The Home Health Scheduler is 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 of the following staff within a Home Health Agency:
RN Case Manager
OT, PT, ST
Home Health Aides
Home Health Care can be covered through a number of payers; Medicare, Medicaid, Commercial, Worker’s Comp, VA and Private Pay. Payer requirements are very specific with respect to documentation of services provided. To learn more about best practices for clinical documentation of services in a Home Health setting, please take a look at a past blog Best Practices for Documenting Home Care Skilled Care
The scheduler is primary Gatekeeper for your agency.
Home Health Staff are scheduled as often as needed. However, individual patient’s needs are different and visits are coordinated and scheduled according to the specific needs of the individual patient.
The patient’s Plan of Care (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.
The scheduler will use the POC, authorization and/or the State Plan information to schedule visits.
The State Plan represents the state authorization of services to be rendered for a specific time and day. For example:
Home Health Aide Visits: Monday, Tuesday, Wednesday and Friday
8 hours per week/2 hours per day
There are service limitations for Home Health Services:
Visits maximum of 4 hours (16 units)
Minimum 2-Hour break between visits
No more than 8 hours (32 units) combined Home Health Nursing/Aide and therapies
No more than 14 hours (56 units) Home Health Nursing/Aide
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. For example, 4 RN visits, 10 Physical Therapy visits for the time period…January 1, 2017 to January 31, 2017.
Pending Authorizations are internal visit approvals used until an authorization request has been approved and issued to the agency by the payer. Agencies decide the frequency of pending authorization usage. Usage should be limited and highly monitored.
The Home Health Scheduler is responsible for managing the schedules of the following visits in accordance with payer and CMS guidelines:
Patient’s first visit at the start of care
Routine Discipline Visits
Subsequent visits made by nursing, therapy, home health aide and/or social worker
Visit to recertify the patient eligibility for continued service
Supervisory visits for CNAs, LPNs, COTAs and PTAs by RN Case Manager or Appropriate Therapist
Missed Visits = Missed Revenue
A Missed visit modifies the frequency of visits listed on the Plan of Care (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 Plan of Care (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.
Scheduling Best Practices
With the start of the New Year several patients will change insurance plans and the agency doesn’t find out until a claim is denied. In January, verify the insurance payers for all patients on service and obtain new authorization as needed.
Monthly – Re-verify all Medicaid payers.
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 ASAP.
Track and review expiring authorizations weekly.
Do not schedule more than 3-5 visits with a Pending Authorization.
Management of field staff schedules by requiring prior approval before making schedule changes.
Missing a visit
Moving a visit
Consistently provide feedback to the field staff regarding how well things are going.
For efficiency and higher productivity, staff to provide the maximum coverage with a minimum number of staff.
Avoid staffing 7 day a week cases with only one person. Make it a practice to schedule two care givers.
Alert assigned staff of client challenges as you are notified.
Make customer service calls to 25-30% of clients on service each month.
Remember that the performance of your scheduler can result in either a negative or a positive impact on your agency outcomes and revenue. Poor performance can results in any of the following:
Home Health Billing delays due to incorrect or missing visits
Claim rejections or denials
Low staff productivity
Adherence to the guidelines outlined above should result in positive outcomes. These include:
Prompt Reimbursement by payers
Compliant scheduling of visits
To learn more about how Richter Healthcare Consultants can help your agency to meet the regulatory, reimbursement and operational challenges, give us a call. We offer a complimentary 30 minute analysis with one of our Home Health Consultants. Contact Jennifer Richter at 216.593.7150 or Jennifer.Richter@richterhc.com.
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