Since moving to prospective payment from cost-based reimbursement in October of 2000, our research has shown that many providers with in-house home health agencies have been under-reimbursed. One reason for this is due to the complexity of the billing procedures.

The effect of such a complete change in reimbursement methodology in such a short timeframe was manifested in billing departments nationally. Typical results were:

• IT departments and/or vendors were not able to modify their billing systems appropriately and in a timely manner.
  
• The elimination of Periodic Interim Payments (PIP) caused immediate financial pressure on most Home Care Agencies.
  
• New requirements such as a Request for Advance Payment (RAP) have not provided the expected flow of funds necessary to the Home Care Agencies.
  
• Failure of Medicare payment remittances to reconcile to check totals.
  
• Breakdowns in timely submission of claims for payment or timely follow-up of rejections because of unfamiliarity with new terms(SCIC, PEP, RAP, LUPA, etc)
  
  In the past few months, at the request of several of its clients, Healthcare Affiliates, Inc. has reviewed Home Care Agency reimbursement and identified specific areas of opportunity to increase reimbursement with retroactive and prospective applications. Utilizing our extensive database, we have developed a profile for candidate hospitals that could potentially receive additional home health care reimbursement from the identified areas.
  
  Recently, HAI hired Ronald Wood on a temporary basis to train our staff to manage these engagements. He is the former CFO of the largest home health organization in the MD/DC/VA area. Ron first detected the problem and has developed a means to correct it.
  
  Whether the problem exists at your facility, should be determined. In order to make this determination, HAI would visit the Hospital and conduct a sample survey. HAI will then extrapolate the results in order to make a fair judgment as to whether the project should continue.