Home Health Care Reimbursement Problems

Home health care provides skilled nursing, physical, occupational and speech therapy to home-bound patients. These services can benefit the patient and make a profit for the provider, but only if the provider recognizes and overcomes potential reimbursement problems.

Not Filing Claims in a Timely Manner

• After the year in which services are provided, home health agencies have another full calendar year to file Medicare claims. Surprisingly, some don't and Medicare doesn't reimburse claims filed past the deadline.

Filing Under the Wrong Insurance

• Medicare is usually the primary payer for home health patients, but occasionally another insurance takes precedence. If the business office files improperly with Medicare, the home health care service doesn't get paid until the confusion is cleared up.

Filing the Wrong Information

• This can include errors like misspelling the patient's name or providing an incorrect date of birth or insurance number. Although these problems are often sorted out eventually, they can result in reimbursement delays.

Fraudulent Billing

• Anybody can make a mistake. Fraudulent billing, however, is when a home care service deliberately mis-codes a patient's illness or bills for services it didn't provide in order to get a higher reimbursement rate. Those found guilty of fraudulent billing can face fines or prison terms or both, and the suspension of their billing rights.

Self-Pay Clients

• Clients with no insurance, or whose insurance doesn't cover the full cost of the care, are a unique reimbursement problem, since they're often unable to pay out of pocket. Each home health service must decide how aggressively it wants to pursue clients who can't pay.