According to a report by OIG in 2016, nearly 5% of Home Healthcare Providers (about 500 agencies in US) are at potential risk of failing due to compliance and fraudulent activities in their Billing processes.
Government agencies are putting increased scrutiny on Providers’ billing practices in order to improve compliance, reduce human errors and mitigate fraud. These agencies are leveraging modern digital tools to detect fraud and error patterns in billing practices in home healthcare industry.
Organizations such as ACFE point to some common patterns across most compliance failures e.g. incorrect reporting of diagnoses, billing for services not rendered etc. Human errors, mistakes in documentation and misrepresentation of field activities can lead to compliance failures and loss of revenue for providers – even if these mistakes are not intentional.
These issues can be easily addressed with the help modern digital technologies and processes – mobile phone apps, cloud hosted business planning software AND automated field operations workflow to monitor any exceptions in real-time and maintain electronic audit logs.
Here’s a list of three most widely seen problems and how to address them:
- Billing for Services not Rendered: During every care visit, the attendant can collect the member’s digital signature & note via their mobile app as a proof-of-service at the time of service. myGeoTracking provides mobile forms, pictures and signature capture to facilitate this.
- Misrepresenting Dates of Service: Hand written notes and hours logging is prone to errors. Mobile time & attendance Apps combined with a plans-of-care forms can be used to address this issue. Apps can precisely log the date-of-service at the time the service is delivered. The billing department could then rely on this instead of the date that the claim form is signed/submitted (which is usually on a different date).
- Misrepresenting locations of service: use mobile app to geotag all activities at the patient’s site. This realtime location tagging can be further enhanced with automation to create alerts based on scheduled events e.g. late arrival alerts, care-provider absence alerts, entry / exit alerts from patient homes etc. This setup would then ensure that the service is delivered by the care provider OR an alternative arrangement in real-time in case of an absent attendant. All billing reports would now carry a location-tag to ensure point-of-care delivery is consistent with the patient records.
As listed above, smart phone app (or Text and IVR) can be used for easy-to-generate attendance logs, accurate billing reports and audit files for home care service providers. These technologies can help agencies become compliant with State and Federal requirements while also mitigating fraud activities and improving the overall care delivery for members.