Home Health & Hospice Week

Ask any agency which billing scenario it dreads the most and you'll likely get the same answer: patients who transfer from one agency to another during their episodes.

Bad: Whether you receive a patient from another agency or your patient transfers out, you could be on the losing end of payment. That's because the initial agency could claim it provided services for the full episode even if the patient transferred out before the 60-day period expired. Similarly, the receiving agency could provide services at the tail end of that episode but reap full payment simply because you can't prove otherwise.

Better: You can easily smooth out any wrinkles in your patient transfers and ensure you reap your rightful reimbursement for the services you provided. Here's how:

If an agency takes on a patient who is transferring from your agency, you should know about it -- preferably from the agency that accepted your transferred patient. However, your patient and her caregivers may not tell the new agency about what services they've been using, or the new agency might not be able to find you.

This means you may not find out that your patient transferred until your payment goes missing. "Agencies often don't know their patient has even transferred until they submit their final claim and it is denied for overlapping," says Rose Kimball with billing company Med-Care Administrative Services in Dallas.

Worst case scenario: Sometimes agencies don't figure out until much later that a transfer is what caused their [partial episode payment (PEP)], relates consultant Aaron Little with BKD in Springfield, Mo. In some cases "a beneficiary transfer situation ... was not known until over a year after the transfer occurred," he warns.

But just because you don't find out until later that your patient transferred to another agency doesn't mean you shouldn't get at least the partial payment -- even if that doesn't fully cover all the services you provided.

Do this: You can get at least a portion of your reimbursement, but you must act fast. As soon as you discover there's a problem with a patient's transfer, you must initiate the dispute process --otherwise, you may be shut out of billing altogether.

Even if a receiving agency performs all the steps necessary to complete a transfer, it might still find itself in the middle of a transfer dispute.

However, your agency can prove it has performed its due diligence -- and that it deserves payment -- simply by providing the right pieces of information, according to Cahaba.

Key: You must immediately provide your patients with your notice of patient rights on Medicare payment liability, Cahaba outlines. The minute you give that information to your incoming patients, you begin an episode and are guaranteed your rightful payment, the RHHI says.

If you fail to provide patients with that notice, your request for anticipated payment or final claim  may be cancelled and the full episode payment will go to the first agency -- leaving you empty handed.

Try To Resolve Disputes On Your Own The Centers for Medicare & Medicaid

Services wants you to arbitrate disputes for yourself  before you bring in your regional home health intermediary. "The initial HHA must make at least three contacts with the receiving HHA," according to Cahaba's guidelines. If the receiving agency doesn't respond or you can't resolve the dispute, you can then escalate the process to your RHHI.

Best practices: Each time you reach out to a receiving agency, document the date and time that you called, as well as the name of the person you contacted. This record will show that you made the attempt to work out the dispute on your own.

And while you may not think it necessary for a patient to be re-admitted to another agency after your agency discharged him, that doesn't mean you can dispute it. "When there are no overlapping dates of service between the date of discharge and second admission date," a transfer dispute does not exist, Cahaba points out.