2023 Is the Year of Changes for the Healthcare Industry
As we progress through 2023, the healthcare industry is experiencing significant transformation. This year marks a pivotal moment for home health medical billing services and coding, with new trends emerging that can greatly benefit revenue generators. Understanding these trends and adapting to them will be crucial for success in the field. Below is a summary of the key trends impacting the home health medical billing service revenue cycle.
Medicare Fee-For-Service Challenges
The discussions surrounding proposed cuts in 2022 have resurfaced in 2023. While the Centers for Medicare and Medicaid Services (CMS) have not yet enacted these proposed cuts, they are planning to recover perceived overpayments associated with the Patient-Driven Groupings Model (PDGM). This approach aligns with the Medicare Payment Advisory Commission’s perspective that home health agencies may be overcompensated.
Healthcare providers have expressed concerns, highlighting ongoing staffing issues, rising inflation, and increasing operational costs. A glimmer of hope for medical billing services lies in the omnibus spending bill passed in December 2022, which mandates greater transparency from CMS in its decision-making processes. However, some experts, as reported by Home Health Care News, suggest that legal action may become a necessary recourse.
Increasing Complexity of Patient Conditions
As the baby boomer population ages, the demand for home health medical billing services is expected to rise, leading to more complex patient conditions. A report from WellSky in May 2022 indicated that home health referrals surged to 123% of their 2019 figures. This increase is largely attributed to the COVID-19 public health emergency, which underscored the importance of home health services for infection control.
Although referral levels may not remain consistently high, there is still potential for growth, especially with the legalization of the Choose Home Care Act of 2021, which supports the shift towards home health services. However, staffing challenges persist, with rejections in home health claims rising to 71% due to limited staff capacity. The growing demand for services will be of little consequence if providers cannot effectively address these staffing issues. Notably, the obesity rate among skilled nursing facility (SNF) residents rose by 11% in 2022, while complications related to diabetes and hypertension increased by 34% and 25%, respectively.
Impact of the Home Health Value-Based Purchasing Model
The introduction of the Home Health Value-Based Purchasing (HHVBP) Model, effective January 1, 2023, adds further pressure on home healthcare billing agencies. As patient complexities rise, providers who have not yet embraced value-based care may find themselves compelled to adapt. The first performance year has commenced, signaling a significant shift toward value-based care within the industry.
Leading experts predict that 2023 will mark a turning point for value-based care acceptance. Organizations like Humana have emphasized the importance of home health in their value-based care strategies, while Aveanna, a provider of home health and hospice services, has reiterated its commitment to this approach long-term.
Despite delays in the national expansion of the HHVBP due to pushback from a segment of the industry, revenue cycle leaders should anticipate significant investments of time and resources in 2023 to update home health billing and coding practices in response to these evolving challenges.