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Home Care Assistance Case Study

About the Business

Home Care Assistance of Fort Worth, Texas was opened in 2011. The former owners, Mr. and Mrs. Alan and Alistair Young, opened the business to provide in-home care services to their community. The Home Care Assistance franchise family is looking to change the way the world ages, now with a reliable in-home care agency in Fort Worth, Texas.

 

Challenge

Home Care Assistance of Fort Worth was challenged with managing the billing and claims submission for its long-term care insurance clients. “Long-term care insurance policies can be confusing to understand,” said owner, Alan Young.  “The jargon in the policy is difficult to interpret and when you call the carrier to get clarification, they do not give you a straight answer.”

The agency faced significant difficulties with clients whose policies had elimination periods.

“One of our biggest issues was understanding elimination periods. We did not know how to calculate and satisfy the time so that the policy would start reimbursing for care. Obviously the clients did not want to pay out-of-pocket during that period even though we were servicing them, so that added to the challenge,” said Mr. Young. “Being unfamiliar with the legal terms in policies made it even more difficult to determine how much care each client was allowed. The clients did not fully understand their policies either, so we were at a loss.”

“The legal jargon in the policies made it difficult to determine how much care each client was allowed. When you call the carrier to get clarification, they do not give you a straight answer.”

Mr. Young and his staff ran into roadblocks unlocking clients’ benefits and submitting claims correctly.

“Long-term care insurance claims can be difficult and time-consuming to prepare and submit. It is important to make sure the claims are approved for full reimbursement the first time they are submitted; we had to jump over hurdles just to accomplish that.”

After dealing with several challenging client cases, Mr. Young knew it was time to call in the experts.

“We needed to streamline the billing process and make sure that the caregivers were paid on time. We could not afford to wait weeks to get reimbursed by the long-term care insurance carriers. We decided to partner with FHS because we wanted to make the process easier for our agency and our clients.”

Solution

Home Care Assistance of Fort Worth enjoys many benefits as a result of partnering with FHS. FHS reduces the office staff’s administrative burden, improves the billing processes and cash flow, and enables the business to service more profitable long-term care insurance clients.

“We no longer have to worry about third party billing. The team at FHS is extremely helpful and deals with that for us, which frees up a lot of time on our end,” said Mr. Young. “It is easy to fall behind on long-term care insurance billing, so having FHS manage it all takes a huge weight off of our shoulders.”

Another benefit the agency enjoys is streamlined billing processes and improved cash flow.

“FHS minimizes the amount of work we need to do on our end while guiding the billing and payment processes. With their help, we receive reimbursements from our long-term care insurance clients faster. FHS makes sure that everyone gets paid when they need to be paid.”

Finally, one of the most valuable benefits the agency enjoys is learning exactly what each long-term care insurance client’s policy will cover before care starts.

“FHS cuts through the clutter to determine the specific rules and regulations of each client’s policy. Then we know exactly what we can and cannot do in terms of the type of care and the number of hours that the policy will cover. We have found first-hand that there is no standardization across the insurance carriers. It’s very time-consuming to decipher each policy, so we love that FHS does that upfront investigative work for us. FHS takes care of collecting all the paperwork and information that is needed in order to bill the insurance carrier correctly and get reimbursed in full and in a timely fashion. If an insurance carrier needs information from our agency, we know what to give, when to give it, and what to expect from that client case.”

Before partnering with FHS, the agency had to limit the number of long-term care insurance clients it accepted because all of its third party billing was performed in-house.

“We knew how much revenue we could earn by servicing long-term care insurance clients, but we could only manage so many of those clients at a time by ourselves,” said Mr. Young.  “We are planning to add more long-term care insurance clients to our office because of how helpful FHS has been.”

Result

The partnership between Home Care Assistance of Fort Worth and FHS has benefited the owners, the office staff and the clients and families that they serve.

“Working with FHS has made the billing process easier for us and for our clients. Clients and their families appreciate FHS because they no longer worry about paying out-of-pocket while they wait for reimbursement from their insurance company. Knowing that the payment process is being taken care of makes the experience so much better for our clients.”

“FHS takes the responsibility of decoding the policy, submitting claims, and distributing payments. As for our office, caregivers and clients, we no longer have to worry about who needs to be paid or who has not yet paid. FHS advances funds so that our office and our caregivers still get paid on time.”

“I would recommend FHS because other home care agencies face similar obstacles. If agencies are looking for someone to assist them with third party billing, we recommend FHS.”

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