Mitch Abrams has come up with a way to build a solid home care agency: He has developed a good system for seeking reimbursement from private long-term care insurance (LTCI) companies.
Abrams has been a managing partner at Homewatch Caregivers Northshore since 2009. His organization now helps send more than 200 professional care providers into clients' homes.
About 42 percent of the clients have some kind of private LTCI coverage, compared with a percentage of about 5 percent to 10 percent at a typical home care percentage.
The high use of private LTCI is partly the result of the fact that the agency is based in Northbrook, Ill., and operates in affluent communities near Chicago. But the agency also has a high percentage of private LTCI patients because it takes responsibility for filing LTCI claims with insurers and resolving problems with claim payments.
For a look at some of what Abrams has learned from setting up a system to bill the LTCI carriers, read on.
1. The little things count
Abrams says his agency is different from many because it puts all service and billing records online, and it uses telephone calls from the care providers and the Caller ID to document what care the providers have delivered, where, and when.
The agency uses its system to create detailed invoices for patients every two weeks. The detailed invoices can help patients show why they qualify for private LTCI benefits, Abrams says.
But, in many cases, he says, Homewatch has to print out the invoices and fax them to the insurers, because LTCI claim administrators often have no ability to handle electronic claim submissions.
See also: Will home care get more high tech?
2. The percentage of LTC providers prepared to bill private LTCI carriers — and resolve billing problems — is low
Abrams says his agency sets itself apart from the competition by performing some patient advocacy services.
In many cases, if consumers have problems with getting claims paid, his agency will get clients or family members to give the agency the authority to help them communicate with the insurer. At this point, he says, even many hospitals and other acute care providers that are used to untangling major medical insurance claim problems have the agency tackle any claim problems that involve private LTCI.
