Medicare Compliance & Reimbursement

5 tips keep you in the black and off the feds' radar screen.

It's time to put on your detective hat and follow the benchmarking clues to better costs and outcomes.

Comparing yourself to your peers can give you a big signal of what you need to work on at your home health agency (HHA) to boost profit and improve your patient outcomes and clinical practices, advises consultant Karen Vance with BKD in Springfield, MO.

And one of the most important numbers to monitor is the average number of visits per episode, Vance recommends. "You want to watch [this number] very carefully," Vance urged in an Eli Research teleconference on clinical management and benchmarking earlier this year. "It is the one number over which you have the most influence and control. [And] it gives you most directly what your average cost is."

Beat them to the punch: Besides furnishing you with critical operational, clinical and financial information, the benchmark may keep you off authorities' radar screens. Medical reviewers, federal investigators and even surveyors use visit utilization to target providers for further scrutiny and investigation, experts warn.

Here are Vance's tips for using average visit per episode benchmarking to thrive under the prospective payment system:

1. Compare yourself. First determine your own average visit per episode number. Then benchmark that figure against both your own earlier-period numbers and your peers' numbers for the same period, Vance recommends.

Where to find it: HHAs can obtain benchmarking reports from a variety of companies (including a report offered by Eli Research and BKD).

2. Compare apples to apples. It's important to know what data the report you choose compares, Vance cautions. If you try to compare your numbers against others that don't include the same information, you'll never get an accurate picture of your performance.

Some reports offer data only from agencies that subscribe to a service, while others use cost report data from all HHAs. Reports that contain cost report data will be more inclusive, but also will contain older data due to the delay in the collection and release of cost report information.

Examples: All Missouri Medicare agencies had 16.19 visits per episode in 2003, according to a report compiled by BKD from cost report data for that year. In comparison, 152 agencies using The Analyzer software system from VantaHealth Technologies saw average visits per episode of 19.00 in 2005, according to a presentation by Roberson, Muck & Associates at the recent annual meeting of the Association for Home & Hospice Care of North Carolina in Durham, NC.

The Analyzer data didn't include low utilization payment adjustments (LUPAs) while the BKD information included all episode adjustments. Be aware of crucial differences like these when you do your own numbers comparison, Vance urges.

3. Investigate. [...]