Home Health Agencies Continue to Struggle with Orders Tracking

The switch from the Prospective Payment System (PPS) to the Patient-Driven Groupings Model (PDGM) in 2020 has posed a slew of challenges for home health providers. Orders tracking is one of them.

The slicing of billing periods from 60 to 30 days has raised the stakes when it comes to obtaining signed orders. During the COVID-19 crisis, it has been doubly difficult to get signatures from physicians on time, especially from the ones that are less technologically inclined.

“For orders tracking, the fact that we’re reducing those billing periods from the 60-day episodic claim now to those 30-day payment periods, in most cases, the one piece that’s going to be holding those bills up from getting billed out are going to be the signed orders,” Nick Seabrook, the managing director at BlackTree Healthcare Consulting, said during a recent webinar. 


Home health agencies are now seeing the value in adopting technology to decrease the turnover time of physician signatures.

Alternate Solutions Health Network, for instance, has continued to add on to its technological capabilities to address these issues with the help of its tech partner, WorldView LTD.

WorldView helps home health agencies increase efficiency by automating medical records processing, assisting with inventory management and supporting billing departments.

On its end, Kettering, Ohio-based Alternate Solutions Health Network is a national provider of post-acute solutions, including home health and hospice. Because Alternate Solutions operated in a state with Review Choice Demonstration (RCD), workflow efficiency is even more crucial.

“One of the technologies that we adopted — with the help of WorldView — was segregating out the incoming plan of care versus subsequent orders, so that we could put a faster priority on indexing, processing and getting it back into the system, because of RCD and the timeliness needed there,” Amy Smith, the corporate VP of revenue cycles at Alternate Solutions Health Network, said on the webinar.

That change has allowed Alternate Solutions to achieve a 99% RCD success rate.

The coding changes under PDGM have had a huge impact on providers across the country, but orders tracking — which has somewhat gone under the radar — continues to be a pain point for agencies adjusting to the new payment system.

“If you’re starting to see any spikes in your days to file claims, or if you have been experiencing that, chances are it’s probably an issue with your orders tracking,” Seabrook said.

With half the time to collect necessary signatures than before, agencies are tweaking their methods to make sure they’re seeing fewer outstanding orders, Rachel Wennekamp, an account executive at Worldview, also said on the webinar.

“Agencies that may not have been utilizing the orders tracking solution at WorldView are now seeing the value in leveraging that technology to track and gather physician signatures on all their outstanding orders,” Wennekamp said. “Utilizing an auto-fax schedule to ensure timely delivery of all orders into the physicians’ hands helps ensure quicker turnaround time for getting those signed orders back.”

COVID-19 impact

For obvious reasons, the COVID-19 pandemic has exacerbated the orders tracking pain point.

“Really, the primary challenge has just been access to physicians for a number of different reasons,” Samantha Soulas, BlackTree’s orders tracking expert, said on the webinar. “Because especially right in the beginning of the pandemic, physicians and staff in offices and facilities weren’t even there to receive or sign orders.”

There are a lot of offices that still prefer hand-delivery methods. During COVID-19, that was either not allowed or not possible.

That left providers in the dark when it comes to orders tracking and physician contact generally, which has forced them to instead begin investing in new strategies.

“I know that my clients left a lot of voicemails in the early months of COVID,” Soulas said. “And we’ve obviously seen since then offices and facilities opening up more. They’re now seeing patients, but they’re still a little less available. Physicians are still not visiting the office as many days as they were and there are a lot of telemedicine visits going on.”

Even if home health providers have adopted more technology since COVID-19 hit, without the physicians doing so as well, their efforts are often all for naught from an orders tracking perspective.

That’s why it’s been encouraging to see some physicians that prefer hand delivery begin to open their minds a bit more to alternate forms of delivery over the last few months, which many have, Soulas said.

“They’re now actually starting to adopt fax, portals or email, which has been one silver lining here,” she said.

Overall, agencies should focus on building positive relationships with physicians, shift to automated services as much as possible to free up productivity for workers elsewhere and set goals for faster documentation processing.