The Americare Companies (Americare) provides quality skilled and unskilled home care to the behaviorally and developmentally disabled as well as the general population. In addition to geriatric services, Americare delivers Special Needs, Mental Health and Concierge Services. Americare has been classified by CMS as the best quality home care agency in NY with a star rating of 4.5.
Based in Brooklyn, NY, with over 6,000 home health aides serving approximately 6,000 clients across metro New York City, Long Island, and the greater Hudson Valley, 14 counties in all; Americare is dedicated to outstanding outcomes and a commitment to personalized and individualized care.
Americare operates a Medicaid Certified Agency, a Rehab Therapy company, and the largest private duty agency in New York and contracts with providers throughout the state of New York. Americare provides services under the Medicare and Medicaid programs as well as through Managed Care (MLTC’s), other insurance, and private duty funding sources.
When Michael Mayer, Chief Information Officer with Americare, joined the organization, the company was managing clients and employees with both paper and an older software system for the Licensed Agency. These systems required a tremendous amount of manual intervention which was both labor-intensive and inefficient. As an organization that not only provides short term care themselves, they also have a large network of contracted providers to deliver long term home care services. Because of this, they act as a payer, case manager, and provider. Americare’s environment is further complicated by the fact that additional programming logic is necessary because the episodic payment requirements for Medicaid differ from that of Medicare.
In order to provide the best patient care and stay competitive within the marketplace, Mayer and the executive team recognized the need to strengthen its visibility and oversight to the delivery of services by agencies within the network. Their strategy included enterprise-wide improvements in the key areas of clinical and operational automation, home care visit verification and claims management. Mayer and the Compliance team saw this strategy as the most expeditious way to prevent fraud, waste and abuse (FWA) and drive more profits into the business. What they didn’t realize was the additional tangential benefits this key initiative provided to the organization, the provider network and the patients being serviced.
Americare chose HHAeXchange Professional (Professional), the Payer Management Solution designed for home care, to ensure all communication across different lines of business was seamless. After implementing Professional, Americare had an integrated case management solution allowing insight into all aspects of their contracted provider business, including communication, referrals & authorization, scheduling, caregiver and plan of care (POC) compliance and billing.
Deploying Professional allowed Americare to move from paper to a fully electronic, automated system. The new system created a central repository of information and data, with full tracking and audit capabilities. Americare was also able to validate claims against the system, resulting in a drastic reduction of denied claims and the prevention in fraud, waste and abuse. Through the single claims system, manually processed connections with each provider across the network was no longer required. Today, the providers connect to Americare through a single portal via HHAeXchange.
“HHAeXchange changed the game for us by providing a window into the real-time patient service activities of home care agencies,” said Mayer. “This enabled management oversight like never before.”
Almost immediately after implementation, Mayer’s staff as well as senior administration noticed how flexible the solution was, particularly the new automation for difficult-to-place cases that previously could take hours or days. Care coordinators noted that in the past, placing the cases and authorization changes required many faxes, texts and calls to multiple providers. After HHAeXchange, the providers were gaining acceptance of cases within minutes via the HHAeXchange “uber-like” broadcasting feature. All communications about a member takes place within the solution, providing time stamps with an audit trail, eliminating confusion.
Electronic visit verification and reporting proved to be instrumental to success. The built-in tool provided real-time information regarding missed or late service visits, confirmation of start and end times and access to schedules. In addition to providing an up to date view of all caregiver compliance across all providers, HHAeXchange worked with Mayer’s team to create business intelligence reports. For example, the staff can now run a conflict report to see if a caregiver has billed for the same time through another agency. Mayer and his team has also gained the ability to run scorecards of their best performing agencies across the entire network.
Error checking and validation of claims became a thing of the past after implementing HHAeXchange. Typically, paper claims are riddled with wrong member IDs, DX/billing codes, and denials at the Payer level, requiring significant effort to correct. In addition, setting up a new provider took a significant amount of effort from the EDI group. After HHAeXchange, claims now undergo pre-bill edit checks and will not pass through unless the service reconciles with both the authorization and electronic verification of the visit. HHAeXchange allowed Mayer to redeploy denial reprocessing resources and all paper claims were converted to electronic files for greater efficiency and reporting.
“The shared platform has created a new eco-system for us,” says Mayer. “We now have peace of mind that FWA is being reduced and in some cases, eliminated.”
Americare ultimately decided to implement both HHAeXchange Professional and Enterprise, the agency management solution, for their private duty agency. Members of their network of providers have also opted for HHAeXchange Enterprise. Today, the relationship between Americare and their network of providers has become more transparent and therefore improved significantly. “What was once seen as disparate organizations is now perceived as a partnership and team effort aiming to improve outcomes for the clients,” says Mayer.
Since implementation of the HHAeXchange solutions, the daily census has consistently increased while decreasing back-office staff by 20%, most notably in claims processing, allowing staff to be re-assigned to other areas of the business where they are most needed.
HHAeXchange has become an integral part of the Americare operations. “Our state-of-the-art computer management system enables us to generate many routine and custom reports that monitor performance, verify eligibility, and generate electronic or hard copy billing. A call to our Central Intake Unit is all that is needed to make a referral,” stated Mayer.
The end result is a comprehensive solution from HHAeXchange that manages the business across the continuum of care, adapts to the Americare workflows, and ultimately increases efficiencies without sacrificing high quality client care.