Healthcare Consulting Business Start-up Notes
docx
keyboard_arrow_up
School
University of Houston, Clear Lake *
*We aren’t endorsed by this school
Course
3351
Subject
Health Science
Date
Jan 9, 2024
Type
docx
Pages
9
Uploaded by SuperHumanEelPerson999
1.
Do you think I should do both Medicare and Medicaid at the same time or focus on one at a time?
Medicare Part A (hospital) and Medicare Part B (medical)
cover some home health services such as intermittent skilled nursing care, occupational and physical therapy, medical social work, speech-language therapy and limited personal care. Medicare will not pay for home delivered meals or in-
home meal preparation, around-the-clock home care, or personal care services such
as assistance with bathing, dressing or toileting when this is the only type of support required by the client.
Medicaid and Medicare will not cover homemaker services including assisting clients with personal shopping or errands, doing laundry or cleaning, or providing companionship when no other care is required. Government-funded home care services are focused on delivering services at the lowest possible cost, and that often means caregivers cannot deliver the services that the client requires. Private duty home care agencies have complete control over their margins. Far more appealing than working as a government-contracted agency.
Private duty home care agencies are also free to offer a broad range of non-medical services to their clients, such as homemaking, companion care and ongoing personal care, regardless of whether or not the client is recovering from an
injury or illness.
2. What are the major differences business-wise with both?
3. In regard to insurance, would I send the template on a weekly basis or monthly? Would I send it after the services are rendered or prior to?
Contracting
Home health agencies must pinpoint the specific insurance companies with which they’d like to partner, if they wish to become in-network providers. You can be out-of-network
Find out what insurance companies operate nearby. There will be big players
like Aetna or Blue Cross Blue Shield that are more obvious, but there might be smaller, more local companies that could be ideal for contracting, as well.
Apply online via the company’s website or call directly to begin the enrollment process. It will take time,
Ask insurance companies several important questions, including whether they accept electronic claims, what the timely filing deadlines are and what type of claim form should be used. This type of information isn’t always in the contract.
Make sure staff is aware and educated on accepting commercial and managed care plans.
Eligibility
Not properly performing eligibility checks could lead to providing services that aren’t covered and won’t be reimbursed.
Understand the difference between commercial insurance and Medicare HMOs. “Knowing the type of insurance plan the patient has is going to help you understand the process you’re going to follow in the office. Public health insurance, such as Medicare and Medicaid, isn't considered commercial health insurance because it's government-run. However, Medicare Advantage and Medigap plans count as commercial health insurance since private health insurance companies manage them. What Is Commercial Health Insurance?
Commercial health insurance is an insurance plan that’s not administered by a state or federal government. Instead, this type of insurance is managed by a private or public company. The majority of Americans use commercial health insuran
++ce.
Since many plans don’t cover home health care, ask insurance companies
up front whether they do. Also determine whether the companies accept claims from out-of-network providers. These pieces of information help agencies make a decision on whether to admit a patient or not.
Figure out whether authorization is required by the insurance company. Most commercial insurance plans are going to require authorization, while the majority of Medicare HMOs are not.
Pinpoint patients’ deductibles and copayments. It’s up to home health providers to collect both, so it’s important to be aware of what’s due.
Billing Process
Avoid paper billing, if possible (Home Health especially). Electronic billing is the most efficient,
For example, some insurance companies require providers to fill out an electronic data interchange (EDI) application if using their own software. Otherwise, claims can be submitted through a clearinghouse or directly through the company’s portal.
Pay attention to timely filing deadlines. Agencies must know claim and too late to submit a claim, and establish billing cycles that make sense for the type of insurance, for commercial insurance, it would be beneficial to bill
weekly or monthly, while for Medicare HMOs, episodic or monthly billing is more reasonable.
Follow up on submitted claims within two weeks. Without a timely follow-
up process, home health agencies will stumble across reimbursement issues and cash flow problems,
the key is to have billers who are properly trained and familiar with each step of the insurance company’s billing process. Follow ups can be done by phone or online.
Denial Management
Until processes are fine-tuned, denials are inevitable, so it’s necessary for home
health agencies to manage them accordingly, and use errors as learning opportunities.
Make a phone call to determine exactly why a claim was denied. Since most denials are related to billing errors, there might be an easy fix once mistakes are
identified.
File corrections within seven days to avoid going over timely filing deadlines and losing the payment altogether.
Prioritize follow-up efforts. Since the goal with billing managed care and commercial insurance is to bring in more revenue, seeing claims through to completion is crucial. Deal with the easiest to correct or those with the highest dollar volumes first.
Example: Some insurances offer up to eight hours per month of non-medical care. There might be a two-hour minimum for shifts, unused hours do not roll over. Up six hours of care up to 30 days for medical.
4. When you hiring an employee, do you have them fill out an I-9 and W-4? Are there any other important forms I need to keep in their file aside from the
application, resume, experience, job description, receipt of policies and procures, NAR/EMR?
The I-9 for work authorization and the W-4 to establish tax withholding. Both forms are mandatory.
1. What it is:
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
I-9
— You’re required under the Immigration and Reform Control Act to use Form
I-9, Employment Eligibility Verification to confirm an employee’s eligibility to work in the United States. This includes reviewing certain legal documents, such as driver’s license, Social Security card, birth certificate or green card, to establish identity and eligibility.
W-4
— The Internal Revenue Service (IRS) requires every employee to complete the Form W-4. Employee’s Withholding Allowance Certificate to indicate allowances, which affects how much federal income tax you withhold from an employee’s paycheck. The form includes information on marital status, number of dependents and additional withholding amounts.
2. When to complete:
I-9
—
Form I-9
is a three-part document. The employee fills out Section 1 on the first day of work, and you must complete Section 2 within three days of this date. You’ll also need to check the documents the employee provides from the “List of Acceptable Documents.” (Section 3 is completed, as necessary, to update or reverify an employee’s work authorization.)
W-4
— The new hire should fill out a W-4 on or before the first day of work. Be certain the employee signs the form, because it’s considered invalid without a signature. You must process the W-4 by the start of the first payroll period ending on or after the 30th day from the date received.
3. How to maintain:
I-9
— Your work is done once you’ve completed an I-9 for U.S. citizens and lawful permanent residents. For foreign workers with temporary authorization, however, the employee must indicate the expiration date under Section 1 — and you must reverify eligibility on or before this date. You can do this by completing Section 3 or filling out a new I-9 altogether.
W-4
— You need to maintain up-to-date W-4s that include recent changes to an employee’s personal or financial situation (such as moving, marriage, children or divorce), so it’s a good idea to have employees resubmit a W-4 each year.
COMPLIANCE TIP:
Employers should not give employees advice on how to complete the W-4. If an employee makes a poor decision based on your input, the company may be held
liable in the event of a dispute. Rather, direct them to resources that can help, such as a printed or online tip sheet.
4. How long to keep:
I-9
— You must keep the I-9 on file for three years after the employee’s first day of work or one year after termination — whichever is later. After that, shred and discard the new hire paperwork because you could still be fined for improperly completed forms, even when they’re kept past the retention timeframe.
W-4
— The IRS requires you to keep employment tax records for at least four years after taxes were paid. In addition to W-4 forms, this includes records of employee wages and tips (if applicable).
Did you know?
Although you don’t have to formally submit the I-9 and W-4 forms to the federal government, compliance is still necessary in case you’re ever inspected, audited or asked to provide related information about an employee.
5. Penalties for noncompliance:
I-9
— Not properly completing, retaining or making I-9s available for inspection could result in fines from $230 to $2,292 per form violation. If you knowingly hire,
or continue to employ, an unauthorized worker, you could face civil penalties ranging from $573 to $22,927 per violation (depending on first, second or subsequent offenses).
W-4
— If an employee doesn’t fill out a W-4, you must withhold tax as if the employee were single with no allowances. Also, if the IRS identifies a problem with an employee’s withholding, it may issue a “lock-in” letter indicating the maximum number of allowances permitted. You then could be penalized for not honoring the lock-in requirement, or held liable for any back taxes.
KEY TAKEAWAYS
A complete and accurate
I-9 and W-4
is mandatory for every new hire.
The employee should fill out both forms on the first day of work.
As part of the I-9 process, you’ll also need to review acceptable documentation provided by the employee.
It’s important to mind the retention timeframes for both forms to avoid penalties.
Employee Personnel File
Job application
Resume
Education verification
Employment verification
Position job description (signed)
Job offer letter or employment contract
Employment agency or temp agency agreement, if used
Emergency contact information
Signed employee handbook acknowledgment form showing receipt of the employee handbook
Notes on attendance or tardiness
Performance improvement plan documentation
Copies of any performance appraisal used or employee development plans
Any relocation agreements and documentation
Disciplinary action reports
Training records
Needs assessments signed
Complaints from clients or co-workers that have been discussed with the employee
Employee resignation letter
Final accounting for all aspects of the employee's employment such as the final paycheck, vacation pay, the return of company property,
5.
I am trying to save as much money as possible, do you think for now I can forego the fax and work through email?
How am I able to get HIPPA compliance email? eFax Phone: 800-878-7151
(
No fax machine required, Local, toll-free, and international numbers available, Fax online from anywhere using your computer, tablet, or smartphone).
HIPAA Emails: Virtru, Paubox, NeoCertified, HIPAA Vault, Aspida Mail, Protected Trust, MailHippo
6. I would like to do supervisory visit every three months is that reasonable?
No. Every 60 days. 7. What are your thoughts on post hospital visits?
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Visit the hospital for Home Transitional Care
Discharge coordination and execution – working with a senior patient's hospital staff to help create a plan of care.
Medication management – assistance organizing and tracking medications to
make sure they're taken as directed.
Follow-up physician visit assistance – helping seniors keep track of and attend all necessary follow-up medical appointments.
Nutrition management –providing assistance with food shopping and meal preparation to help ensure the senior maintains a healthy diet.
Warning sign monitoring and notification – watching for warning signs and taking appropriate action.
Record keeping – keeping track of the senior's recovery progress to share with his or her physicians.
8. Would it be reasonable to conduct the attendant orientation during the initial visit with the supervisor?
The objective of the home health supervisory visit is to determine
1.
if the aide is following the care plan,
2.
if the care plan is meeting the patient's needs,
3.
if the patient/caregiver is satisfied with the care plan and the performance of the aide.
The supervisor determines the frequency of supervisory visits and enters the frequency (e.g., every 60 days, or every 30 days) at the initial visit as documentation of the plan of supervision. The Conditions of Participation require a supervisory visit for patients receiving only personal care services at least once every 60 days. Only a registered nurse can make these visits and the home health aide or personal care worker must be present and providing care.
When HHA services are provided in addition to an SN service, an RN must make a supervisory visit to the client’s residence at least once every two weeks. The supervisory visit must occur when the HHA is present and providing care to the client.
Only visits to the home, not telephone calls, fulfill the supervision requirements
The every-two-week requirement for supervisory visits for patients receiving skilled care translates into at least once every 14 days.
The home health aide, per federal regulations, does not have to be present for any supervisory visit for the patient who receives skilled care.
An agency must check state licensure requirements to determine whether there are any specific requirements.
A therapist can supervise the aide if the patient receives therapy as the only skilled service.
There are no federal restrictions on the scope of supervision by a therapist. If the aide is providing only personal care services, the therapist can still make the supervisory visits.
When only home health aide services are being furnished to a recipient, an RN must make a supervisory visit to the recipient's residence at least once every 60 days. These supervisory visits must occur when the aide is furnishing patient care.
9. Can you elaborate on the QAPI process? QAPI is the merger of two complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI)
. Both involve using information, but differ in key ways:
QA is a process of meeting quality standards and assuring that care reaches an acceptable level. Agencies typically set QA thresholds to comply with regulations. They may also create standards that go beyond regulations. QA is a reactive, retrospective effort to examine why a facility failed to meet certain standards. QA activities do improve quality, but efforts frequently end once the standard is met.
PI (also called Quality Improvement - QI) is a pro-active and continuous study of processes with the intent to prevent or decrease the likelihood of problems by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems. PI in nursing homes aims to improve processes involved in health care delivery and resident quality of life. PI can make good quality even better.
A title and description of what the measure is. Denominator: defines the population being measured. It could be the whole population or a subset. Numerator (also called the measure focus): describes the target process, condition, event, or outcome expected for the targeted population.
10. Vesta has a 3040 form for the attendant orientation/supervisory visit, did you create your own at the beginning? Same for the 3050-A?
(a) Supervisory visits. A supervisor must conduct in-person supervisory visits to assess and document on a single form whether:
(1) the service delivery plan is adequate;
(2) the individual continues to need the services;
(3) the individual needs a service delivery plan change;
(4) the attendant continues to be competent to provide the authorized tasks; and
(5) the attendant is delivering the authorized tasks.
(b) Frequency. A supervisor must establish the frequency of in-person supervisory visits, based on the specific needs of the individual, the attendant, or both. The frequency of in-person supervisory visits must be at least annually.
(c) Documentation of supervisory visits. The provider must maintain documentation of each supervisory visit in the individual's file.
(d) Combining a supervisory visit and a new attendant orientation. A supervisor may conduct a scheduled supervisory visit and a new attendant orientation at the same time.
11. Should I keep the same paperwork straight across the board for all patients even though they have different insurances? Yes.
I also need assistance with the DADS application process, website review, job description review, and miscellaneous forms.
I will be available tomorrow at 3:30pm til the end of the day if you have an opening.
Disclaimer: The content on this page is for informational purposes only, and does not constitute legal, tax, or accounting advice. If you have specific questions about any of these topics, seek the counsel of a licensed professional.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help