Home health care is an industry destined for growth
Home health care is more affordable and better, and patients are much happier receiving care at home. It is the most cost-effective post-acute care solution compared to skilled nursing facilities, inpatient residential facilities, and long-term care hospitals. The health care costs in the U.S. are unsustainably high, and the population is aging fast, only pushing that cost higher, burdening the taxpayers.
Given it’s more affordable and achieves improved outcomes, it is inevitable for Medicare and other commercial payers to promote home health care more aggressively. The industry will see growing demand in the number of patients wanting care at home by clinicians for decades to come. However, existing home health care agencies need help to meet this demand successfully.
Clinician shortage and burnout
The shortage of nurses has been building and is expected to continue for years to come. Multiple studies show that over 1 million new registered nurses (RNs) will be needed by 2030 to meet healthcare demands. This shortage is worse in the home health industry and even more severe in rural areas.
Nursing school curriculum and training do not educate nurses on home health care regulatory compliance or the other nuances of delivering home care. Being a home health care nurse entails documenting at the point of care. During their first visit, commonly known as an admission or Start of Care (SOC), field nurses must complete the Outcome and Assessment Information Set (OASIS) while interacting with the patients and delivering care. The clinician then develops a plan of care (POC/CMS 485) which includes the frequency and mix of clinical services to be provided over the next 60 days to the patient to improve their health. The POC is approved by the patient’s physician at the onset of care. At the end of the episode, which lasts a maximum of 60 day, the patient is either recertified for an additional maximum 60-day period or discharged. Like the admission OASIS, the discharge OASIS is a critical piece of documentation as well. Add to that the complex Electronic Medical Records (EMRs) used by different agencies; it becomes apparent that there is an unreasonable expectation placed on nurses and therapists to become data administrators in addition to their patient-care responsibilities.
Regulation and compliance are ever-changing and can be overbearing
Medicare-certified home health care agencies have to stay compliant with many clinical and labor regulations from the Centers for Medicare & Medicaid Services (CMS) and state governments. It’s a full-time job requiring a multidisciplinary skillset which many agencies can’t afford and, in many cases, can’t find the right staff. Even if the initial hurdles of affordability and skillset matching are overcome, it’s hard for individuals in these roles to stay current with ever-changing regulations. Imagine a single individual trying to stay on top of constantly changing regulations relative to a team of experts. The team at Hoolime stays on top of these constant changes and helps you focus on your core business of providing patient care and improving patient outcomes.
We help the administrators, and clinical supervisors of home health agencies stay audit-ready if the state or CMS walks in for a survey to verify compliance with CMS and other regulatory guidelines. For example, home health care requires a doctor’s order, and patients must meet specific eligibility criteria.
Our ICD-10 coding and OASIS Quality Assurance (QA) team reviews patient charts, makes relevant changes, and provides recommendations to comply with CMS guidelines and Conditions of Participation (CoPs). Once finalized, the OASIS is submitted to the Internet Quality Improvement and Evaluation System (iQIES), CMS’s new tracking, analysis, and data repository system.
Accurate OASIS documentation is crucial to receive accurate reimbursements under the Patient-Driven Groupings Model (PDGM) and recent nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model with CY 2022 as a pre-implementation year.
Quality of Patient Care (QoPC) Star Rating
We ensure your nurses and therapists understand various process and outcome quality measures through ongoing education and clinician training. Timely initiation of care and improvement in ambulation, bed transferring, bathing, shortness of breath, managing oral medications, and reducing acute care hospitalization are critical to your Star Ratings.
Different payers require different workflows
Medicare Advantage (MA) Plan enrollments are increasing, currently making up one-third of total Medicare beneficiaries. Most MA plans don’t currently reimburse under PDGM, and many require pre-authorization in addition to meeting all the home health admission requirements.
Our team helps HHAs develop clinical pathways tailored for patients’ diagnosis and conditions, improving outcomes considering the patient’s insurance plan and its reimbursement rates and model. On an ad-hoc basis, we assist in developing clinical programs that target specific medical conditions. Implementing such programs and measuring positive outcomes can be instrumental in negotiating better contracts with commercial payers and MA plans.
Demonstrating the efficacy of targeted programs can also help drive more referrals from doctors.
Hoolime can help
We stay on top of regulations for you:
Our in-house management team regularly updates and trains our coders and OASIS specialists on the changing guidelines in the home health industry. Our team comprises home health and OASIS-certified coders and reviewers trained using proprietary content and curriculum from Fazzi and Decision Health. Coding credentials include AAPC, AHIMA, BCHH-C, HCS-H, HCS-O, HCS-D, COS-C, CCS, CPC-H. All staff comes from a life sciences background, including doctors, Bachelor of Pharmacy, RNs, and PTs with cumulative decades of experience.
We can tailor our solution to your needs:
The Hoolime team’s scope of work includes but is not limited to:
- Start of Care (SOC), Resumption of Care (ROC), REC (Re-Certification), and SCIC (Significant Change in Condition) Follow up OASIS review & recommendations.
- ICD coding suggestions for all types of complicated illnesses and comorbidities.
- POC Review and Creation
- Discharge OASIS review for Star-relevant M-items of Patient History & Diagnoses, Sensory, Integument, Respiratory, Elimination, Mental Status & Activities of Daily Living (ADLs), Falls/Injury, Medication, Care Management, and Functional Abilities & Goals
- OASIS Transcribing / dictating service
- Other value-adds include auditing / reviewing medical records for admission consent, Face-To-Face (F2F) Encounter Certification, Nursing, Therapy, MSW, HHA Visit Notes, Physician Order, Communication Log, Medication Profile, 60-Day Summary, Infection Report, Incident Report.
- We pride ourselves in having a dedicated specialist per medical record who understands the patient’s condition, Plan of Care (POC), ongoing changes/improvements and is in charge of coding and comprehensive review of the patient’s documentation.
- Turnaround time of 24 to 48 hours.
Correct OASIS completion drives clinical and financial results for home health care agencies. Partnering with Hoolime means that we are an extension of your team with dedicated staff on your account responsible for all coding and OASIS reviews. Our goal is to submit a clean claim which ultimately drives clinical and financial results for your agency. As part of our service, we provide reports demonstrating improved performance, clinical trends, and a feedback loop for ongoing learning with your clinicians. Hoolime will help you increase gross profit, improve Quality of Patient Care Star Rating, assure HHVBP readiness and lower audit risk, all while keeping your clinicians motivated and focused on delivering quality care to your patients.
Hoolime’s compliance solution has dedicated specialists who understand every patient’s prognosis end-to-end and help your agency’s clinicians with OASIS documentation and more.
