In the reimbursement partner Q&A series, we share knowledge and expertise from HRS partners across the country who have pursued reimbursement through CMS or private pay programs. Below, Ohio Living Director of Operations, Yvette Valentine, shares her insights into Ohio Living's reimbursement progress with CMS and CMS Medicare Advantage.
1. Why did Ohio Living and your team decide to pursue reimbursement through CMS versus a private pay program?

We anticipated some resistance launching a private pay program, not all patients are willing or able to pay themselves and we didn’t want to risk patients who could benefit from the program denying enrollment. We instead opted to pursue reimbursement under our Palliative Care Program through Medicare and Medicare Advantage plans due to the recent expansion of coverage announced by CMS in 2019.

We have successfully billed and received reimbursement from Medicare, UHC, Aetna Medicare Advantage, and Buckeye My Care for our patients receiving both Palliative care and Remote Patient Monitoring. Initially, we partnered with an external billing company to submit these claims because our Home Health electronic health record wasn't able to do physician/provider billing. Since then, our Palliative program has grown and moved to our Ohio Living Physician services and all Palliative with Remote Patient Monitoring billing is done through their electronic health record.  

2. What obstacles did you face when pursuing reimbursement and how did you overcome them?

The biggest challenge we faced with billing initially was the time it takes to review reports. Proper billing for telehealth and RPM reimbursement requires precise records for the amount of time spent reviewing patient health data. Through our partnership with HRS, our Client Success Manager is able to pull this information on our behalf and send us detailed reports.

3. How do you plan to expand your services due to receiving reimbursement?

Within the next year, we plan to expand our telehealth and RPM services across seven branches. We have a vision that patients will be managed through one, central branch, allowing us to leverage the knowledge of our existing staff that has been trained in telehealth and has delivered virtual care for several years. The program expansion isn’t due directly to our reimbursement efforts, but rather due to long-term and measurable improvements in patient care, outcomes, and satisfaction. However, we look forward to continuing to build upon our reimbursement efforts as we expand our telehealth and RPM program.

4. What advice would you offer to other healthcare providers seeking telehealth and RPM reimbursement?

Unless your organization is already structured to bill physician or provider services through CMS for telehealth and RPM, physician and provider billing relationships are a necessity. When we began billing, we worked with a third party. Since then, we’ve been able to transition to bill under Ohio Living’s physician group. The ability to work within Ohio Living’s physician services has been incredibly beneficial, but this wouldn’t have been possible without relationships across Ohio Living and support from our providers.