and fraudulent payments. Outright fraud obviously carries heavy fines and possible criminal penalties, but even unintentional errors could result in fines or repayment of funds, legal fees, and business distress. To avoid possible issues, home health agencies should take proactive measures to eliminate fraud. Even better than conducting internal audits (which is still recommended), is proper documentation, accurate record keeping, and correctly coding.

If you have questions about impending CMS changes, home healthcare law information, or small business advice, please contact us.