During the first year of the Obama Administration, healthcare reform is once again at the forefront of conversations taking place in the halls of Congress and in neighborhood coffee shops. Cutting payments to home health care providers is one of the “solutions” under discussion.
It is this publication’s editorial position that home health care services, whether reimbursed by Medicare, Medicaid, insurance or the patient, avoid the need to provide care at other, higher-cost venues. Cutting payments to efficient, law-abiding home care providers can only raise the nation’s overall healthcare bill.
It is our position as well that indiscriminately denying and recouping Medicare payments from well-meaning home care providers is the wrong way to control healthcare costs. Though there is a small percentage of fraud plaguing our industry, it involves sufficient total dollars that an organized effort to control it would produce more significant savings than adding a third, redundant layer of scrutiny.
Penalizing good providers for committing unintentional errors while documenting otherwise excellent, necessary care will only result in damaging their ability to provide that care. A better government effort would be one that identifies coding and documentation sloppiness and provides remedial education instead of financial penalties.
Lastly, it is the position of this publication that Congress made a serious error by establishing Recovery Audit Contractors with a percentage-based financial incentive. To support the need of these private, for-profit corporations to expand and train staff, lease additional space, purchase office furniture, phones and computers and pay executive salaries, they are going to have to deploy aggressive efforts and develop broad definitions of “medically unnecessary.” Overreaching efforts are not only possible but likely.
To keep contractors honest and encourage providers to improve clinical and administrative practice, this publication will print good news and bad news about payment denials and overpayment recoupments. For this, we will rely heavily on reader input.
Some criminals wear masks, some wear suits and ties and some wear white coats. If you are a home care provider who constantly strives to provide excellent care while remaining compliant with regulations but find yourself competing with others willing to bend or break the law; if you are subjected to payment denials or RAC audits that seem to be less than reasonable, tell us about it. Shining a light on the types of activity that can damage our important healthcare segment is the best way to stop it.
Tim Rowan, Editor
