At HealthRev Partners, we understand the critical importance of effectively managing eligibility verification and authorization processes for home health agencies. These areas present major challenges that can significantly impact an agency’s ability to provide timely patient care and ensure proper reimbursement.
Failing to obtain proper authorizations before providing care means someone will inevitably have to absorb those costs. Authorizations are an underrated yet crucial piece of the revenue cycle management cycle.
Determining Home Health Eligibility
The first step is verifying if a patient meets the criteria to be considered homebound and eligible for home health services. A patient qualifies as homebound if they require assistance with mobility aids like canes, crutches, or wheelchairs to leave the home safely.
It is essential for the intake team to thoroughly understand payer policies in order to accurately determine eligibility. Scanning insurance cards into the system can help avoid entry errors that cause delays.
Overcoming Authorization Challenges
Some of the biggest obstacles to obtaining timely authorizations include not having the patient’s insurance verified before providing services, as well as missing or incomplete clinical information like orders, plan of care details, and visit frequencies.
Regulations are also making authorizations more difficult in some cases. Certain payers only authorize care in 30-day increments, requiring frequent re-authorizations. Some states mandate seeing the patient a set number of visits before initiating the authorization request.
There are risks to providing too many visits without an approved authorization, as the payer may deny payment for those services. However, delaying care also negatively impacts the patient and agency’s revenue cycle.
Best Practices for Effective Management
We recommend creating detailed payer matrices that outline each plan’s authorization rules and requirements. This provides visibility into which payers need authorizations versus those that don’t, allowing agencies to streamline workflows.
Having portal access to payers is also crucial for real-time submission and tracking of authorization requests. An experienced team trained on payer nuances can process far more authorizations daily compared to manual methods.
Falling behind on authorizations can severely disrupt operations by delaying patient care, preventing proper reimbursement, and potentially leading to recoupment of payments if eligibility and authorizations were mismanaged.
The HealthRev Advantage
At HealthRev Partners, we are committed to developing true experts in eligibility and authorization management through our robust certification program. Our team stays up-to-date on the latest regulations to fully own these processes.
We are launching automation within our Velocity platform to maximize eligibility and authorization workflows with real-time visibility. This powerful solution will enable our clients to meet rapidly growing demands while ensuring a seamless, compliant experience.
Don’t overlook the effective management of eligibilities and authorizations to operate efficiently, provide quality patient care, and help create predictive revenue. HealthRev Partners has the knowledge and innovative tools to be your strategic partner in mastering this critical capability.
