Blog: Keeping up with new home care regulations

With over 12,600 home care agencies servicing more than 5 million Medicare and Medicaid beneficiaries nationwide, it is important that there’s visibility into the services provided to ensure plan of care compliance. (source1) The 21st Century Cures Act, signed into law December 13, 2016, requires all Medicaid providers to use Electronic Visit Verification (EVV) for Personal and Home Health Care services. This mandate is a significant step in helping the home care industry become more efficient and transparent, while saving costs and improving patient care.

Like the 21st Century Cures Act, there are other rules and regulations being put into place to help the growth and success of the home care industry. It is important that we help the home care industry because the cost of care at a hospital or facility is so much higher than at home. For example, treatment cost for acute care hospital is around $3,250 per day, whereas home care cost is approximately $50.00 per day. (Source 2)

On January 13, 2017, Centers for Medicare & Medicaid Services (CMS) issued its final rule 3819-F outlining the Medicare and Medicaid Conditions of Participation (CoP) for home health agencies. There are now specific requirements that an agency must meet. (Source 3) The main purpose of these rules is to ensure the patient is receiving the highest quality of care from its home care agency.

The preferred shift towards home care will demand a larger workforce to help fulfill these services. With the potential increase in job opportunities, agencies need to be prepared for onboarding, training, and monitoring of new staff. Home Care Agencies are faced with several challenges in today’s market; however, having procedures in place can help overcome these obstacles and allow them to focus on the patients’ care.

Here are some key areas to focus on:

  • Communication: ongoing among the care coordinators, care takers, and the patient. Having a clearly defined plan of care in place that has been agreed upon and signed off by the physician, agency, and the patient.
  • Documentation and tracking: the care taker is responsible for documenting the services he/she has provided, and the agency is responsible for making sure those services were completed in accordance with the care plan.
  • Reimbursement: the agency must be diligent in submitting accurate and timely claims to the payer in order to get paid without denials or penalties.
  • Follow up: with the patient and other constituents in the care network once the services are completed to ensure the goals have been bet, and all parties are satisfied.

Running an agency can be difficult, especially if you do not have the right solutions in place to help manage your daily operations. By utilizing software, you can easily maintain your key operations, such as scheduling, documentation, compliance, electronic medical records, billing, payroll, and reporting. Choosing the right software company doesn’t have to be hard. There are many options available to you, but make sure you know exactly what you’re looking for, don’t be afraid to ask questions, view demonstrations to make sure it fits your needs, and compare services. Here at Sandata, we’ve been proving home care solutions to the industry for over 35 years. It’s our goal is to ensure our solutions deliver benefits to all the constituents in the home care industry, including Payers, Providers, and the Participants in the home.