It’s 2021, so it’s no surprise that artificial intelligence (AI) is rapidly growing in the healthcare industry. A recently published survey on home health care revealed meaningful insights into many agencies’ challenges and areas of growth. The 2021 Home Health Care News Outlook Survey and Report showed that one of the top three takeaways was on telehealth and the rise of remote patient technology.

Specifically, 52% of surveyed home health agencies identified chronic disease management as the top telehealth and remote patient monitoring technology to consider for the coming year, followed by vital signs monitoring at 47%. According to the survey, improving patient outcomes was the top reason for prompting a change in technology, followed by the need to reduce operating costs and payment/reimbursement issues. Following adjusted regulations due to the COVID-19 pandemic, this area is projected to be ripe for growth in the years to come.

With technology adaptation being in the minds of home health players, AI now has a growing potential to revolutionize home health care. AI is expected to reinforce remote patient monitoring and data analytics by enabling real-time extraction and processing of large amounts of data, which is very useful in improving care quality and creating efficiencies in staffing utilization.

Potential Roles for AI in Home Health Care

Virtual health assistance

AI-powered virtual assistants are available 24/7 to make and receive calls easily to and from a large number of patients to check on their physical well-being and medications, and entertain questions about their care. Patients can also be connected to their physician, other services, or a loved one if they need help. All these areas of aid free up valuable clinical resources. Virtual health assistants can also help patients manage chronic conditions at home or after they’ve been discharged from the hospital. This increases patient engagement and improves self-management skills to prevent chronic situations from getting worse. By removing barriers to care and enhancing communication among patients, their families, and their providers, these virtual assistants can empower people to age in place, improve care, and deliver better outcomes while reducing costs.

Empower patients to age in place 

It cannot be denied that there is a huge gap between what healthcare providers know is best for a patient and what patients are able to do about it, especially if they’re homebound. For instance, a diabetic who lives alone several miles from the nearest grocery store and cannot drive wouldn’t be able to practice the ideal diet fit for them. Using home health care software, AI providers can identify which patients have limited to no access to the resources they need to fulfill doctor’s orders, and help them find what they need.

Remote patient monitoring

AI-powered devices (e.g. wearables and sensors) that learn patients’ routine over time make it possible to provide patients with reminders and interventions in real-time to prevent and detect health issues before they get worse. The data collected by these devices allow clinicians to see changes in patients’ behavior patterns and activity to identify and prevent potential health problems. For instance, there are sensors that can track a patient’s biometrics 24/7 even while they are sleeping or resting. Abnormalities including a slower heartbeat or an increase in pulse rate or body temperature will automatically send alerts to caregivers for potential issues.

Vanguards of fraud

Fraud in home health care is a growing problem. Despite the efforts of CMS, Medicare fee-for-service (FSS) estimated the improper payment rate at 6.27%, which represents $25.74 billion in improper payments in 2020.

Medicare processes and pays about $4 million FSS claims daily and over $900 million claims annually. Majority of these need immediate medical review before being processed for payment. This is an area where AI could potentially assist, according to CMS.

CMS is also exploring AI-powered tools to provide help in overseeing value-based payment programs. They have implemented a number of value-based payment programs that have improved quality and managed cost, but also bring new challenges in identifying improper payments, beneficiary safety and quality issues, and other program integrity concerns. Moving forward, as part of its Medicare integrity efforts, CMS will focus on stopping bad actors, preventing fraud, and mitigating emerging programmatic risks.

Other fraudulent acts include medical identity theft and false claims. Hackers sell data at a high price to buyers who use it to create fake IDs to buy medical equipment or drugs that can be resold, or file made-up claims with insurers. AI and machine learning systems can analyze the vast amounts of data that the healthcare industry generates on a daily basis that even a team of human experts can’t do. They can sort, categorize, and analyze immense quantities of information in a fraction of the time without the possibility of human error. AI systems can comb through years of patient history and related data in seconds, rather than just looking at recent data, which can help find signs of fraud and anomalies that human analysts might overlook.

Documentation accuracy

While improper payments do occur in home health, industry leaders point out that they are often not a result of intentional fraud. Many times, these are due to inconsistencies in the documentation.

While CMS continues to prevent fraud, it also intends to help reduce the burden of providers and the risk of documentation errors by leveraging new technology tools, including artificial intelligence.

When claims are medically reviewed, or when the patient medical record is looked over to confirm compliance with Medicare FFS documentation rules, CMS sees a five-to-one return on investment when comparing cost to recoveries, the agency noted.

The Future of Home Health Care with AI

The transformative power of AI is truly life-changing. Today, AI’s power is being harnessed in homecare settings for documentation accuracy, fraud reduction, as a preventive measure as far as patient health is concerned, and as a powerful data analysis tool. While it is not meant to replace the human touch, it can improve care by making it more efficient, safer, and compassionate with more personalized and effective treatment plans that meet people where they are: at home.

Can AI replace doctors and healthcare providers in the future? Maybe not. There’s the element of empathy that machines do not possess. After all, they are supposed to enhance people’s lives and should not be seen as enemies or threats. Collaboration between humans and technology is the ultimate response. Imagine the innovation possibilities of home health care if the creativity and problem-solving skills of humans were combined with the infinite data processing and cognitive power of technology. That door of opportunity is already here. We just need to enter and embrace it.

Read more about the survey here.

The post [TECH] Transforming Home Health Care with AI first appeared on Qavalo.

With the Patient-Driven Grouping Model (PDGM) ruling out therapy volume as a driving factor for reimbursements, home health agencies are challenged to explore ways to optimize utilization and revenue base.

The new Medicare Home Infusion Therapy (HIT) benefit, which took effect on January 1st, 2021, holds the potential for home health agencies to offer a new service line. It covers the professional services, including nursing services, patient training, and education (not otherwise covered under the Durable Medical Equipment [DME] benefit), remote monitoring, and monitoring services for the provision of home infusion drugs furnished by a qualified HIT supplier.

Essentially, this category covers the service component of safe and effective administration of certain drugs. Here is a rundown of the criteria for skilled services to be covered under the HIT benefit:

• Covered services include patient evaluation and assessment, training and education of patients and their caretakers, assessment of vascular access sites and obtaining any necessary bloodwork, and evaluation of medication administration.
  
  
• Skilled services provided must be complex enough that they can only be safely and effectively performed/supervised by a professional.
  
  
• The patient must be under the care of a physician, nurse practitioner, or physician’s assistant in accordance with an established Plan of Care (POC) that prescribes the type, amount, and duration of infusion therapy services that must be periodically reviewed by a physician.
  
  
• Patients must receive the drugs at home and through an external infusion pump.
  
  
• The drugs must be either IV or subcutaneous and have an administration period of 15 minutes or more and less than five hours.
  
  
• Infusion pumps and supplies are covered under the Part B DME benefit, and the DME supplier is responsible for the delivery and setup of the equipment and training and education on the operation of the infusion pump.
  
  
• The DME benefit also covers pharmacy services (i.e. drug preparation and dispensing).

The home health agency and the HIT supplier can be the same organization. Agencies that meet the qualifications can also be accredited as HIT suppliers and can offer it as a specialty service. Since the HIT benefit does not require patients to be homebound nor needing other skilled services, these agencies can offer HIT as a standalone service.

If the home health agency is NOT accredited as a HIT supplier, the agency would NOT be able to admit patients requiring the HIT services unless there is an accredited supplier willing to provide the service or the home health agency is subcontracted to provide the service.

While a lot of agencies have yet to explore this new opportunity, there is still confusion about how it really works. It is important for agencies to fully understand the dynamics of this new benefit and strategically assess if it is highly beneficial for them to pursue in order to diversify their income source. 

The post [HIT] The New Home Infusion Therapy Benefit, Explained first appeared on Qavalo.

A recent survey covering the home health industry reveals the greatest challenges in the year ahead, areas of expense specifically related to the COVID-19 pandemic, technology adoption, and areas of growth and efficiency, among other findings.

Key takeaway

Staffing remains the single most challenging aspect of home health. It’s been a top concern for a few years now, but the pandemic has intensified the challenges of sustaining a clinical workforce. Because of this, many agencies are looking into finding efficiencies in their staffing utilization.

Other highlights

• Getting on top of changing payment models was reported to be the second greatest challenge faced by the home health industry.
  
  
• The survey shows that staffing and PPE are expected to garner the greatest expense in 2021.
  
  
• Despite the projected expenses, many home health organizations still expect their revenues to rise in 2021.
  
  
• The most cited reason for prompting a shift in technology was improving patient outcomes, followed by the need to reduce operating costs and payment/reimbursement issues.
  
  
• Home health businesses are now more open to data sharing across tech platforms to process their information and help them drive business growth and improve patient outcomes. They believe interoperability will have a high impact on their organization’s ability to scale up in the coming year.

Looking ahead: Opportunities for efficiencies and growth

Investments in home health are predicted to reach new heights in 2021, and many home health businesses are now embracing the idea of utilizing third-party solutions, such as outsourcing, to support them for progress. 

When outsourcing covers other key functions, agencies can regain focus on sustainable business growth and leverage the full utilization of their in-house clinical teams to elevate patient care.

Beyond allowing focus on core functions, outsourcing providers can be a rich source of industry best practices. It maintains the high-level clinical expertise needed over equally significant administrative tasks such as coding, documentation, and data analytics, to name a few.

On top of these, outsourcing partners also help ensure that home health businesses meet the CMS guidelines and are on top of the ever-changing systems so they can continue to optimize their revenue and resources.

Where there are challenges, there are also opportunities for growth and innovation, whether it be within the internal processes or in technology. This makes the home health industry a space ripe for growth, where players can flourish and thrive in the years to come. It is now up to individual home health businesses to keep up with the times and be receptive to the changes in order to survive.

Resource:
Download and read the full 2021 Home Health Care News Outlook Survey and Report here>

The post 2021 Top Challenges and Opportunities in Home Health first appeared on Qavalo.

As agencies are getting into the rhythm of the new timeline for no-pay RAPs, more questions and challenges are expected to arise.  Here are some tips from industry experts that can actually work:

1. Know your EMR

Agencies need to get acquainted with their EMR’s workflow changes and new requirements about generating RAPs, payor set up, and other related processes. The updates should include mechanisms to help agencies manage timely RAP submissions and prevent chances of delays.

2. Coordinate your clinical and revenue cycle functions

Patient admissions and RAP timelines should be coordinated between clinical and revenue cycle teams. Once a patient admission is completed, the billing team must be informed of the RAP submission and acceptance timeframe to avoid delays. The 3% penalty may not sound intimidating but the delay can really hurt the agency’s cashflow. Remember that the penalty for late submission of no-pay RAPs starts the count from the first day of the 30-day period, NOT the first day after the agency missed the deadline.

3. Use a default HIPPS code

No-pay RAPs only need a primary diagnosis to generate the Health Insurance Prospective Payment System (HIPPS) code; however, agencies may opt to use a default HIPPS code when a complete OASIS is not available to calculate the actual HIPPS value. 

NOTE: Industry experts advise against using a default HIPPS code all the time. If it is inevitable to use a default HIPPS code, use a low-value code such as 1AA11.

4. Submit two RAPs at once

If the agency anticipates billing two payment periods within one 60-day care period, it is recommended to submit both RAPs at the same time. When a plan of care dictates multiple 30-day periods of care are required to effectively treat a patient, agencies are allowed to submit no-pay RAPs for both the first and second 30-day periods of care (for a 60-day certification) at once, to help to reduce administrative burden.

The ‘from date’ on the RAP can also also be considered as the ‘service date’ associated with revenue code 0023 —essentially, this gives reassurance for agencies to not incur penalties if the second period’s first billable visit happens beyond the 5-day window. Moreover, the previous criterion that matches the first service date on the RAP versus the first service date on the final claim no longer applies.

5. Keep tabs on the Patient Admission Date

Always remember that the ‘from date’ on the claim (the first date of the payment period) is day 0. For a RAP to be considered timely, it needs to be accepted by the MAC by day 6— or 5 days after the ‘from date’.

NOTE: Generally, the Fiscal Intermediary Standard System (FISS) is not open on Sundays and holidays— this practically means that submission timelines can vary based on which day of the week has the patient admission been accepted. Refer to the timetable below assuming the agency submits a day before day 5 (or the last day of timely acceptance).

Success in the new RAP filing method depends on developing a mindset of streamlining the documentation, adhering to strict timelines, and adopting smarter, more efficient workarounds. On the other hand, while agencies should keep an eye on documentation priorities, it is equally important that patient care should be kept in check and constantly improved.

The post New RAP Filing Tips That Actually Work first appeared on Qavalo.

According to the final rule issued on Oct 31, 2019, the following are the three behavioral adjustments assumed by CMS:

• HHAs will try to place 30-day episodes into a higher-paying clinical group by changing their documentation/coding practices trying to put the highest paying diagnosis code as the principal diagnosis.
• By taking into account additional ICD-10-CM diagnosis codes listed on the HH claim (that exceed the six allowed on the OASIS), more 30-day periods of care will receive a comorbidity adjustment than periods otherwise would have received if CMS had only used the OASIS diagnosis codes for payment.
• To receive full 30-day payments, HHAs will provide one to two extra visits for about one-third of LUPAs that are one to two visits away from the LUPA threshold. 

Despite this unavoidable adjustment, HHAs can still implement measures to recover from the negative impact on their reimbursements. Here are some tips to avoid further setbacks while still maintaining quality patient care:

1. Consider all disciplines when scheduling patient visits. Quality patient care should not be compromised even with a limited number of visits.
2. The LUPA threshold varies per PDGM clinical grouping every 30-day period of care.  You must be familiar with the LUPA thresholds and plot visit schedules with adequate intervals so as not to frontload the visits.
3. Therapy visits are still an important component of patient care. Schedule therapy visits according to the patient’s medical necessity.
4. While it is true that certain clinical groupings provide higher reimbursements, you should avoid switching the principal diagnosis with the secondary diagnosis.  Instead, make sure that the ICD-10 coding for the principal diagnosis reflects the primary reason for which patients are receiving home health services under Medicare home health benefits. Remember that this should be properly supported by a physician’s order.
5. The patient’s risk for hospitalization can affect visit scheduling.  If plotted visits are canceled due to the patient’s admission to an acute care facility, and your actual visits have not reached the LUPA threshold, then your claim may fall under a per visit pay.  Hence, the risk for hospitalization should be properly addressed in the patient plan of care.
6. Only add PRN visits for complex cases and if really needed for the plan of care —do not add them only for the purpose of avoiding LUPA.
7. Only add secondary diagnoses that can affect the plan of care and are properly documented by the physician.  Avoid adding secondary diagnoses that are inactive or conditions that have already been resolved for the purpose of comorbidity adjustment.

Optimize your reimbursements under PDGM —Qavalo’s coders and QA professionals can support your team in streamlining your new revenue cycle while keeping quality patient care.

Contact us today to learn more about Qavalo’s flexible and cost-efficient PDGM documentation solutions tailored to every agency’s unique needs.

The post 7 Tips to Help You Recover From PDGM’s Behavioral Adjustment first appeared on Qavalo.

The primary function of the OASIS Encoder is to accurately encode OASIS charts and answer M-items and GG-codes with information from the Encoding Form and the provided referral documents guided by client set protocols.

To be successful in this role you will need:

• Bachelor’s Degree in any Allied Medical Course (i.e. Nursing, Pharmacy, Biology, PT/OT, etc.)

The post OASIS Encoder first appeared on Qavalo.

This new feature is currently optional, but we wouldn’t be surprised to see it eventually mandated for all users. We have listed down some helpful tips to ease your team’s migration to KInnser’s new Progress to Goals feature:

1. Standardize your interventions per goal. Kinnser has a pre-built library of interventions for Progress to Goals, but it would help to integrate agency-specific interventions for your clinicians to choose from. This will not only save your clinicians time and effort but will also keep the flow of information consistent and smooth for the succeeding episodes following your migration. Don’t have standardized interventions yet for your agency? Qavalo can help you utilize this feature—contact us to learn more.

2. Timely submission of notes. This is an ongoing challenge for agencies, but the automated ‘lock’ once goals are met can wreak havoc on documentation flow if not submitted in sequence. Not only will timely submission make charting more accurate, but it will also make notes available for reference on the next visit.

3. Train clinicians to refer to the prior visit note. Reviewing notes from the previous visit will keep the narrative cohesive over the course of the episode and most importantly, will encourage progressive tracking of goals.

4. Update the Plan of Care (POC) as new goals are added mid-episode. It is critical to update the Plan of Care if new patient goals are added so that the goals are appropriately reflected in the discharge summary by the end of the episode. This will also be necessary for justifying recertifications as needed.

We see benefits to being an early adopter of the new Progress to Goals feature (particularly before the OASIS-D updates come out), and we hope that our tips will ease the transition for you and your team.  Message us for more best practices on this and other documentation challenges. We can also help you customize your library of agency-specific interventions or let you know about Qavalo’s other services.

The post Optimizing Your New Progress to Goals Feature first appeared on Qavalo.