Two Roadblocks in the Era of Consumer Directed Service

January 12, 2017| Blog, CDS

Consumer Directed Service (CDS) is not new to the home care industry, yet it’s becoming a focal point in 2017. Home care members are continuing to leverage family members as primary home care providers, and, as a result, are facing payroll and visibility issues.

An upcoming HHAX survey highlights the continued role of CDS, as more than 60 percent of respondents indicated they have used a family member as a primary home care giver.

While leveraging family can be a necessary and useful way to receive convenient in home care, particularly for members in rural areas, it also results in a couple of significant issues for payers and providers.

Check Your Costs

Administratively, many home care providers are wasting significant money on payroll for hundreds of family caregivers. With costs as high as 30 dollars or more for CDS payroll checks every period, home care providers are spending significant money that could be saved. Read More

Home Health Care News: Addressing OIG’s Characteristics of Home Health Fraud — Without Toppling the Whole System

January 9, 2017| Blog, Health Care, Homecare, Payer, Provider
Posted by Home Health Care News; contributed by Tom Meyer, HHAeXchange

The numbers don’t lie.

After more than 10 years serving in the New York Office of the Medicaid Inspector General, including as the Acting Inspector General, I can attest firsthand to the unfortunate instances of fraud, waste and abuse that occur with too much regularity in home health care and home care.

Between 2011 and 2015 alone, investigations from the national Office of the Inspector General (OIG) resulted in more than 350 criminal and civil actions and $975 million in receivables. In fact, the OIG estimates more than $10 billion in improper payments in the 2015 fiscal year.

In spite of the numbers that point to the need for improvements, home health and home care play a vital role in the broader healthcare ecosystem, and increasingly, states are relying on managed care organizations (MCOs) to deliver efficient and effective Medicaid programs. For MCOs and state Medicaid programs alike, the balance between preventing fraud and continuing to provide quality care is a delicate one.

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Moving Forward in 2017: Top Trends and Predictions

December 22, 2016| Blog

We’ve reached an inflexion point in the home care industry, and the coming year is likely to result in several major steps forward in the areas of technology, quality and structure in the industry.

Over the past year, Medicaid payers at the state and Managed Care Organization (MCO) level have begun to realize the value of a continued emphasis on collaboration to ensure better member care. As part of this shift, stakeholders within the home care industry are placing increased value on communication and collaboration as it relates to compliance and better care.

This shift in sentiment is sparking change in several areas. As we gear up for 2017, there are noteworthy industry trends that are hold outs from last year that we can expect to stick around, and some new trends that will play a prominent role within the industry. Read More

CURES Act’s EVV Mandate for Home Care is the First Step

December 16, 2016| Blog, Compliance, Homecare, Payer

In an industry where issues of mistrust and system abuse often rule the headlines, family and friends want reassurance that their loved ones are being provided with proper care. Government programs, like Medicaid, need accountability for the money they pay out, and proof positive that members are receiving proper care and caregivers are being held accountable. Electronic visit verification (EVV) alone doesn’t solve all problems, but implementing an EVV system is the first step to combatting fraud and abuse to ensure program integrity.

Signed into law this week by President Obama, the 21st Century CURES Act mandates, among other actions, that EVV be used for in-home visits for home care and personal care visits.

While EVV is an effective monitoring tool for tracking arrivals and departures – thereby reducing false claims of time spent with a member – it only goes so far. Capturing and tracking data from an EVV solution won’t help Medicaid payers reduce readmissions unless they actively manage the process and consider a collaborative and transparent home care platform.

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Why home care is more important than ever before

December 1, 2016| Blog

This November, we joined the rest of country in celebrating National Home Care and Hospice Month, and with it came a renewed focus on the ins and outs of home care, why the need for quality care is growing and the situations facing home care members. At HHAeXchange (HHAX) we are constantly seeking better outcomes for members, and November is another reminder of the importance of improving the quality and efficiency of today’s home care.

According to U.S. News and World Reports, there are more than 40 million Americans age 65 and older, comprising 13 percent of the population in the United States. The dynamics are changing, and aging generations are uncomfortable with nursing homes. The preference of many baby boomers has shifted toward home care, which allows them to age in place and be independent for as long as possible. Read More

Ensuring Compliance

September 29, 2016| Blog, Compliance, Payer, Provider

Solving the Most Common Compliance Problems

HHAeXchange’s web-based software platform dynamically links payers and providers — creating a shared environment to effectively interact in real-time allowing increased operational efficiency.

Benefits include: Read More

How does a Verification Organization benefit you?

September 21, 2016| Blog, Payer, VO

Verification Organizations (VOs) have helped to reduce fraud, waste, and abuse in New York State. HHAeXchange achieves this by employing an integrated, shared-platform that allows full visibility to your provider and MCOs’ activities.

More specifically, you could view processes such as:

  • Electronic Visit Verification (EVV) Processing
  • Scheduling  vs Confirmed or Unconfirmed Visits
  • Billing Read More

Status of House of Representatives Bill 2446

September 6, 2016| Blog, HR Bill 2446, Payer

HR Bill 2446 was rolled into section 207 of HR 2646 and passed the House by a vote of 422-2 on July 6, 2016.

  • There were some Medicaid provisions in the Mental Health bill and therefore, to incorporate the following items
    • EVV vendor neutrality clauses were added
    • The scope was expanded from PCA services only to include home health services as well

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What is a Verification Organization?

August 23, 2016| Blog, Payer, VO

In 2011, the New York Office of the Medicaid Inspector General (OMIG) passed into law a measure that required home health providers who exceeded $15 million in Medicaid and/or Medicaid Managed Care reimbursements to utilize a Verification Organization (VO). A VO is an entity that analyzes data captured by Electronic Visit Verification (EVV) software to verify that services billed to Medicaid are legitimate and were provided to an eligible Medicaid beneficiary.  In addition, the VO utilizes this data to prepare an assessment of each selected provider to ensure that their processes are compliant with CMS and state guidelines. This also educates organizations on how to improve their compliance processes.  Read More

Is Your CDS Program Working for You?

July 21, 2016| Blog, CDS, Missouri, Provider
Managing your consumer-directed services (CDS) program can be easy.

HHAeXchange’s (HHAX) comprehensive and fully integrated solutions that will not only save money, but ensure you keep the money you are paid.

Experience the ease of simplified payroll and EMOMED billing. With HHAX solutions you’re always in full compliance with the state. Read More