New Home Health Agency Contracting

[Tender HH RN]

Hello, I searched for topics that are related to my situation and could not find any so sorry in advance if there is a thread that answers this. I am completely new to forums so forgive any mistakes I may make. I started a new home health agency and we are in the process of getting Medicare certified. We are still waiting on our CMS 855A to be approved and have yet to be surveyed by JCAHO for deemed status. Therefore, our wait time to become Medicare certified is still pretty high and our resources are running out.

In the meantime, we have been trying to contract with PPOs, HMOs, and other managed care organizations but most are either closed or require Medicare certification or JCAHO accreditation in order to get some sort of reimbursement.

We have already learned that we can subcontract with a pharmacy to get some payment for visits, as they will bill the insurance or health plan when you cannot but that would only be for IV patients.

Does anyone know any other way we can get reimbursed for services without being Medicare certified? Any advice on this matter would be fantastic. Thank you :).

[4evernrs]

What about offering private pay / private duty services? Life insurance assessments? Try CareLink. You might also consider staffing contracts (temp staffing) to get you over the hump. Good luck to you!

[Tender HH RN]

First, thank you so much for your reply. We have definitely looked into private pay. Private insurance is one option but we can't bill for most until we're Medicare certified. Have you ever dealt with out of pocket patients? Would you have any advice on how to obtain patients like those?

I am not familiar with life insurance assessments nor staffing contracts, how do those work exactly?

[4evernrs]

I may have misspoken about the staffing contracts - I'm not 100% sure about the licensure requirements for that, but I would think that a home health agency license would also cover licensure as a nurse registry (staffing). Life insurance assessments - I can only think of one company at the moment, which is Carelink. Basically, they pay for nurses to go out to patient's homes and complete evaluations to help determine eligibility. Private pay - advertise anywhere and everywhere: churches, bingo halls, MD office lobbies, etc. You will want to have patients pay up front for private services - at least until they are established and you are relatively confident that they are going to pay you. Credit cards are great if you are able to take them. Good luck!

[KateRN1]

Sadly, for the most part, until you get your accreditation and certification, you will be operating in the red--far in the red. You may recoup some with private pay home health aides, but that is another headache. It's hard to find good CNA/HHAs that show up on time, behave appropriately, document well, and take good care of the patients. And since the patients are paying out of pocket, they expect to be catered to, so that can be another hassle. I've seen a lot of CNA/HHA turnover, lots of call outs, time spent orienting only to have them quit in a month or two because another agency pays $1/hr more. Good luck, it's a hard business.

[Tender HH RN]

Kate - I know, I'm seeing that now and its depressing. We actually have not had a patient with the need for a home health aide, do they usually last a full episode?

4evernrs - thank you for the advice. I will definitely be doing some heavy marketing.

[KateRN1]

Private pay home health aides do not have to meet Medicare skilled criteria since they are not providing skilled care, therefore have no ties to the 60-day episode. They are basically just contracted to provide what the client needs, whether companionship, cooking, light cleaning, bathing, dressing, etc.

[NRSKarenRN, BSN, RN]

Your business plan for start-up of HHA should have accounted for 3yr timeline to break even/make a profit and allow you enough cashflow to permit operations before payments start trickling in.

Medicare requires that you accept first 10 patients without payment; they will evaluate you for care provided and meeting COP's prior granting Medicare approval --process taking about 1 1/2-2 + yrs depending on # MC reviewers in your area.

State approval for Medicaid payments is usually easier to accomplish and can be an entrance into market. Check state DOH website for info. Once MA certified, other insurers often will sign-on.

Sign up for a Home Health newsletters: Eli Homecare Week or Decision Home Health Line that can help you learn and grow your business and keep abreast of changing healthcare regs. Both have websites and discussion forums.

[Tender HH RN]

Awesome links, thank you Karen. We actually did look into Medi-cal but they do not do separate surveys for those. Forgive me, I'm very new to this but what is the exact difference between something like Medi-cal and Medicaid?

[caliotter3]

Medi-Cal is the California version of Medicaid. I think it is called Badger Care in Wisconsin, just saw something like that recently.

[Tender HH RN]

Got it, thank you!