The Fickle Millennial: Meet the new work force at your agency door

fickleadjective – changing frequently, especially as regards one’s loyalties, interests, or affection.

By JASON LEWALLEN
HHS Director of Sales and Marketing

There’s a new worker on your home health agency doorstep, one of a rising labor force segment known as Millennials, with a great outlook, an impeccable resume, and a sincere desire to make a positive difference in the world.

As an employer in the home health industry, you know the risks that come with every hire. Training is time-consuming but necessary, and carries a substantial price tag. It also places an additional burden on an agency staff already stretched thin by patient needs and compliance burdens.

There’s no guarantee that your agency’s investment in any new hire will pay off; in fact, odds are that this worker will not remain at your agency for a full year before moving on. Some home health experts estimate that up to one third of all newly-hired clinicians leave their new positions within the first six months.

Certainly it’s fair to wonder how the advent of the Millennial worker will affect those odds. This is a matter of growing concern among home health agencies and other employers nationwide, as young adults whose coming-of-age near the turn of the 21st century bring fresh attitudes and new demands to the workplace. Fair or not, Millennials are developing a reputation for much less employer loyalty and far greater expectations of job fulfillment than previous generations. They are more likely to feel discontent and switch jobs at a much higher rate than any previous workforce.Changes in our workforce initiated by a Millennial mindset are expected to accelerate as more enter the labor force and transition into management positions. In the next 8 years, U.S. Chamber Foundation estimates that 3 out of 4 workers will be Millennials.

What does this mean for home health?

Employee retention is a particular concern for home health agencies, who have learned from disappointing and frustrating experience that many of the clinicians they hire will not make it past the first quarter of employment. One in three of every new hires leaves an agency before the first six months are up, according to Heather Calhoun, Director of Appeals and Special Projects Coordinator for Home Health Solutions LLC.

“It takes about six months before a new home health or hospice clinician really begins to know what they are doing in this field,” Heather says. She works with agencies of all sizes to conduct a series of new-hire orientation and training programs for HHS, and finds the turnover rate is the same regardless of an agency’s size, ownership or geographical location.

Heather believes this is because the work often turns out to be more challenging than expected. Many nurses come to the home health field from a hospital background, where they are accustomed to less autonomy and more structure – and, often, more sharply defined duties with advance scheduling. They are surprised by increased scrutiny on their documentation, frustrated by constant schedule changes and can quickly feel burdened by a fluid scope of duties.

“Some of them also find that they just don’t like going into nasty houses, but that’s just part of what we do in this field,” Heather says. “This is a different type of job, and some people just can’t handle the hassle.”
With staff turnover and retention already major concerns for the home health field, how will agencies adapt to an emerging, and perhaps more fickle, workforce?

The solution begins with gaining a better understanding of the Millennial mindset.

Who are they?

In 2016, Millennials surpassed Baby Boomers as the nation’s largest living generation, according to statistics from the U.S. Census Bureau. For reporting purposes, the Census Bureau defines this population segment as the more than 75 million people who were born within the past 36 years.

They are tech-savvy and well steeped in social media connectivity, and nearly one quarter of them are likely to sport tattoos or body piercings, according to U.S. Chamber Foundation statistics. Almost 70 percent of them have never been married, and they seem in no rush to follow the historical trappings of growing up.  In general, Millennials tend to take years longer than Baby Boomers to reach traditional milestones such as home ownership or parenthood.

Some experts claim Millennials are the hardest working, most motivated and socially conscious generation of workers we have ever seen. Others experts claim that they are lazy, uncommitted and have a deep-seeded belief that they are entitled to privileges and provisions that generations before them had to work to obtain.

Regardless of which view you take regarding Millennials, it is becoming clear that it will require a different approach from employers to successfully engage and retain them, but we are just beginning as a society to pay more attention to the how and why of it.

Thought leader Simon Sinek recently made waves across social media with his release of a video discussing Millennials in the work place. (Click here to watch the video) In the video, Sinek takes issue with the parenting skills that he believes made Millennials what they are today. Evaluating an entire generation that seems to be set up for emotional failure makes the future look glib and hopeless. Sinek charges in the video that the responsibility for engaging Millennials belongs to employers who hire them. I disagree with several of the points that Simon makes (like marginalizing an entire generation), but overall I agree with his overview of the many challenges Millennials are facing and their outlook.

The good news is that Millennials aren’t without work ethic or potential. They want to love their jobs. On survey after survey, Millennials score as much more interested in the kind of work they do, job flexibility and balancing work-life demands than in salary levels or promotions.

More of them finish college (63%, according to the U.S. Chamber Foundation) than previous generations and feel a vested responsibility to a higher cause such as helping others, the environment, or simply “doing the right thing.”

Those characteristics perfectly position this generation to find purpose and fulfillment in our industry. So how do we as employers align our message with their need for a job with meaning?

Point out the obvious

Home health and hospice providers are already providing a service that fits well into the scope of work Millennials find appealing. We are providing services in most cases to the most fragile and dependent section of our populace, and our work can absolutely be considered “doing the right thing.”

So why would a Millennial leave a company providing such worthwhile service?

The answer is simple. They don’t understand the value they provide and the impact they are making.
Taking the time to acknowledge employees and the good work they are providing is key. The positive work is already there, but making sure that you acknowledge their impact will motivate employees to do more. This tends to push back insecurity and, as they see you as an authority figure, will give them the assurance that they are achieving something of value.“

Our goal is not just to hire, maintain and motivate our staff, but also to learn the tools to show them they are appreciated and recognized on a regular basis,” Home Health Solutions Onboarding Specialist and Operations Coordinator Christina Nuqui told a group of home health care professionals at the Home Care Association of Florida’s Winter Warm-up Conference earlier this year.

Among Christina’s suggestions:

  1. Create a formal Employee Recognition and Appreciation Program. Establish, at a minimum, an “Employee of the Year” system to recognize workers. To the extent possible, build on the annual recognition with many more opportunities. Add an “Employee of the Month” or “Star of the Week” program. The reward can be a small gesture, perhaps a $10 card to buy coffee, or add the employee’s name to a jar for an end-of-the-year drawing to win a larger prize. Remember that Millennials particularly value time off work, so consider offering a day off as a reward.
  1. Create an informal culture of appreciation. Being ignored is anathema to the spirit of productivity. On the other hand, simple words of appreciation and encouragement can reap an orchard of benefits. Make it a point to praise your employees in front of co-workers, and highlight achievements on office bulletin boards or in agency newsletters. Millennials may especially appreciate being recognized on the agency’s Facebook page as having made worthwhile contributions. Yes, it takes extra time to do these things, but the payoff is invaluable.

Provide a voice

We’ve all seen and heard of Silicon Valley software companies that provide full service restaurants, sleeping rooms, and even video arcades to entice potential employees. While that can draw talent, that is rarely what ensures loyalty to an employer.
Loyalty is built on an emotional level rather than with financial reward or access to enticing perks. Kevin Kruse, author of Employee Engagement, defines employee engagement as “the emotional commitment the employee has toward the organization and its goals.”

Getting employees – especially Millennials — to buy into your agency’s goals means making sure they feel that their input is welcomed and valued, that their suggestions are opinions are listened to, and that feel they have a valid stake in the ultimate success.

It may be as simple as putting up a whiteboard in the agency office with a big, “What do YOU think?” written across the top. Invite employees to answer questions such as, “What did we do well this week?” and “What do we need to do better?” Be sure to acknowledge what employees write there.

Give them a career path

Ambition runs stronger in this generation than many that have come before it. According to Britt Hysen, the editor-in-chief of MiLLENNiAL magazine, “60 percent of Millennials consider themselves entrepreneurs, and 90 percent recognize entrepreneurship as a mentality.”

Historically, career advancement was necessarily guaranteed, but college graduates today are looking to build a career that is rewarding and full of growth opportunities.

The Deloitte Millennial Survey 2016 discovered that 63% of Millennials say that their leadership abilities are not being developed.

How are you developing your Millennial talent? Do you provide opportunities to develop new skills or give them opportunities to prove themselves?

Invest in their tech aptitude 

Each time an agency brings in new technology or invests in a new electronic medical records software, challenges abound. In general, Millennials possess a near sixth sense for technology.

Don’t get me wrong; there are plenty of exceptions, but you will rarely have to show a member of this generation how to send or upload a photo and how to operate new equipment. They have been taught or have simply learned how to type, interact with computers, and generally how to find information that they may not have quick access to. This combined with an aversion to “doing things the way they have always been done” makes them an asset worth developing.

 Loosen the reigns 

Of all the changes home health and hospice agencies must make to better engage and retain Millennials, this may be one of the hardest and most important. Work flexibility has moved from a “nice perk” to an absolute requirement for much of this generation. They have seen the ill effects of distant parents and consider it vital to maintain good work/life balance.

As an employer, try to cut them loose when they request it. Studies have concluded that Millennials not only respond well to that flexibility,  but tend to work harder and stay longer when necessary.

In Conclusion

The home health field is growing more challenging and complex each year, with increasing regulatory demands and growing pressure to adapt quickly and thoroughly to constant change. There has never been a stronger need for smart, self-motivated employees with a passion for helping others and an innate appreciation for flexibility on the job.

Millennials bring that skill set to the home health marketplace.

Employers who take the time to understand this generation’s need to be valued and to feel they are providing value will be able to successfully tap into this burgeoning segment of the labor force, creating the professional environment necessary to turn  fickle  Millennials into long-term, committed employees.

About the author:
Jason Lewallen has helped hundreds of agencies grow and rise to their potential. He is an industry author, a technology evangelist, a seasoned speaker, and a trusted voice. His passion comes in the form of assisting agencies to have the resources and finances they need to fulfill the mission that each agency set out to do.

EDITOR’S NOTE: This article first appeared in The Absolute Agency,  the e-newsletter Jason prepares each month for Home Health Solutions as a free best practices resource for administrators, executives and leaders in home health and hospice.
Click here to subscribe to The Absolute Agency.

 

 

Three steps to take when your home health referrals drop

BY JASON LEWALLEN 

When a home health agency experiences a decrease in the flow of patient referrals, it’s easy to turn a critical eye toward the sales and marketing team. That’s exactly where the evaluation should start, but all too often, it’s also where the evaluation stops.
To experience true referral growth, agency management must shoulder some of the responsibility for the decline in admissions.
did-you-know-we-save-hundredsSales is a vital and important part of driving growth, but home health agencies which fail to deliver an in-house customer experience matching sales expectations are stacking the cards against success.
Here is where the tough love comes in: In many situations, we tell our sales team to sell a service that our employees are not inclined to provide. We assume our operations side is prepared to deliver what our sales side has promised, but without intentionality on our part to have the two sides work together, we won’t feel that synergy. An agency which does have that synergy in place almost never faces a referral decline.

Thousands of blogs and articles have been written about evaluating and motivating a sales team. Below I have outlined 3 key steps to evaluating the other parts of your agency to ensure that you are providing the experience that encourages referral sources to work with you.

Step 1: Evaluate your approachability

We all work with that one person who lacks a proverbial “filter.” Some folks can be incredible clinicians, but have communication skills that are lacking. It is really our responsibility if we let those individuals communicate with our clients and referral sources. One bad attitude on a bad day can lose a referral-providing physician or facility forever. With stakes that high, we cannot afford to risk our customer experience.
The resolution here is to evaluate and educate. When you find that a team member lacks the level of customer service you would expect, take the time to educate them or simply remove them from the phone queue.

Step 2: Consider your referral process

Some referral sources will seriously consider which agency provides the best service, the best care, and has the most trusted outcomes. However, many will simply look for the one that is easiest to work with.
When you get an order, do you call the referral source, ask for more info, ask them to fax a slightly modified version of the order, or request a new order to reflect your inability to admit the patient in 48 hours? We all have those days — and many times it is crucial to take these steps in order to secure accurate documentation needed for compliance.
Bear in mind, however, that another provider who is prepared to admit the patient without bothering the referral source for more of their time and effort may be perceived as more efficient.
Education is the key to resolving this conflict of interests. It’s not just your staff that needs the education here, it comes down to you having to educate your physicians and discharge planners on the process. Either way, keeping referral sources content is often directly related to how simple and streamlined it is to work with you in comparison to other providers.

Step 3: Cultivate a sales culture

If you cannot keep your patients and referral sources engaged and content, you are one good competitor away from losing your position in the market. Considering the steps outlined above, this may be the most important and the glue that keeps the other two steps together. Without your patients you have no business.
Taking the time to set solid expectations and guidelines foryour entire company – and focusing on providing an out-of-this-world customer experience – will have far reaching returns.

If you are seeing your referrals falling, consider treating the whole agency instead of just the symptoms. You will most likely see an increase in census and a prevailing culture of growth from a team that knows each person makes a difference.

 EDITOR’S NOTE: Jason Lewallen serves as Director of Sales and Marketing for Home Health Solutions. Jason is an accomplished speaker, blogger and author, with work published in Caring Magazine, The Home Health Technology Report, HME News, and Curaport. This article first appeared in SOLUTIONS, the monthly e-newsletter produced by HHS. 

Outsourcing: Tips for choosing the right partner

Economics of Change

Editor’s Note: Jason Lewallen is Director of Sales and Marketing for Home Health Solutions and a noted speaker, blogger and author in the home health field. This article first appeared in SOLUTIONS, the monthly e-newsletter from HHS.

By JASON LEWALLEN

Outsourcing is a hotly debated issue in the home health and hospice industry.  Home health agencies know they need to narrow their margins while maximizing their reimbursement, but historically, it has been thought to be more beneficial to have a person on staff to handle each part of the process. This especially applies when it comes to clinical matters.  Legal risks, privacy concerns and the delicate nature of our business makes us wary about trusting another entity with these matters.

Whether outsourcing is the right option for your home health agency depends largely on how you answer the following questions.

Do you really need a specialist?

In a fluid health care market where guidance changes frequently, regulatory demands are constantly evolving and penalties are formidable, agencies recognize the indisputable value of staying fully informed and well trained. Even so, agency leaders often struggle to justify hiring specialized services. The simple fact is you would not ask a plastic surgeon to treat cardiac issues. Even as a legally practicing physician with a medical background that encompasses many of the basic concepts of how the heart works, the plastic surgeon lacks the specialized training needed to adequately address the cardiovascular system.  The best results could be expected from the cardiac specialist.

The same logic applies to obtaining the best results for your home health agency by outsourcing coding services. The best clinical consultants who handle coding and OASIS review are uniquely trained to maximize your reimbursement and reduce your compliance risk.

How will outsourcing affect reimbursement?

The difference in reimbursement when switching from in-house coding to outsource coding varies from agency to agency. There is always a chance that you have an optimized coding team who can deliver optimum results, although that is not what is commonly discovered. A reputable provider will work with you to evaluate whether you are achieving the maximum reimbursement that you are due. Remember, this is money that you should be receiving when there are no coding errors.

While averages vary, most outsourcing partners can generate $200-$300 per chart for a majority of  their clients simply by correcting coding errors and helping review the OASIS to ensure compliance. At a loss of just $100 per chart, an agency might be looking at $20,000 in recovered losses for just 200 patients.  Outsourcing has other benefits in addition to making agencies more profitable. It frees agencies from worrying about benefits, sick days, or performance issues.

Can you trust the specialist?

This can be a loaded inquiry. We’ve all known a few subpar medical professionals, and frankly there are coding firms which do not perform at the necessary level of expertise.  Having a partner who will ensure that you get the full reimbursement due to your agency for each episode is critical.

Choosing the right one requires knowing what to look for and what to avoid.

Here are a few tips:

  • The right firm will have credentials, experience and a reputation in the industry for consistent performance. It will offer a demonstrable commitment to monitoring industry regulations and providing the support you need for clinical and financial success.
  • Look for a firm headed by a confident, approachable coach who is in demand as a leader and teacher in the industry and can build a solid case for increased outcomes for your agency.
  • Verify that you are working with a team of experienced clinicians who know how to evaluate a clinical narrative. Some outsourced coding providers will certify non-clinical individuals to save money. In the long run, this can damage the integrity of your organization and more often can help to drive down your outcomes scores as well as your reimbursement.
  • Another valuable area to explore the process and ease of accessibility. Some outsource providers will require you to scan or fax mass amounts of information or have a long series of steps that make working with them seem like you are working for them. Others will not be able to guarantee that you will receive your work in a timely fashion. These days, the best providers can actually work within your electronic medical record (EHR) system to improve the timeliness of chart completion while minimizing the work required of clients.Regularly scheduled reviews to evaluate your coding and OASIS for optimization can help you determine whether an in-house coding specialist or an outsourcing partner may be the more viable and cost-efficient solution. Your agency may well have the top-notch coding talent that is helping you get the maximum reimbursement, but in today’s home health market, can anyone afford not to be sure?

Top Four Fall Priorities for Home Health Agencies

solutions-october-4-ways
Where is your home health agency’s focus this fall?
Smart home health agencies are focusing their efforts on housekeeping,  trying to shore up bottom lines by rectifying errors and inconsistencies that result in costly claims denials, and scheduling crucial training for all agency staff.
The four cornerstones for success in today’s home care market are  training, internal reviews and audits , preparation and streamlining operations, according to Home Health Solutions owner and president J’non Griffin.
If your agency isn’t working on at least one of these areas right now,  it’s losing ground in the effort to stay abreast of industry regulations and maintain clinical and financial success.

Training

Did you know home health agencies lose, on average, $200 to $300 per episode to coding and OASIS errors?
The money agencies spend on staff training is more than recouped in improved performance of its employees. Home Health Solutions provides convenient online training courses available through our online store for continuing education credits.
But we realize not every agency has the same training needs, so we also work with agencies to provide customized training and education.
Our goal is to provide the solutions your agency needs. Contact us today to talk about how we can help you.

glitch-hunting-promo

Self audits and review

The goblins and gremlins may not getcha  this Halloween season, but the glitches sure will.  Errors and inconsistencies are the hobgoblins of the home health field, resulting in costly claims denials , Survey issues and more.
Smart home health agencies are conducting self reviews and analysis on every level to find glitches before surveyors do.  But there’s only so much time in a day — and it’s often hard to be objective about self evaluation.
Our Mock Audits are the resource agencies need to experience firsthand the same thorough investigation a real Survey would bring, allowing agencies to clean up errors before there are costly consequences.  Click here for details about the value of a Mock Audit.

Preparation

When CMS suspended rollouts of pre-claim reviews after a disastrous initial experience in Illinois, home heath agencies breathed a collective sigh of relief.
But the reprieve is only temporary, and smart agencies are using the extra time to get prepared.
From Value-Based Purchasing to pre-claim reviews,  a new way of doing business is on the horizon for home health agencies, and meeting the new requirements is going to take a strong commitment to adequate preparation.
Here’s an easy and inexpensive first step for agencies looking ahead to pre-claim reviews:
Order our DIY Pre-Claim Review Preparation Kit for just $25.  It’s the compass your agency needs to get started on the road to preparation.

Outsourcing

Compliance is costly.
It takes time, manpower and relentless commitment on the part of home health agencies to stay up-to-date on current regulations — and it can’t come at the expense of an agency’s primary focus on patient care.
More and more agencies are determining that the most cost-effective means of doing business is to outsource all or some portion of operations.  And we’re not just talking about coding, OASIS or billing.  Some agencies need help with specific aspects such as developing POCs, handling ADRs or service specific probe reviews.
We can help.
No matter what your need is, we have the solution.
Give us a call today at 888-418-6970 and see what we can do for you.

The value of a Mock Audit: Why home health agencies need to do this


It may be the season for goblins and gremlins, but in an era of unprecedented regulatory scrutiny for the home health field, it’s the glitches home health agencies really need to worry about.
solutions-october-main-artErrors, oversights, and inconsistencies are the hobgoblins of the home health industry, carrying high price tags in the form of claims denials – or, even more frightening, fraud investigations and hefty fines.
And, to frame things in the spirit of the season, the  scary shadow of scrutiny is looming larger.
The future of home health is filled with quality improvement requirements that have not yet been fully determined to be either tricks or treats, but home health professionals know they’re coming, sooner or later. From value-based purchasing to pre-claim reviews and a proposed new Condition of Participation for Medicare, agencies are feeling the squeeze to reduce errors and improve performance.
There’s pressure to become faster as well as better. While the Centers for Medicare and Medicaid Services has temporarily delayed rollouts of pre-claim reviews to give agencies more time to prepare, home health experts agree, by and large, that the eventual implementation will force agencies to speed up as well as fine-tune their processes.

Let’s go glitch hunting

This season, Home Health Solutions owner and president J’non Griffin recommends agencies who are serious about success take a broom, figuratively speaking, to the cobwebs and shine a light into every dark nook and cranny, to ferret out the vulnerabilities in the operation and take corrective action.
“Smart agencies are doing everything they can right now to mitigate risk,” J’non says. “They’re honing in on the quality of their documentation, reviewing clinical notes made by nurses and therapists, prioritizing internal audits and quality reviews, and following up with extra training measures to address any shortfalls.”
Done well, self-assessment takes extra time, and for an agency already struggling under clinical and operational demands, creating the time for self-evaluation can seem like an overwhelming task. It’s hard to remain objective and easy to overlook crucial details that surveyors won’t miss.
Many agencies are finding the solution is to rely on outside firms to provide the thorough and objective assessment needed to identify compliance risks and provide a plan of remedy.

What does a Mock Audit entail?

From identifying expired items in an agency’s supply closet to revealing inaccuracies in its personnel files, a Mock Audit can be a comprehensive tool for determining exactly where an agency is headed for trouble.
It’s conducted exactly as surveyors would conduct the real thing; once scheduled, there’s no advance notice given to staff.
A team spends 1-3 days on site, depending on the size of the agency being audited, with some team members remaining in the office to audit charts and personnel files while other team members conduct home visits in all disciplines.
An exit interview concludes the process, and the findings are shared with the administrator along with recommendations for improvement so that a plan of correction may be implemented. Education tailored to address specific deficiencies can be arranged.
“A Mock Audit gives the agency staff an opportunity to practice for the real thing so that they will have an idea of the survey process, whether it be state Survey or advanced accreditation,” says Heather Calhoun, Director of Special Appeals and Project Management at HHS.
She recommends agencies schedule an annual Mock Audit to help control compliance risks.
“There’s no better way for an agency to determine areas of weakness and potential risk,” Heather says.
Jason Lewallen, Director of Sales and Marketing at HHS, agrees.
“With the rapid pace of regulatory change, agencies face an uphill battle when preparing for a survey,” Jason says. “This industry is fortunate that there are programs in place that can minimize the risk of penalty before the surveyor arrives.”
Findings can result in financial gain to agencies, because audits often identify specific areas of improper documentation that result in claims denials.
“Mock Audits offer agencies the opportunity to fix errors before the organization is negatively affected by claims denials as well as accreditation or state Survey,” Jason says.
The cost of the audit, like its duration, depends on the size of the agency and a few other variables.  Give HHS a call today to discuss how a Mock Audit can help shore up your operation, and put your agency on the road to success this fall.
   

CMS suspends pre-claim review rollout in Florida

pcr-rollout-delayed
“Whew!”
That’s the word of the day for home health agencies in Florida, where there is industry-wide relief in the wake of a last-minute decision by the Centers for Medicare and Medicaid Services to suspend a pre-claim reviews rollout.
The rollout was set to begin Oct. 1,  but home health industry advocates and state lawmakers have lobbied hard to postpone the program, saying agencies are not prepared to meet the extra burden of preparing and submitting pre-claims.
Opponents pointed to a disastrous six weeks of initial efforts in Illinois, the first state to be included in the pre-claim demonstration, where very few pre-claims were approved on first submission.
The Home Care Association of Florida  was among the industry advocacy groups cautioning that patients needing home care were at risk as agencies scrambled to meet the pre-claims review burden. HCAF officials expressed relief Monday over the decision by CMS to grant agencies additional time.
No new timeline has been provided for the PCR demonstration in Florida or in other states which were previously scheduled to become part of the PCR demonstration over the next few months. Texas, Michigan and Massachusetts were on track to become part of the demonstration by Jan. 1.
CMS has indicated it will provide a 30-day notice before resuming the demonstration.  The demonstration already underway in Illinois is not included in the suspension, and will continue.
   In making the announcement, CMS acknowledged that problems experienced during the initial rollout in Illinois showed additional education will be needed before the demonstration can proceed.

Illinois non-affirmations

In Illinois, the demonstration that rolled out Aug. 1 has been marked by widespread non-affirmations, with an estimated 80 percent of first submissions failing to meet approval.
A large number of non-affirmations were based on the failure of agencies in Illinois to establish homebound status of the patient and medical necessity for home health services.
The National Association of Home Care and Hospice has fought the PCR demonstration, citing numerous problems with electronic submissions. NAHC’s Vice President for Law Bill Dombi called it “a complete mess.”

Use the reprieve to get prepared

“This delay gives home health agencies some much-needed time to better prepare for the pre-claims review demonstration,” says J’non Griffin, owner and president of Home Health Solutions LLC.
“But it is important to note that the process has only been postponed, and not canceled, so agencies will still need to prepare.”

Not sure where to start?

Home Health Solutions has a great DIY Kit to get your agency started, and it’s priced at just $25. Give us a call at 888-418-6970.
Many agencies are also considering outsourcing the preparation and submission of PCRs. Home Health Solutions is working with agencies who need PCR assistance, and will be glad to speak to you about how we can help your agency.

 

How home health agencies can meet the pre-claim reviews burden

preclaims-reviews-2
Do you know the two primary risk areas?
Here’s a look at what’s being rejected —
and four things agencies need to do

This article first appeared in the September issue of SOLUTIONS,  a monthly e-newsletter from Home Health Solutions LLC.  If you’d like to receive our free newsletter,  click here to subscribe. 

Six weeks into the first Medicare pre-claim review demonstration in Illinois, the rest of the home health field is watching, hawk-like, to assess the damage and determine industry-wide risk.
Uneasy curiosity hinges on three questions:
What’s being denied? How bad is it? How can agencies insulate themselves?
“As a whole, it’s not going well,” reports J’non Griffin, owner and president of Home Health Solutions LLC.
“One agency has reported getting no non-affirmations — and they say they are uploading 80 to 100 different pages to justify the care for each claim.
“The last figure I saw, though, was about an 80 percent non-affirmation rate overall on the first submission.”
J’non’s assessment is backed up by the National Association of Home Care and Hospice. Bill Dombi, NAHC’s Vice President for Law, has called the pre-claim demonstration in Illinois “a complete mess.”
Agencies have reported individual claims taking up to an hour each to submit.
Some say they are unable to stop and save partially uploaded submissions once the uploading process has begun.
Several agencies say they have repeatedly been told their submissions are illegible. Many say their documents were lost during transmission.
The number of disappearing documents prompted CMS at one point to advise agencies to rely on fax submissions rather than electronic.

What’s ahead?

Currently, NAHC is lobbying Congress to suspend the next rollouts planned in Florida, Texas, Michigan and Massachusetts between now and the first of the year. Florida legislators are taking the lead in the opposition, since Florida is next in line with an Oct. 1 rollout.
But the clock is ticking, and despite overwhelmingly negative reports from home health agencies in Illinois, attempts by lawmakers there to suspend the process, and current efforts of Florida lawmakers to delay the next round, it seems likely for now that the pre-claim demonstration will move forward.
How can agencies prepare?
“To successfully meet the new burden of pre-claim reviews, home health agencies need to get much faster, with fewer documentation errors and oversights, expedited turnarounds, and a thorough understanding of exactly what is expected of them,” J’non says.

(For more information about how agencies can successfully handle PCRs,  be sure to check out the detailed recommendations in J’non’s 4-Point Roadmap for PCR Success,  below. )

Is your agency ready?

Industry experts agree that agencies will almost certainly be forced to hire additional full-time employees to meet the burden of pre-claim reviews. Generally, they estimate that for every 100 to 350 patients an agency serves, an additional one-and-a-half FTEs (one RN and one clerical) could be required.
For many agencies, however, a faster and more cost-effective solution may be to outsource the preparation and submission of pre-claim reviews. Home Health Solutions is now working with agencies needing assistance with PCRs.
“Agencies are discovering, as the requirements placed upon them increase, that it often makes more sense financially to outsource coding, billing and many other services so that they can focus on patient care,” J’non says.

Going it alone?

For agencies choosing to navigate the PCR process on their own, J’non recommends purchasing a helpful tool from Home Health Solutions. Think of the PCR Do-It-Yourself Kit as a $25 compass to point your agency in the right direction to steer through all the necessary paperwork.  A checklist and staff tutorial are included.
To order,  call HHS at 888-418-6970.

Roadmap for PCR success

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J’non also offers the detailed 4-Point Roadmap below to help agencies successfully prepare for the pre-claim review process:

Step 1: EXPEDITE WORK FLOW 
Agencies must streamline their operations, with faster turnaround times for coding, for developing a Plan of Care and getting the physician to sign off on it, and for collecting all documents needed to submit the pre-claim review.
Efficient teamwork will be an essential part of streamlining operations, J’non says.
She recommends agencies:

  • Identify key staffers and their responsibilities, and make certain there is no confusion about who is responsible for each step in the process of completing documents and collecting necessary forms to submit and re-submit claims.
  • Develop a back-up system to avoid delays in the event a key staffer becomes unavailable.
  • Determine who will be responsible for follow-up, and how often.
  • Make certain the person submitting pre-claims has immediate access to all required documentation and billing information.
  • Review the process with the full staff, stressing the need for timeliness and accuracy. Put policies and procedures in writing for easy access to avoid confusion or delays.

 

Step 2. TARGET TWO AREAS MOST LIKELY TO BE REJECTED
Agencies in Illinois are reporting that a high proportion of pre-claim reviews are being rejected on the basis that the patient is not homebound or the care is not shown to be medically necessary.
J’non recommends agencies look closely at their supporting documentation to make certain they have correctly established both patient eligibility and medical necessity.
A few reminders about documenting homebound status:

  • To be considered homebound, the patient must be unable, due to illness or injury, to leave home without special equipment or assistance from another person. Be sure to document WHY the illness or injury requires special equipment or assistance.
  • Document the impact on the patient from any excursion outside the home, the reason for the trip, and the effort required to leave home.
  • Make certain Face-to-Face documentation specifies why the patient is homebound. The physician’s note must specifically address the reason the patient needs home health services.

 

Step 3:  CLEAN UP DOCUMENTATION
Review, review, review. Agencies can’t do too many in-house reviews and self-evaluations as they attempt to shore up compliance risks, limit oversights and reduce errors.
In particular, J’non recommends agencies focus on:

  • Accurate completion of the OASIS, especially in preparation for C-2 revisions which take place Jan. 1. This data collection tool offers numerous areas where clinicians can become confused. The HHS team frequently sees agencies making mistakes as simple as entering dates in the wrong place on this form, erroneously establishing non-compliance.
  • Proper documentation of Face-to-Face Encounters. Make sure the physician has documented the date of the F2F Encounter and provided the reason home care is necessary. A clinical note from the physician will be required, not just a form, and the content of the note must address the reason the patient needs home health care.The signature of a nurse-practicioner or other provider on the F2F will not suffice unless it is a co-signature with the physician. Even if the nurse-practitioner performed the F2F, the certifying physician’s signature and date will be necessary. Review all F2F dates to make certain there are no discrepancies. Mismatched dates are automatically denied.
  • Collect all necessary information before submitting pre-claims
  • Attach the assigned pre-claim number to all final claims and resubmissions.
  • For re-certifications, be aware that the re-certification statement on the projected length of time the patient will need home care will need to be submitted separately from the Plan of Care.
  • Also note that the projected length of care will shorten each time the patient is re-certified unless there is a documented reason showing why that is not the case. In a recent workshop on pre-claims reviews, Palmetto representatives stated that the re-certification statement is expected reflect a shorter duration for each episode of home health care for which the patient is re-certified. The first re-certification projection, for example, might be six months, but the next re-certification projection would be only four months. Be sure to include supporting documentation showing the need for any change in the projected length of stay.

 

Step 4: INVEST IN TRAINING
Agencies will need to shore up training in many areas in order to reduce compliance risks and achieve success in today’s challenging home health market, J’non says. In particular, she recommend OASIS training and F2F review to prepare agencies to better handle pre-claims reviews.
HHS offers online training for both in its online store, with 8 CEUs offered for the OASIS course.
Click here to shop the online store now.

5 ways we can help home health coders

coders need community
Are you a home health coder interested in keeping up with frequent changes to the ICD-10 classification set, and how it’s interpreted? If so, you need a regular source of information to keep you updated.

Maybe you’re new to home health coding, in need of free practice scenarios and study material and eager to sharpen your coding skills as you prepare for your home health exam.

Either way, you need a supportive community of coders to help you navigate the complexities of the field you’ve chosen — and Home Health Solutions LLC has the solutions you need.

Here are five ways we’re in the trenches with you, helping you master all the challenges of the home health coding profession:

 1. Free coding and OASIS tips on Mondays

newsletter 2Our free weekly e-newsletter is filled with coding and OASIS tips as well as other news of interest in the rapidly-evolving home health field. We know you’re busy, so we deliver it straight to your Inbox every Monday.
Recently, we’ve featured an update on new guidance regarding the link between HTN and heart or kidney involvement, a look at a common OASIS error regarding the entry of dates, and a refresher on THE MONDAY FIX 7the use of the 7th character in wounds coding.
We’re working now on a series of helpful tips on fractures coding and more common OASIS errors.

   If you haven’t subscribed, click here to add your name to our list and you’ll begin receiving this helpful free e-newsletter next Monday. It’s a great time to subscribe, as we’ll soon begin highlighting some of the changes to the ICD-10  classification set that will become effective Oct. 1.

 Our web site has some treasures

     Are you looking at the Home Health Solutions web site regularly to discover all the helpful info we post there?
coding errors blog post art smaller 1
Check out the PRACTICE CODING QUIZ  we’ve just posted. It features 6 trauma wounds cases and invites you to choose the correct code, assigning A or D as the 7th Character. New home health coders  — or those who like to review from time to time — will also discover useful blog posts on topics such as “Four Common ICD-10 Potholes and How To Avoid Them.”

Did you know that we keep a CODING TIPS ARCHIVE on our web site, where some of the coding tips from our weekly e-newsletters are featured in case you missed them?
Heart Translation GuideIf you like visual aids, be sure to click here to check out our helpful infographics, such as the one pictured at left. These graphics are designed to pack helpful information into a visual form, and can be printed out for you to keep with other useful tips.
   Your agency may benefit from “Think Like an Auditor,” our free report on the Top 25 Documentation Errors the HHS Team encounters when working with home health agencies, or by taking THE HHS SECURITY QUIZ, a 5-minute tool designed to help you target areas where you may be out of compliance. The Security Quiz highlights many items which will be noted during Survey.
And, speaking of Survey, did you miss our blog post on an often-overlooked but important area: “How Does Your Agency Handle Complaints?” It offers a helpful list to help your agency shore up the way complaints are documented and addressed.  Be sure to share the links to these items with the appropriate person in your agency.

3. Our Code & Coffee Quiz on Facebook

barbershop quartet art 2Whether you’re a veteran or a novice at home health coding, we have a great educational tool for you every Monday on the Home Health Solutions Facebook page.
Our Code & Coffee Quiz posts a home health scenario with multiple-choice coding sequences, inviting coders to tell us in the comments which sequence they like best and why. One of them is rewarded (in a random drawing) with a $10 e-card to Starbucks — but everyone’s a winner on this weekly quiz, because of the learning opportunities it provides.
   Recent scenarios have featured great examples of new coding guidance on presumed relationships and examples of diagnoses that require a step beyond — and then two more beyond that — with regard to specificity.

The Quiz is pinned to the top of our Facebook page each Monday. Click here to check it out.  (While you’re there, scroll down on the Facebook page to review some quizzes from previous weeks.)

Here are just a few of the reasons you should be joining us every Monday for the Code & Coffee Quiz:

  • You’re a new home health coder who needs the practice every week,
  • You’re an established home health coder who wants to see practical examples of new coding guidance in use
  • You’d like to win a $10 e-card to Starbucks
  • You recognize the value of a weekly forum where coders can discuss scenarios with the rationale provided, learning from each other


 4. Our
Online Store has products you need

    We know you need CEUs and training to stay abreast of constant change in the home health field, so we’re constantly working on new online training programs for you.
When
Home Health Solutions owner J’non Griffin isn’t on the road to teach a workshop or take the stage as a featured speaker for an industry event, she’s recording online training classes. She just finished an OASIS C-2 update, designed to address revisions which will become effective Jan. 1. It’s worth 8 CEUs. Check it out in the HHS Online Store.

   While you’re there, browse around a bit — and be sure to take a look at our Absolute Auditor classes. These classes are offered both online and in person.

 5. Get connected to stay in the loop

     At HHS, we’re committed to helping home health coders and home health agencies achieve excellence. After you check out the blog posts, classes, newsletters and tools mentioned here, check back soon to see what other helpful information we’ve assembled for you.
A great way to stay in the loop is to “like” us on Facebook so that our posts will appear in your Newsfeed. There’s a “like” box on the bottom right side of this post, to make it easier.

   You can also follow us on Twitter at:

@hmhealthsolutions

 

    

Do your OASIS scores add up to what’s really going on?

OASIS Scores Add UpEditor’s note: This article originally appeared in the July 25 issue of The Monday Fix, a free weekly email from Home Health Solutions featuring home health coding and OASIS tips.  Click here to subscribe.

In the complex world of home health, where boundaries and guideposts are almost constantly revised and re-interpreted, an agency’s success may well revolve around one crucial skill: the ability to accurately use the data collection tool known as OASIS.
The Outcome and Assessment Information Set (OASIS) is emerging as a critical performance measure for the field in general and for individual agencies.
“It’s hard to overestimate the importance of this data set,” says J’non Griffin, owner of Home Health Solutions LLC. The OASIS affects patient outcomes, reimbursement, STAR ratings, Value Based Purchasing and an agency’s bottom line.
And that’s just in its existing form.
Come Jan. 1, OASIS will ratchet things up a notch. The Centers for Medicare and Medicaid Services (CMS) implements a revised version of OASIS on the first day of 2017, and the new version known as OASIS C-2 will feature the first quality measures from the Impact Act of 2014.
This Act established some standardized measures for easier reporting and sharing of data between skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities and home health. The goal is to facilitate coordinated care and improve patient outcomes, providing better post-acute care for Medicare beneficiaries.
Among other data, C-2 items will capture standardized reports of skin integrity, a patient’s functional status and cognitive function, medication reconciliation, incidence of major falls, transfer of health information and care preferences during a patient’s transition from one facility to another.
This is important information for the home health field, J’non says.      “The overall goal is to collect data necessary to create a vital picture of what’s actually going on in home health care,” she says.
Agencies are tasked with the same goal on an individual level as they complete the OASIS for each patient. But that goal can easily be hindered by hurrying through the process, looking at it as simply additional forms to be filled out, or – perhaps most damaging — limiting its scope by failing to understand the nature and reach of the information it seeks to collect.

The big picture from the details

Accuracy in reporting is requisite for proper use of OASIS to collect necessary information, yet many clinicians struggle to correctly capture  the information.
It’s quicker and easier to create a superficial account, relying on a cursory overview or a patient’s information alone.  But that can be misleading, and J’non believes agencies must train their clinicians to look at how all the information about a patient works together to create a cohesive report.
In some cases, clinicians must look beyond the narrow focus of the question at hand to consider other circumstances which may affect the answer, and carefully weigh what a patient tells them against the realities of a diagnosis by the physician, risk assessments, environmental evidence and more.
Sheena Meeker, a quality review mentor on the HHS team, offers the following example of how it may be necessary to carefully consider all aspects of a patient’s circumstances to make sure OASIS scores add up to a true reflection of what is going on.

EXAMPLE:
Your patient is a 92-year-old male who lives alone in a single-story family home. His daughter assists with some errands, and occasionally meals at home. When you assess your patient’s ambulation status, you note the patient is a high fall risk, and uses walls and furniture to navigate through his home. He has a 2-handed walker in the home which he states he uses more than half the time for ambulation.  His medications are located on the kitchen counter, and he spends more than half his time in the living room. The patient states there is no problem with remembering to take his medications and he does not need any help. You are able to confirm this with his daughter.

How would you score M1860?

a. (0) -Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no human assistance or assistive device)

b. (1) -With the use of a one-handed device (e.g. cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.

c. (2) -Requires use of a two-handed device (e.g., walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.

d. (3) – Able to walk only with the supervision or assistance of another person at all times.

ANSWER: d  
RATIONALE: Even though the patient uses a walker more than half the time, safe ambulation for this patient requires at least supervision due to a high fall risk score. Safety of the patient is the key consideration in this case, and the high fall risk score directly impacts the correct response here.

How would you answer M2020?

a. (3) Unable to take medication unless administered by another person.

b. (1) Able to take medication(s) at the correct times if:(a) individual dosages are prepared in advance by another person; OR (b) another person develops a drug diary or chart

c. (0) Able to independently take the correct oral medication(s) and proper dosage(s) at the correct times.

d. (2) Able to take medication(s) at the correct times if given reminders by another person at the appropriate times

ANSWER: a
RATIONALE: Since the patient spends the majority of his time in the living room and his meds are in the kitchen – AND he requires assist or supervision for safety with ambulation – this would require someone to assist with medications for safety. The patient’s safety is again the key consideration, and impacts the correct answer.
This example illustrates how easy it can be for inexperienced, untrained and/or rushed clinicians to inadvertently mark the wrong answers on M1860 and/or M2020. The best protection against these kinds of accuracy errors is ongoing training, according to J’non.

What is your agency doing to prepare?   

Smart home health agencies are gearing up for the implementation of C-2 by using the next few months to carefully review how well their clinicians are using OASIS, and provide the training needed to shore up weaknesses, J’non says.
Who should agencies target for OASIS C-2 training?
“Everyone,” J’non says.
She is currently finishing up a brand new recording from HHS offering C-2 training, and will make it available via the HHS online store in the next few days.
In today’s fluid home care climate, where regulations and requirements shift rapidly and the only thing certain is the likelihood of more change soon, J’non  says agencies can’t afford to look at training as “over and done.”
Being serious about providing excellent care means getting serious about providing ongoing training and support to clinicians.

Click here to browse the HHS online store to see which online courses are available to help your agency. 

Home health agencies brace for next 6 months

Main art July SolutionsWith six months of adjustment to the 68,000 new health codes known collectively as ICD-10-CM now under its belt, the home health industry is buckling up for Round 2: six more months of new codes to assimilate, code revisions to integrate and new pre-claim reviews to handle.

More than 2,500 changes to the ICD-10-CM classification set are expected to be implemented Oct. 1: at least 1900 new codes, some 350 revised codes and more than 300 deleted codes.  The Tabular List will change, some Excludes Notes will shift and others will disappear completely in this first reworking of the code set since its implementation at the first of this year.

While home health adapts to this newest version of the new classification set, agencies in at least 5 states will also grapple with rollouts of new pre-claim reviews changing the way they process claims for services.  The Centers for Medicare and Medicaid Services (CMS) will require agencies in the affected states to secure prior authorization before processing claims.

Home health agencies in other states, expecting to soon be under the same requirement,  will pay close attention to next month’s initial rollout in Illinois, as well as similar implementations in Florida on Oct. 1, Texas on Dec. 1, and both Michigan and Massachusetts on Jan. 1.

Don’t even think about muttering a “whew” under your breath — at least not yet. There won’t be any rest for the weary at the end of these next six months.

In fact, what’s in store next could possibly have one of the largest impacts yet on home health.

THE IMPACT OF OASIS C-2

It’s hard to overestimate the importance of the Outcome and Assessment Information Set, the CMS data collection tool known by the acronym OASIS, to a home health agency’s operation. This intake of information can affect patient outcomes, reimbursement, STAR ratings, Value Based Purchasing and an agency’s bottom line.

And it’s about to become even more important.

The revised version known as OASIS C-2 becomes effective on Jan. 1, 2017, ratcheting things up a few notches with the implementation of the first quality measures from the Impact Act of 2014. This Act establishes some standardized measures for easier reporting and sharing of data between skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities and home health.  The goal is to facilitate coordinated care and improve patient outcomes, providing better post-acute care for Medicare beneficiaries.

Some OASIS C-2 items, for example, are designed to help capture standardized reports of skin integrity, a patient’s functional status and cognitive function, medication reconciliation, incidence of major falls, transfer of health information and care preferences during a patient’s transition from one facility to another.

“As integral as OASIS has become to the success of home health agencies, it is only going to become more crucial in the future,” says J’non Griffin, owner of Home Health Solutions LLC.  “Moving forward with the Impact Act initiatives in a value based environment, inaccuracy in OASIS reporting will cost agencies not only valuable dollars but also referrals. Providers will only want to partner with agencies that have excellent outcomes.”

In the five states selected for pre-claim review, OASIS C-2 will be one of a triad of components integral to set up patient eligibility and establish medical necessity.  OASIS C-2 data will be used along with the patient’s comprehensive assessment and supporting documentation from the care provider to demonstrate why home health is necessary and support the pre- claim.

Home Health Solutions is offering assistance to agencies in the five initial states for reviewing and submitting those claims, and will expand the services to other states as needed. One of the first efforts the  HHS team undertakes when working with agencies on their pre-claim reviews  is stressing the importance of accurate OASIS completion.

Successful home health agencies, according to J’non, will be those who understand how crucial it is to collect OASIS information accurately, maintain effective and ongoing staff training and review to ensure continuity and efficient adaptation to changes, and develop a reliable system to bridge potential glitches such as those caused during periods of staff turnover.

Every employee needs training, every employee’s understanding of the material needs to be reviewed and every employee’s training needs to be updated regularly in order to maintain quality expectations.

“Because of the complexity and the frequency of changes not only in regulations but in the caregiver turnover in agencies, OASIS training is a continual education process,” J’non says. “Success can’t be achieved with a ‘one-and-done’ type training with clinicians.”

A LOOK AT C-2 CHANGES

The new version of OASIS will add several new items, including a GG-Functional section, and modify how some items are worded or numbered. Five items are revised and clarification is provided with regard to many of the questions submitted to the OASIS Help Desk.  “In addition, there are some major wound guideline changes that could mean a significant decrease in case mix points,” J’non says.

Perhaps the most surprising change for many clinicians has been a startling change in how pressure ulcers are to be reported under OASIS C-2, but there are numerous other changes that will require clinicians to undergo a thorough training session in order to best adapt, J’non says.

She is putting the finishing touches on an all new online training session for OASIS C-2 which, while not yet available for purchase at the time of this post, is expected to be uploaded to the Home Health Solutions LLC Online Store within the next week to 10 days.

Browse all the products on our  online store at:
The HHS Online Store