If There Ever Was a Time for Your HHA to Consider Automating Paperwork, Now Is the Time

To say that the lives of home health agency (HHA) operators got more challenging in 2020 would be an incredible understatement. If you run an HHA, here are just a few things on your plate right now:

  • The Centers for Medicare & Medicaid Services (CMS) launched its new Patient-Driven Groupings Model (PDGM) reimbursement process on Jan. 1, dramatically changing how HHAs document and bill for care they provide to Medicare beneficiaries.
  • Then the coronavirus outbreak hit. Declared on March 11 by The World Health Organization as a global pandemic, the outbreak is dramatically changing the role HHAs play in caring for Medicare beneficiaries during a public health crisis.
  • Two day later, on March 13, the Medicare Payment Advisory Commission (MedPAC) released its annual March report to Congress. In it, MedPAC said Medicare “has always overpaid for home health services,” putting even more pressure on HHAs to be as efficient as possible to maintain their margins.
  • Then on March 25, CMS released its annual projections on national health expenditures. CMS said total spending on home health care will jump 73.3 percent to $201.3 billion in 2028 from $116.2 billion this year. That would make home health care services one of the biggest drivers of rising healthcare costs and a target for federal budget cutters.

Against that serious backdrop, thinking about how to streamline your paperwork burden via innovations like automation, digital forms and electronic signatures may seem like a luxury. Yet, they might be what you need right now as an HHA operator to improve your billing compliance, reduce your operating costs, ensure a steady cash flow and, most importantly, avoid delays in getting patients the care they need.

I’m not alone in that opinion. Last December—before the PDGM began, before the COVID-19 outbreak started, before the MedPAC report came out and before CMS released its spending projections—Home Health Care News asked nearly 550 HHA operators about the trends that will drive technology adoption at their agencies. Topping the list of tech drivers was the PDGM, cited by 27 percent of the respondents.

You can download HHCN’s survey results here.

If you thought then that you needed more tech, just think about how much more you need tech now.

Consider the new documentation requirements that the PDGM placed on you. As you know, the CMS started the PDGM will really two goals in mind:

  • The first is aligning reimbursement with patient need. Similar to DRGs for inpatient hospital care, the PDGM created 432 case-mix adjusted payment groups based on patients’ medical condition and treatment needs.
  • The second is reducing fraud. Under a less granular payment system prior to the PDGM, Medicare often overpaid for home-care services, paid for home-care services that patients didn’t need or paid for home-care services that patients never received.

Those two goals translate into greater documentation requirements for you as a Medicare-certified HHA operator. For example, under the PDGM:

  • Physicians have to sign an order authorizing or prescribing home-care services for a patient
  • Physicians have to attest to the fact that they examined a patient face-to-face before authorizing or prescribing home-care services for the patient
  • Home Health nurses have to develop and the physician needs to certify and recertify treatment plans for each home care patient
  • Physicians’ clinical documentation has to support the diagnoses codes used for billing purposes
  • Patients’ medical records have to support the services provided and the codes for those services
  • All of that has to be done every 30 days rather than every 60 days as was the case before

Documentation now requires comprehensiveness, accuracy and speed. With those as your parameters, paper forms, faxes, erroneous data and missing signatures just won’t cut it anymore under the PDGM. They cost you money, and they cost your patients time. I’m sure you or someone you know has driven to a physician’s office to get a signature on the day that a claim is due to Medicare. You’re counting on your car having gas and physician being in. That’s no way to run an HHA.

A better way to run your HHA in terms of documentation is what I call “smart automation.”

Smart automation means looking at every step along the paper trail for each patient and figuring out how you can use technology to automate that step and stop doing it manually. Here are a few ideas based on our experience helping other HHAs:

  • Replace paper forms with digital forms. Every paper form that you use to comply with the PDGM’s clinical documentation requirements has an electronic twin. Start filling them out electronically and sending them out electronically.
  • Use digital forms with error prompts. No different from getting a form kicked back because you didn’t put in your zip code, digital forms will alert you, doctors and other users to a missing field that must be completed to be accepted by the intended receiver.
  • Use auto signatures on forms. Signing and submitting a paper form requires too many steps when time is of the essence for your home care patients. Replace pen and paper (and a trip to the physician’s office) with two or three clicks on a keyboard.
  • Integrate digital documentation into EHR systems. Workflow is everything. Embed your digital forms and your auto signatures into your EHR systems. If your physicians can fill things out and sign them as part of their clinical documentation, their compliance will improve exponentially.

Successfully executing the four steps will take the adoption of new technology, the acceptance of new workflows and training and education for everyone involved.

But, your HHA will see the return on that investment in cost-saving efficiencies in clinical documentation and claims submission, improved cash flow from improved billing compliance, fewer affiliated physicians burned out on paperwork and better clinical outcomes for patients who received the appropriate home-care services without avoidable delays.

It’s time for your HHA to automate.


Christina Wong is a senior product marketing manager with Docusign’s healthcare and life sciences business unit.

Related: Download Docusign’s brief on reducing the paperwork burden on home care and hospices.