Stay Ahead of Payer Changes Using Your Home Care Software

The frequent payer and regulatory landscape changes in home care make it hard to know when and how to place bets. We can’t win every time we try to negotiate a higher rate, but we prepared a few tips and insights that can help you achieve better outcomes for your clients. 

Be intentional about who your partners are.

Specific payers have set reimbursement cycles, some of them will fit with your business—others won’t. Here’s a way you can test the waters: 

• Will this take up enough time than you and your team have bandwidth for?
• Let’s say you get a referral today, is there ample opportunity for future growth?
• Does their reimbursement cycle work in parallel with your business needs and at a fair rate? 

If you said yes to more than 2, this is likely an opportunity that’s worth your time. This isn’t just a one-off exercise, but you should repeat this at least every six months if not more often. 

As a quick audit, pull a payer report in your home care software to see which payers are pouring into you the most. This can help you shortlist the payers that are most worth the time and effort, and where you could potentially shift priorities in the future. 

In addition, financial stakeholders across the aisle in healthcare also agree, “We’re seeing an uptick in the volume and velocity of payer policy changes, updates, requirements and terminations. It’s a tremendous amount of information to stay on top of, especially if you’re trying to do it manually,” shares J. Scott Milne, Senior Director of Product Management at Experian Health. 

What payers have you enjoyed working with the most? Let us know why!

Use fee schedules as an outline for your marketing and sales outreach.

If you look at fee schedules for your area, find out the best tasks and service highlights you can share to optimize your rates. 

For example, rates may differ between transportation visits than a bath aide or personal care services. This doesn’t mean that you hide or don’t offer services, it just means presenting information that highlights the value your agency provides to referral partners and payers. 

You can also analyze these trends year-over-year by referencing fee schedules from previous years. Did one rate increase 3% while another service increased 5%? This indicates a higher year-over-year valuation of the services that you offer, whether that’s a VA Community Care network offering or choosing to work with a certain Medicaid Waiver program. 

One way you can do this is by pulling a billing rate report by payer in your system and seeing year-over-year which services are increasing. A full fee schedule might have irrelevant services and codes that don’t pertain to you like home health, etc.

Align your agency management system and operations around what payers care about. 

These priorities can change often, but here are a few core topics that health plans and payers across the healthcare continuum are paying attention to. 

Honesty and transparency

This means ensuring that your privacy and security measures are up to date. It also begs the question: How are your services improving the quality of life for your clients as well as saving payers (in terms of preventing unnecessary care utilization, fall prevention, lowering readmission, etc…)? This is something that not all providers are able to quantitatively or quantitatively answer, and something we should continue to ask in the years to come. 

The need for technology and proper integrations

Many tasks at the administrative level are time-consuming and often take away from time that could’ve been spent with clients, caregivers, or developing relationships. Make sure that you are using a home care software system that integrates with programs that you need access to, makes scheduling easier, and reduces clicks across the board. 

Streamline operations in line with labor issues

When you think about growing your caregiver and client roster, it’s important to have processes, procedures, and technologies in place that make your (and your team’s) life easier. With a tight labor market, make sure that you have the right people in the right seats and the right resources to support them. 

Prepare for more diverse client populations

Home care has traditionally been about seniors/older adults, but the total market for home care services is a much larger group of people. Did you know that 1 in 4 Americans are living with a disability? 

Demographically, the US is becoming increasingly diverse, requiring more diverse cultural care considerations from home care agencies and other auxiliary care providers. Make sure this is a key consideration as you build care plans and manage caregivers. 

Lastly, if you consider clients who live in rural areas, they may have no-call-no-shows or late arrivals than other clients. This disparity doesn’t have to persist. If you are unable to offer higher wages, you may also want to consider offering virtual care visit options to remove barriers to accessing care. This also allows you to streamline the use of your care staff without going past their desired mileage from home.

This is only a starting point to help you unravel the priorities that payers have and not an exhaustive list. 

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At CareTime, we have in-depth expertise in home care and are closely following the legal and payer landscapes to deliver the most up-to-date information to you. 

We recently covered: How does the 80/20 Rule impact home care? 

The 80/20 rule hasn’t been put into effect yet, but in the article, we share tips and insights that can help you prepare for this legislation that may be pushed through.

Our goal as a home care software vendor is to be your partner, not just a platform. Our success means helping you succeed, and that starts during our first call thorough the entire duration of your service with us. 

Stay up to date on the payer landscape for your agency’s success.

The home care payer landscape is complex and we hope this article provided you some clarity as to what you should do to stay ahead. Whether you’re selecting payer partners or trying to align with current payer needs, make sure you’re using a home care software that’s built to support your goals. 

If some of these tasks are burdensome or the reports are hard to find, consider switching to CareTime V3 today. Out of the box, it comes with advanced billing features you never knew you needed like automated rules engines, a complete EVV and claims dashboard, and last but not least: billing while you sleep. 

Let us know how you’re going to stay on top of the home care payer landscape in the years to come.