How Private Insurance Credentialing Pays Off for Home Health Agencies

How Private Insurance Credentialing Pays Off for Home Health Agencies

As reimbursement by Medicare and other government insurance plans continues to decrease, home health agencies (HHAs) need to look at shifting their dependence on these payors in order to keep their revenue streams healthy. The most effective strategy for the diversification of revenue streams is by contracting with private insurers. Here’s why your HHA should consider it and what you need to do to get started:

Adoption of private insurance among the senior market is growing, especially among older Americans with Medicare. According to statistics from American Health Insurance Plans (AHIP), 22 percent of Medicare enrollees had private supplemental insurance coverage in 2016 and this enrollment rate continues to increase.

Private insurance reimbursement for Medicare Advantage rates can be comparable to government insurance plans. In addition to supplemental private insurance plans and credentialing services, Dominion Revenue Solutions can provide the expertise you need to negotiate favorable reimbursement contracts with a wide range of private insurers. We have seen agencies improve their revenue by as much as 40 percent through new or revised contracts and credentials. While each agency is significantly different from another, this significant revenue improvement is even more likely if your last review was conducted more than three years ago.

Improving the speed of payment from private insurers is key to keeping your HHA’s revenue flowing smoothly. Since private insurance companies may have slower payment cycles, it is critical to ensure your medical billing is done efficiently and accurately to avoid further delays. Dominion Revenue Solutions is dedicated to helping our HHA partners avoid lags in private insurance payments by billing clean claims. We also assist agencies in recovering denied private insurance payments through our revenue recovery process and expert appeals.

Breadth of coverage being a credentialed provider for one or more private insurers gives you more exposure to these networks and opportunities for developing referral relationships within them. Privately insured patients often check their insurance company’s website for a list of local providers and becoming a credentialed private insurance provider with that company, you won’t be on their list.

Credentialing is the key to increasing your home health agency’s bottom line with private insurance. In order for an HHA to participate as an in-network provider for any private insurance plan, it must be appropriately credentialed according to the plan’s requirements. At the completion of this process the insurance plan will extend a contract for participation, essentially an offer to participate as an in-network provider. The contract will detail what you can charge and receive for reimbursement.

Dominion Revenue Solutions simplifies private insurance credentialing for HHAs. Getting your HHA credentialed for private insurance can be a complex process and requires that you meet many mandates. As an experienced, affordable and trusted partner to HHAs, the credentialing team at Dominion Revenue Solutions can guide your agency through the private insurance credentialing process and ensure that you meet the requirements of each provider. Learn more about our contacting us at 888-471-9333.

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