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.
Errors, 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.