Are you struggling to streamline your home health billing services? Is your facility suffering from claim denials? Do you have a monumental accounts receivables pending?  

Home Health Billing can be a strenuous task. Without proper billing and coding knowledge home health bills will get rejected by insurance payers. Also, the rising demand for home health services further increases billing complexities. As a result, about 10% to 15% of home healthcare claims end up in denials. That significantly affects their revenue cycle with increasing account receivables. 

Also, in a recent report on home healthcare and reimbursements, it is seen that – 

• CMS estimates a 0.5%, or $85 million growth in Medicare payments to home health agencies (HHA) in 2025 compared to last year. 
• In 2023, the home health market reached a striking $100 billion. However, they lose 3-5% of revenue due to billing errors. 
• In 2022, home healthcare in the US was valued at $142.9 billion and is anticipated to grow 22% by 2032.  
• 77% of home health service providers reported delayed reimbursement due to nominal billing errors. 
• 74% of providers stated they need to appeal for reimbursement multiple times which affects their revenue cycle.  

Hence, we can understand from these statistics not only contribute to a significant workload for in-house staff but also disrupt billing operations. This affects the overall functionality. Also, often the lack of proper updated billing knowledge ends up resulting in claim denials that hinder the revenue cycle.  

So, what are the signs that suggest home health providers must outsource billing to ensure timely reimbursement without the stress of administrative burden? 

Staff Working Under Huge Administrative Burden

If your staff are continuously working but can’t finish their pending tasks on time, it states that you need outsourced specialists. Home healthcare staff need to perform several tasks that include billing, coding, documentation, pre-approval, claim submission, and appeal. Each of these tasks requires optimum expertise. In-house staff often lack this all-round knowledge. Therefore, hiring an outsourced medical billing company significantly reduces their administrative burden. Moreover, they ensure maximum reimbursement right on time. 

Hindered Patient Outcome

The primary focus of home healthcare providers is to ensure the finest patient care. Billing and coding difficulties make their job more hectic. When they spend their working hours fixing and resubmitting denied claims, they can’t focus on healthcare services. It declined the overall efficiency of the home healthcare provider. Moreover, many patients get delayed treatment due to claim denial on initial submission. Here, outsourced home health billing service offers their efficiency. They efficiently eradicate billing errors. Hence, providers get reimbursements on time. Furthermore, when they take care of billing and denial management, in-house staff can concentrate on caregiving. 

Unavailability of Prior Authorization expert

Prior authorization is one of the most crucial steps to ensure maximum and timely reimbursement. Home health billers need to submit all documents with accurate medical codes to establish the necessity of prescribed treatment and supplies. However, industry data shows that payers reject about 5-10% of home health claims due to prior authorization errors. The outsourced home health company has prior auth professionals with the in-depth knowledge and understanding to secure the maximum approved amount. So, they can significantly reduce pre-auth errors and ensure the patient gets maximum coverage. 

Claim Denials Due to Coding Errors  

Home health coders must have in-depth knowledge of updated CPT, HCPCS, and ICD-10 codes. As per our observation, up to 23% of submitted claims are rejected due to coding errors. Due to administrative workload in-house coders often miss out on the latest coding updates by CMS. As a result, home healthcare providers lose approximately $20 billion every year. Here, the expertise of outsourced medical coders ensures optimum perfection. They follow regular updates related to any coding and regulatory changes. Hence, they can efficiently eradicate this large number of claim denials due to wrong coding. 

Higher Claim Denial Rates

Claim denials are the worst nightmare for home health billers because denial management significantly increases their workload. When they appeal denied claims they must appropriately identify and correct all errors before resubmission. Also, they must resubmit the claim within ATFL (Appeal Timely Filing Limit). The ATFL varies per payer. Hence, billers must have a thorough knowledge of payer policies. In-house billers often miss out on these details which leads to claim denials. Here, the expertise of outsourced billers comes to the rescue. They can instantly identify billing errors and resubmit them with rectification within the same day. It ensures reduced denial rates and improved cash flow. 

Moreover, Outsourcing home health billing services has several benefits, such as –

Outsourced billing services employ specialized experts to perform different medical billing tasks. Hence, they have thorough insights into every process associated with home health services. Outsourcing offers the following benefits to home healthcare providers – 

• Third-party billers offer the highest productivity by eradicating errors 
• Specialist home health billers ensure 99% billing accuracy 
• Outsourced billers secure the maximum pre-approved amount 
• Engaging outsourced billers saves approximately 80% more cost than in-house staff 

So, outsourcing home health billing is thoroughly beneficial for both providers and patients. When third-party billers address all billing and coding requirements, in-house staff can focus on their primary task, i.e. offering top-notch healthcare. Moreover, outsourced billers will eradicate claim denials and minimize accounts receivables. This way, home health providers can maintain a healthy revenue cycle with improved patient care.