In this blog, we shine the spotlight on home health, and specifically, the home health scheduler, a crucially important member of your agency team. We explain the roles that this person plays; how home health care in general is covered; how visits are scheduled; service limitations; and best practice tips for scheduling that enable home health schedulers to promote positive outcomes for your agency and its patients.
A home health scheduler is the primary gatekeeper for your agency, serving as the liaison between the agency, client, caregiver and the payer. Their primary function is to schedule and manage the flow of patient care, ensuring that quality service is provided and patient satisfaction met. The scheduler provides the scheduling and coordination of the daily schedules for the following within a home health agency:
Home Health Staff Scheduling Basics
Home health staff are scheduled based on services and visit frequencies identified in the POC and payer authorizations. However, individual patients’ needs are different, so visits are coordinated and scheduled according to specific needs of the individual patient.
The patient’s POC is a patient assessment that identifies the type of services required, frequency of visits, diagnoses and all other pertinent information that will be addressed during the patient’s delivery of services. The care plans provide continuity of care, safety, quality care and compliance.
It’s important to note that there is a difference between a Formal Authorization and a Pending Authorization. A Formal Authorization represents the payer’s approval for reimbursement of services to be provided for a specific time frame (e.g., four RN visits, 10 physical therapy visits for the time period Jan. 1, 2017 to Jan. 31, 2017).
Pending Authorizations are authorizations that have not been final-approved by the payer source. An agency will request one based on the needs of the patient for the physician orders. Pending authorizations are necessary, as it could take 48 hours to get approval from an insurance company. Yet, the agency still needs to go through the patient.
The home health scheduler is responsible for managing the schedules of the following visits in accordance with payer and Centers for Medicare and Medicaid Services (CMS) guidelines:
Missed Visits = Missed Revenue…Making Sure Your Bases are Covered
A missed visit modifies the frequency of visits listed on the POC/physician order. The home health agency must notify the physician about the missed visit. The conditions of participation require staff to notify the physician about changes that suggest a need to modify the POC. The home health agency should notify the physician of the date and reason for the missed visit. It is important to also document and track missed visits in the medical record.
Under PDGM, you could be hitting a LUPA threshold and not even know it. Therefore, you should be proactive in making sure that any missed visits are rescheduled.
Integrating Scheduling Best Practices Can Boost Efficiency and Streamline Patient Care
Some best practice tips fall under four general categories: payer verifications; scheduling; authorizations; and communication. A brief explanation of each category is below.
Agencies may not find out about when a patient changes insurance until a claim is denied. Therefore, we recommend utilizing your EHR insurance verification tool to check benefits. This could be as often as 15 days, or at minimum, once per month. It’s also advisable to re-verify all Medicaid and Medicare Advantage payers on a monthly basis.
Carefully select the staff at the beginning of a new case. Good staff selection will improve client satisfaction. Review schedules each morning and troubleshoot scheduling conflicts and issues. Reschedule missed visits as soon as possible.
If you’re an agency that allows your staff to self-schedule (i.e., you don’t have a scheduler on staff), you’ll need a good case manager who maintains oversight of their staff’s schedules.
Track and review expiring authorizations weekly. Do not schedule more than 3-5 visits with a Pending Authorization.
Limit the number of staff who enter a patient residence and provide care. For example, utilize one specific nurse for all skilled nursing visits, one CNA for home health aid visits and one therapist for therapy visits. In other words, consistently provide the same person for the same service. Also, supervisory visits can be conducted via telehealth, which eliminates the need for an additional in-residence visit.
Manage field staff schedules by requiring prior approval before making schedule changes. (i.e., missing a visit and moving a visit).
It’s also important to consistently provide feedback to the field staff regarding how well things are going. For efficiency and higher productivity, the maximum coverage should be provided with a minimum number of staff. Also, avoid staffing seven-day-a-week cases with only one person. Make it a practice to schedule two caregivers. Alert assigned staff of client challenges as you are notified. And finally, make customer service calls to 25-30 percent of clients on service each month.
Remember that the performance of your home health scheduler can result in either a positive or negative impact on your agency outcomes and revenue. Poor performance can result in billing delays due to incorrect or missing visits; claim rejections or denials; low staff productivity; and unsatisfied patients.
Adherence to the guidelines outlined above should result in positive outcomes, including prompt reimbursement by payers; compliant scheduling of visits; efficiency; and most importantly, satisfied patients.
Contact Richter Home Health Care Consultants
Do you have questions about home health scheduling duties, or other home health financial or clinical challenges? Call Richter’s home health care consultants at 866-806-0799 to schedule a free consultation.
Yolanda Riley is a Senior Consultant for Richter.
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