Tips for Billing Managed Care and Commercial Insurance in Home Health – Home Health Care News

Historically, the home health industry has been driven largely by Medicare payments, and agencies have been hesitant to turn to managed care and commercial insurance to generate additional revenue.

It’s understandable, as the process to seek and secure payment outside of traditional channels can be overwhelming, said Lynn Labarta, CEO of iMark Consulting, a home health and hospice billing company. but considering that some agencies you’ve worked with have seen revenue increases of 20% to 30% by overcoming fear of alternative payment sources, it’s certainly worth it, especially as medicare increases regulations and measures of compliance.

Reading: How to bill insurance companies for home health care

“Because of all these changes, it’s really important to consider alternative sources of income,” Labarta said Wednesday during a Complia Health webinar hosted by Home Health Care News.

As such, it’s time to start contracting with commercial and managed care insurance companies and processing claims for a larger swath of patients, he said. The following are tips to keep in mind to maximize payment diversification.

contracting with insurance companies

Home health agencies must first identify the specific insurance carriers they would like to partner with, if they wish to become in-network providers.

– find out which insurance companies operate nearby. there will be big players like aetna or blue cross blue shield that are more obvious, but there could be smaller and more local companies that could also be great recruiters.

– Apply online through the company website or call directly to begin the enrollment process. It will take time, Labarta said, but the application process is not complicated.

– Ask insurance companies several important questions, including whether they accept electronic claims, what are the appropriate filing deadlines, and what type of claim form to use. this type of information is not always in the contract, according to labarta.

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– ensure staff are informed and trained on accepting commercial and managed care plans.


Determining a patient’s eligibility for services at a specific home health agency is equally important and the next step in billing managed care and commercial insurance companies. Failure to properly complete eligibility checks could result in services being provided that are not covered and will not be reimbursed.

– understand the difference between commercial insurance and medicare hmos. “Knowing the type of insurance plan that the patient has will help you understand the process that you are going to follow in the office,” said Labarta. Also, try to get a copy of the patient’s insurance card, so workers can identify plan type and process billing accordingly.

– Since many plans don’t cover home health care, ask insurance companies if they do. Also determine if companies accept claims from out-of-network providers. these pieces of information help agencies make a decision about whether or not to admit a patient.

– find out if the insurance company requires authorization. Most commercial insurance plans will require authorization, while most Medicare hmos do not, according to labarta.

– identify patient deductibles and copays. it’s up to home health providers to collect both, so it’s important to be aware of what you owe.

billing process

Controlling the billing process can mean the difference between claims being approved and denied.

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– avoid paper billing, if possible. electronic invoicing is the most efficient, labarta said, but requires agencies to follow certain protocols. For example, some insurance companies require providers to fill out an electronic data interchange (EDI) application if they use their own software. otherwise, claims can be submitted through a clearinghouse or directly through the company portal.

– pay attention to timely submission deadlines. Agencies need to know when it’s too late to file a claim and set up billing cycles that make sense for the type of insurance, Labarta said. for commercial insurance, weekly or monthly billing would be beneficial, while for medicare hmos, episodic or monthly billing is more reasonable.

– Track submitted claims within two weeks. Without a timely follow-up process, home health agencies will run into reimbursement issues and cash flow problems, Labarta said. The key is to have billers who are properly trained and familiar with every step of the insurance company billing process. follow-ups can be done by phone or online.

denial management

Until processes are fine-tuned, denials are inevitable, so home health agencies need to manage them accordingly and use mistakes as learning opportunities.

– make a phone call to determine exactly why a claim was denied. Since most denials are related to billing errors, there could be an easy fix once the errors are identified, labarta said.

– Submit corrections within seven days to avoid missing submission deadlines and losing payment altogether.

– prioritize follow-up efforts. Since the goal of billing for managed care and commercial insurance is to generate more revenue, it’s crucial to see claims through to completion. deal with the easiest to fix first or those with the highest dollar volumes.

written by kourtney liepelt

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