Medical billing is a crucial process for any kind of healthcare practice. Revenues and reimbursement of the home healthcare service provider also depend on the proper medical billing. Now, this process involves having the knowledge of correct terminologies, codes, and coding guidelines, as well as insurance payers’ requirements. All of this contributes to the proper medical billing process and, therefore, faster payments. Similar to any other healthcare service provider, a home health care physician or provider also involves patient care and revenues for the services rendered.
Revenue cycle management is an essential component of any healthcare practice’s financial health and smooth growth. For this reason, various healthcare providers choose to outsource their medical billing to the hands of professionals to:
- Lower the risk of errors in the medical claims
- Avoid claim denials or rejections
- Faster payments
- Increase the revenues and reimbursement rate
Home care services can be provided in two ways; Home Health & Hospice Care. Note that these are two different types of care and are covered by Medicare typically.
CPT Codes for Home Health Procedures & Services
The Current Procedural Terminology (CPT) code range for Home Health Procedures and Services is 99500-99602. This code range is a medical code set maintained by the American Medical Association (AMA). It is further divided into sub-categories, including:
CPT Code: 99500-99600 – Home Visit Services
CPT Code 99501
A home health provider, such as a registered nurse, visits a patient and her newborn at home to review plans of care and provide additional resources to the patient.
CPT Code 99502
A home health provider, such as a registered nurse, visits a patient and her newborn at home to evaluate the newborn and provide newborn care education to the patient.
CPT Code 99503
A licensed respiratory therapist or other nonphysician provider provides respiratory therapy in the patient’s home.
CPT Code 99505
The provider makes a home visit to a patient with a stoma, an artificial opening in the abdomen for the passage of stool or urine.
CPT Code 99511
The provider visits a patient at home to manage treatment for and remove the patient’s fecal impaction.
CPT Code 99512
The provider visits the patient at home to provide hemodialysis, which removes waste from the blood in a patient with kidney failure.
CPT Code 99600
Use this CPT code to report a home visit service or procedure that does not have a specific code.
CPT Code: 99601-99602 – Home Infusion Procedures and Services
CPT Code 99601
The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for up to the first two hours of a visit.
CPT Code 99602
The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for each additional hour of the visit after the first two hours.
HCPCS Codes for Home Health Services:
The HCPCS codes range Home Health Services is T1019-T1022. It is a standardized code set necessary for Medicare and other health insurance providers to provide healthcare claims.
T1019-T1022 Home Health Services
Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR, or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)
Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, ICF/MR, or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)
Home health aide or certified nurse assistant, per visit
Contracted home health agency services, all services provided under contract, per day
Other HCPCS codes for Home Health:
HCPCS Code for Home health aide or certified nurse assistant, providing care in the home; per hour
Home Health Vs. Hospice Care
Home health includes the medical or healthcare services provided by professional and skilled nursing care. Some of the other services that are included in home health services include:
Speech-language pathology services
Continued occupational services
Part-time or intermittent home health aide care (as needed)
However, hospice care revolves around managing the patient’s symptoms with a prognosis of six months or less. Services for hospice care include the following:
Bereavement counseling for the loved ones
Eligibility Criteria for Home health and hospice care
Medicare, Medicaid, and some other private insurance carriers do cover home health services as well as hospice care. Some of the CPT & HCPCS codes for home health are listed above. Note that, typically, medications aren’t covered. The eligibility criteria for home health and hospice care differ.
For home health, the patient must meet the eligibility criteria for coverage. For instance, according to this, the patient must be home-bound. Meaning they can’t leave the house without assistance based on their limited ability to do so. Some of the services covered by Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) include:
- Part-Time Or “Intermittent” Skilled Nursing Care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Durable medical equipment
- Medical supplies for use at home
- Injectable osteoporosis drugs for women
Medicare doesn’t pay for:
- 24-hour-a-day care at your home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry) that aren’t related to your care plan.
On the other side, for hospice care eligibility, the patient must have a diagnosis stating that they have less than six months to live. Note that this prognosis is only if the illness follows its usual course. Unlike home health, being home-bound isn’t necessary as the eligibility criteria for hospice care patients.
Errors & challenges in Home Health Billing
There are several errors associated with home care billing. Errors in medical billing for home health services can directly impact the revenues and reimbursement rate for the provider. According to CMS, there can be various reasons and errors for home health medical billing. Following are the two common errors identified by the CMS:
Number of units errors
- This happens when the healthcare provider bills the incorrect number of units for a procedure code. Following are the common errors associated with home health services:
- The number of units documented and the ones billed for a procedure code is different.
- The number of units billed exceeds the number of units authorized by the physician’s order in the person-centered plan.
- The wrong procedure code and a number of units are billed in error.
- The units are not calculated correctly for the procedure code, such as billing for units of service in 15-minute increments when the requirements specify one-hour increments.
- Services provided overnight are not appropriately divided into units per day. For proper billing, documentation must show the date span.
Incomplete or insufficient documentation
Ensure that the paperwork, information, and other medical records are valid and complete. Insufficient or incomplete documentation is when the procedure code billed doesn’t match/support the documentation provided and vice versa. Any invalid or incomplete information in the documentation can lead to issues in medical billing for home health services.
Home health services and agency provided equipment, supplies, and appliances include the following errors:
Service logs are missing, including the following
- The provider’s name
- Dates of service
- Time spent
- Activities performed
Logs were not signed by the provider or validated by the beneficiary.
Progress notes do not indicate if the services billed
- Were provided
- Are not signed
- Are missing for the date of service.
Written person-centered plan with physician authorization is missing signatures.
Other Common Errors in medical billing
There are several errors associated with medical billing that can lead to claims being denied or rejected and therefore affecting the revenues. Following are some of the other common errors/mistakes in medical billing:
Even a minor mistake in the code can lead to the use of incorrect procedure code. Missed digit, incorrect procedure code or diagnosis code, or using an outdated code. All of these can lead to the claim being denied and hence affect the revenues of the healthcare practice.
Unable to verify the eligibility and coverage of the patient prior to the service provided is one of the most common errors. However, it is one of the errors that can be easily rectified.
Ways to overcome errors in-home health billing
CMS identified several practices that can play a vital role in managing and reducing errors. These practices include:
– Quality control on:
To improve the quality of the services, make sure of the following:
- Make sure the staff person providing the service is authorized to provide the service
- Make sure that the services provided are authorized in the written person-centered plan
- Documentation includes the date, time, type, and service provider;
- To validate services provided, check for signatures.
Make sure and check the following factors:
- Required forms in the record (person-centered plan)
- Physician orders
- The beneficiary identifier on each document.
Check the following factors:
- The calculation of the number of units for the procedure code or service code
- The procedure codes
- The unit pricing of supplies
- Make sure the dates of service entered match the dates of service on the documentation
- The person-centered plan for the number of units authorized for the procedure or service code.
Outsourcing home care billing services can also result in various benefits for the healthcare practice.
Outsourcing Home Health Billing
Outsourcing medical billing services to a well-reputed home health billing company can result in several benefits for the healthcare provider. One of the major benefits of outsourcing medical billing is the fact that you have an entire team dedicated to managing your billing process. Some of the other benefits of outsourcing home health billing services:
A team of highly experienced and qualified medical billing professionals
- The lesser risk of errors in medical claims
- Avoid claim denials or rejections
- Faster payments
- Higher revenues and reimbursement rate
- Lesser expenses & fixed costs
- HIPAA Compliance
- Decreased liability
- More focus on providing quality patient care
Choosing the best home health billing company makes a huge difference in revenue cycle management (RCM).