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How to Keep Your Home Health Care Agency Compliant

Doctor holding a stethoscope while crossing his arms

Home health care providers cover many medical needs and help many patients live more comfortable lives. Medicare pays for most of the costs of these services, which is why providers have to adhere to set standards. It’s crucial to know these standards to prevent adverse consequences for your healthcare business.

Medicare/Medi-Cal Enrollment and Changes of Ownership

You will need to check the different enrollment options if you are planning to sell or buy a home health care provider business. As a part of the change in ownership, you will need to submit a “Successor Liability with Joint and Several Liability” document. You’ll also have to provide complete information about the business.

Change in ownership counts as those who have more than 50% ownership of a company. In cases where there are minor changes in the ownership infrastructure, the business only needs to disclose it. Failure to follow requirements can mean delays or disapproval. Having legal help can improve your chances if you’re unsure of the requirements.

HIPAA/State Patient Data Privacy and Security Requirements

The transition from paper to electronic documentation for patient data has revealed vulnerabilities in information keeping, leading to the establishment of The HIPAA Data Privacy and Security laws. These laws protect any identifiable information of patients and require all health care providers to exercise security measures for any electronic documents. The general rules that govern are as follows:

  • Ensure availability, integrity, and confidentiality of all electronic health information.
  • Protect against anticipated disclosures with no permission.
  • Protect against potential security threats.
  • Ensure that the workforce complies.

From the management of documentation to personnel, home health care providers need to be HIPAA compliant. Failure to comply can result in legal repercussions.

Licensing, Operational, and Reimbursement Compliance

Stethoscope on top of patient documents

One major part of the success and unity of the healthcare system is compliance. All health care providers should have complete licensure requirements to show they are up to date with current standards. It includes all manner of certification that helps the provider run their operations.

In cases where a provider encounters a compliance issue, a legal team is necessary. Lawyers can help create action plans to improve the chances of a business maintaining or renewing its license. They can also help when it comes to reimbursement protocols. Reimbursement can stem from professional or personal disputes.

Marketing Practices and Business Development Compliance

Marketing in the health industry operates on a much different level compared to other businesses as many of the popular methods of marketing go against the regulations set by HIPAA. The vendors you work with need to sign an agreement, and you’ll need to adhere to data security measures.

You are also limited to targeting patients that fit in with home health care and cannot target the general public. If you use unapproved tools and measures, you could end up with fines or worse. If you want to set your marketing for compliance, you’ll need legal help to verify that all of your efforts fall in line.

Prepayment Review Corrective Action Plans

On occasion, a healthcare organization may need to undergo a prepayment review. These reviews examine your documentation and your current billing practices. These usually happen if your business encounters a claims process. It will take around six months, and you’ll have to submit the necessary documentation for each claim. HIPAA will then observe the following:

  • If you followed Medicaid policy
  • If you delivered the appropriate treatment
  • If the services remained consistent with the case
  • The work had authorization
  • The staff involved fulfilled all qualifications
  • The provider had all the necessary licenses and certifications
  • All third parties received billing

If you complete the requirements, the review can go faster. You can then undergo a corrective action plan or any other actions deemed necessary by the compliance office.

Establishing Medical Necessity

When a healthcare organization bills a patient, it must be within the realms of medical necessity. You cannot bill a higher level of treatment or service when a lower one is available. It prevents organizations from abusing the control they have over what they charge. All organizations must document billing and maintain an accurate record for review.

Solutions With Fenton Jurkowitz Law Group

When it comes to home health care compliance, you need a specialized legal team at your side. Fenton Jurkowitz Law Group can help you navigate all the regulations set by HIPAA. Our team handles all forms of regulatory defense, compliance issues, and other litigation and have worked with many businesses in the home health care industry.