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:
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:
There are service limitations for Home Health Services:
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:
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
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:
Adherence to the guidelines outlined above should result in positive outcomes. These include:
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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To view more news and insights from our Home Health and Hospice consulting team, we invite you to visit our Sharesource Blog
Jodie Abbinante
Business Development Representative
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