Home Health & Hospice Week

Scenario: Your home care patient is in an auto accident that leaves her in a wheelchair for an unspecified period of time. Her auto insurance -- not her medical insurance -- will foot the bill for her injuries. That leaves you out of the equation, right?

Wrong. "You can submit a claim to an auto insurance company," assures M. Aaron Little, senior managing consultant with BKD in Springfield, Mo. But you shouldn't submit the claim and hope the auto insurance company will pay it, he says.

Best bet: You should find out up front whether an auto or medical insurance company is handling a patient's injuries, Little recommends.

That way, you can get a head start on the reimbursement process -- and warn patients that they may wind up paying for some services out of pocket while waiting for the auto insurance to process their claim.

Good idea: Contact the insurance company -- before you submit the claim -- to discuss how and when it will be paid. By making arrangements in advance, you'll ensure that you submit the claim in a way the insurance company prefers, and you'll have a good idea of what to expect so you don't wind up providing more services than your patient can afford.

And you don't have to worry about whether the patient wants you talking to her insurance company,Little says. You can work with the company without the patient's permission or involvement.

Good to know: Your discussions with the insurance company will also hash out who will be the one paying you. For example, the insurance company may cut you a check directly -- or it may send that check to the patient. In that case, you'd bill the patient for that insurance money, Little says.

Official stance: Regional home health intermediaries want you to connect with auto insurance companies, says Cahaba GBA in its August newsletter to providers. When it receives claims containing trauma diagnosis codes like V15.88 (Personal history of fall), the RHHI must research the claim to make sure another payor isn't liable under auto, liability, or workers' comp insurance.

Your hard work upfront will save RHHIs' time and ensure your claim is processed more effectively.

Do this: Use the "Remarks" field to clue RHHIs into whether another insurer is also liable, Cahaba suggests.