Balancing Act: Promoting Home Health Services While Reducing Overpayments

For many health plans, care provided in the home health setting presents a dilemma.

On one hand, the home is often the final step on a member’s care journey to recovery and typically has lower costs than the inpatient or skilled nursing facility settings. Members also prefer the convenience of being at home and report higher levels of satisfaction. On the other hand, though individual claim amounts may be low, increased claim volumes mean any oversights can quickly snowball into significant financial losses. Increasingly, we also see disreputable providers using the home health setting to submit fraudulent claims.

So the question health plans must answer is, how do we ensure the payment integrity of home health claims while continuing to encourage its use as a cost effective setting?

At SCIO, we’ve been considering this question for over 10 years and seen first-hand each new challenge and reimbursement methodology emerge. During this time we’ve supported health plans strike a fair balance with providers by correcting problematic policies and developing high quality audit programs with low appeals rates.

We invite you to join us for a complimentary educational Webinar where our experts will share their thoughts and discuss best practices related to the below topics:

  • Optimizing Home Health: Identifying policy gaps
  • Patient-Focus: Defining “homebound” and medical necessity reviews
  • Provider-Focus: Role of fraud-like SIU audits
  • Future State: Trends you need to be aware of

Attendees will learn specific actions they can bring back to their organization and there will also be time set aside at the end to ask any specific questions you may have.

We look forward to your attendance!


Nicole Cormier, Senior Manager, Home Health, SCIO Health Analytics

Nicole has worked in healthcare for almost 30 years and over 20 years as a nurse. Her experience includes working as a floor nurse as well as home health, hospital case management, charge master management, and as an internal audit nurse for Medicare compliance. In her current role at SCIO, she develops and maintains audit programs to validate payment integrity for healthcare focused enterprise.

Leslie Strader, Product Manager, SCIO Health Analytics

Leslie manages the entire product lifecycle from strategic planning to tactical activities for SCIO’s Reimbursement Optimization platform, SCIOMine. In this role she leads the planning and activities that involve working directly with clients, technology, analytics, and business operations to develop new products and enhance existing solutions. Prior to joining SCIO, Leslie spent over 20 years in healthcare consulting, supporting reimbursement integrity for healthcare providers nationwide.

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