Category Archives: Coding

Outsourcing: Tips for choosing the right partner

Economics of Change

Editor’s Note: Jason Lewallen is Director of Sales and Marketing for Home Health Solutions and a noted speaker, blogger and author in the home health field. This article first appeared in SOLUTIONS, the monthly e-newsletter from HHS.

By JASON LEWALLEN

Outsourcing is a hotly debated issue in the home health and hospice industry.  Home health agencies know they need to narrow their margins while maximizing their reimbursement, but historically, it has been thought to be more beneficial to have a person on staff to handle each part of the process. This especially applies when it comes to clinical matters.  Legal risks, privacy concerns and the delicate nature of our business makes us wary about trusting another entity with these matters.

Whether outsourcing is the right option for your home health agency depends largely on how you answer the following questions.

Do you really need a specialist?

In a fluid health care market where guidance changes frequently, regulatory demands are constantly evolving and penalties are formidable, agencies recognize the indisputable value of staying fully informed and well trained. Even so, agency leaders often struggle to justify hiring specialized services. The simple fact is you would not ask a plastic surgeon to treat cardiac issues. Even as a legally practicing physician with a medical background that encompasses many of the basic concepts of how the heart works, the plastic surgeon lacks the specialized training needed to adequately address the cardiovascular system.  The best results could be expected from the cardiac specialist.

The same logic applies to obtaining the best results for your home health agency by outsourcing coding services. The best clinical consultants who handle coding and OASIS review are uniquely trained to maximize your reimbursement and reduce your compliance risk.

How will outsourcing affect reimbursement?

The difference in reimbursement when switching from in-house coding to outsource coding varies from agency to agency. There is always a chance that you have an optimized coding team who can deliver optimum results, although that is not what is commonly discovered. A reputable provider will work with you to evaluate whether you are achieving the maximum reimbursement that you are due. Remember, this is money that you should be receiving when there are no coding errors.

While averages vary, most outsourcing partners can generate $200-$300 per chart for a majority of  their clients simply by correcting coding errors and helping review the OASIS to ensure compliance. At a loss of just $100 per chart, an agency might be looking at $20,000 in recovered losses for just 200 patients.  Outsourcing has other benefits in addition to making agencies more profitable. It frees agencies from worrying about benefits, sick days, or performance issues.

Can you trust the specialist?

This can be a loaded inquiry. We’ve all known a few subpar medical professionals, and frankly there are coding firms which do not perform at the necessary level of expertise.  Having a partner who will ensure that you get the full reimbursement due to your agency for each episode is critical.

Choosing the right one requires knowing what to look for and what to avoid.

Here are a few tips:

  • The right firm will have credentials, experience and a reputation in the industry for consistent performance. It will offer a demonstrable commitment to monitoring industry regulations and providing the support you need for clinical and financial success.
  • Look for a firm headed by a confident, approachable coach who is in demand as a leader and teacher in the industry and can build a solid case for increased outcomes for your agency.
  • Verify that you are working with a team of experienced clinicians who know how to evaluate a clinical narrative. Some outsourced coding providers will certify non-clinical individuals to save money. In the long run, this can damage the integrity of your organization and more often can help to drive down your outcomes scores as well as your reimbursement.
  • Another valuable area to explore the process and ease of accessibility. Some outsource providers will require you to scan or fax mass amounts of information or have a long series of steps that make working with them seem like you are working for them. Others will not be able to guarantee that you will receive your work in a timely fashion. These days, the best providers can actually work within your electronic medical record (EHR) system to improve the timeliness of chart completion while minimizing the work required of clients.Regularly scheduled reviews to evaluate your coding and OASIS for optimization can help you determine whether an in-house coding specialist or an outsourcing partner may be the more viable and cost-efficient solution. Your agency may well have the top-notch coding talent that is helping you get the maximum reimbursement, but in today’s home health market, can anyone afford not to be sure?

5 ways we can help home health coders

coders need community
Are you a home health coder interested in keeping up with frequent changes to the ICD-10 classification set, and how it’s interpreted? If so, you need a regular source of information to keep you updated.

Maybe you’re new to home health coding, in need of free practice scenarios and study material and eager to sharpen your coding skills as you prepare for your home health exam.

Either way, you need a supportive community of coders to help you navigate the complexities of the field you’ve chosen — and Home Health Solutions LLC has the solutions you need.

Here are five ways we’re in the trenches with you, helping you master all the challenges of the home health coding profession:

 1. Free coding and OASIS tips on Mondays

newsletter 2Our free weekly e-newsletter is filled with coding and OASIS tips as well as other news of interest in the rapidly-evolving home health field. We know you’re busy, so we deliver it straight to your Inbox every Monday.
Recently, we’ve featured an update on new guidance regarding the link between HTN and heart or kidney involvement, a look at a common OASIS error regarding the entry of dates, and a refresher on THE MONDAY FIX 7the use of the 7th character in wounds coding.
We’re working now on a series of helpful tips on fractures coding and more common OASIS errors.

   If you haven’t subscribed, click here to add your name to our list and you’ll begin receiving this helpful free e-newsletter next Monday. It’s a great time to subscribe, as we’ll soon begin highlighting some of the changes to the ICD-10  classification set that will become effective Oct. 1.

 Our web site has some treasures

     Are you looking at the Home Health Solutions web site regularly to discover all the helpful info we post there?
coding errors blog post art smaller 1
Check out the PRACTICE CODING QUIZ  we’ve just posted. It features 6 trauma wounds cases and invites you to choose the correct code, assigning A or D as the 7th Character. New home health coders  — or those who like to review from time to time — will also discover useful blog posts on topics such as “Four Common ICD-10 Potholes and How To Avoid Them.”

Did you know that we keep a CODING TIPS ARCHIVE on our web site, where some of the coding tips from our weekly e-newsletters are featured in case you missed them?
Heart Translation GuideIf you like visual aids, be sure to click here to check out our helpful infographics, such as the one pictured at left. These graphics are designed to pack helpful information into a visual form, and can be printed out for you to keep with other useful tips.
   Your agency may benefit from “Think Like an Auditor,” our free report on the Top 25 Documentation Errors the HHS Team encounters when working with home health agencies, or by taking THE HHS SECURITY QUIZ, a 5-minute tool designed to help you target areas where you may be out of compliance. The Security Quiz highlights many items which will be noted during Survey.
And, speaking of Survey, did you miss our blog post on an often-overlooked but important area: “How Does Your Agency Handle Complaints?” It offers a helpful list to help your agency shore up the way complaints are documented and addressed.  Be sure to share the links to these items with the appropriate person in your agency.

3. Our Code & Coffee Quiz on Facebook

barbershop quartet art 2Whether you’re a veteran or a novice at home health coding, we have a great educational tool for you every Monday on the Home Health Solutions Facebook page.
Our Code & Coffee Quiz posts a home health scenario with multiple-choice coding sequences, inviting coders to tell us in the comments which sequence they like best and why. One of them is rewarded (in a random drawing) with a $10 e-card to Starbucks — but everyone’s a winner on this weekly quiz, because of the learning opportunities it provides.
   Recent scenarios have featured great examples of new coding guidance on presumed relationships and examples of diagnoses that require a step beyond — and then two more beyond that — with regard to specificity.

The Quiz is pinned to the top of our Facebook page each Monday. Click here to check it out.  (While you’re there, scroll down on the Facebook page to review some quizzes from previous weeks.)

Here are just a few of the reasons you should be joining us every Monday for the Code & Coffee Quiz:

  • You’re a new home health coder who needs the practice every week,
  • You’re an established home health coder who wants to see practical examples of new coding guidance in use
  • You’d like to win a $10 e-card to Starbucks
  • You recognize the value of a weekly forum where coders can discuss scenarios with the rationale provided, learning from each other


 4. Our
Online Store has products you need

    We know you need CEUs and training to stay abreast of constant change in the home health field, so we’re constantly working on new online training programs for you.
When
Home Health Solutions owner J’non Griffin isn’t on the road to teach a workshop or take the stage as a featured speaker for an industry event, she’s recording online training classes. She just finished an OASIS C-2 update, designed to address revisions which will become effective Jan. 1. It’s worth 8 CEUs. Check it out in the HHS Online Store.

   While you’re there, browse around a bit — and be sure to take a look at our Absolute Auditor classes. These classes are offered both online and in person.

 5. Get connected to stay in the loop

     At HHS, we’re committed to helping home health coders and home health agencies achieve excellence. After you check out the blog posts, classes, newsletters and tools mentioned here, check back soon to see what other helpful information we’ve assembled for you.
A great way to stay in the loop is to “like” us on Facebook so that our posts will appear in your Newsfeed. There’s a “like” box on the bottom right side of this post, to make it easier.

   You can also follow us on Twitter at:

@hmhealthsolutions

 

    

OASIS-C2: Why your comments matter

oasis c2 changes on the horizon 2Editor’s Note: This article appeared in the April 18 issue of The Monday Fix, our weekly email delivering home health coding tips and news of interest to home health coders.

Feeling comfortable with ICD-10-CM yet?
We thought not.
You’re not sweating alone, though.  Assimilating some 68,000 codes is a huge undertaking, and even the “industry experts” are finding glitches, contradictions and confusing spots within this massive code set.
At last count, some 2,564 changes to the ICD-10-CM classification set are expected to be implemented Oct. 1: at least 1900 new codes, 351 revised codes and 313 deleted codes.
monday fix promo 6A few Excludes Notes will shift and others will disappear completely in this first reworking of the code set since its implementation at the first of 2016. Home health coders are awaiting the changes with a mix of curiosity, anticipation and a bit of apprehension.
Meanwhile, slightly less attention has been paid to some other significant changes coming at the first of 2017, although these changes could have a substantial impact on home health agencies.
The Outcome and Assessment Set generally known by its acronym, OASIS, is undergoing its own revisions, with new items, renumbered items, and some other changes in how data is collected.

WHY IT MATTERS

Why are these revisions so important to  home health care?

OASIS, implemented as part of the Improving Medicare Post-Acute Care Transformation Act generally known as IMPACT, has a huge impact on home health agencies in numerous areas.

The data from OASIS affects patient outcomes, STAR Ratings, reimbursement, and Value-Based Purchasing.

If an episode of home health care for a patient could be compared to a race to the finish line (quality outcome), collection of the OASIS data might be the pace car, going first to test track conditions, look for obstructions, set the pace and establish the positioning of all other cars.

“The data collection must be accurate and complete,” says Marti Holthus, a Quality Review Mentor on the Home Health Solutions team. “And it is so important, affecting so many aspects of home care, that the accuracy of clinicians completing the OASIS assessment has a direct bearing on the viability of an agency. ”

Proposed changes to OASIS for Jan. 1, 2017, are known as the OASIS-C2 data set. The Centers for Medicare and Medicaid Services has opened a public comment period to solicit input on OASIS-C2 from April 1 through May 31. In soliciting these comments, CMS hopes get a firmer idea about burden estimates from agencies affected. CMS is especially interested in suggestions for how to enhance the quality, utility and clarification of the information to be collected.

WHO SHOULD COMMENT?

” Everyone in the home health industry who will be looking at, completing, educating on, etc., should read the update and comment,” says Kimberly Searcy, Director of Global Education at HHS. “There are changes in wording, numbering, new items,  and these may impact agencies.”

An agency may determine, for example, that revisions will require additional monies for training, that additional time may be required to complete the OASIS, or that  reimbursement to the agency and publicly reported outcomes may be affected.

WHAT’S CHANGING

Specific OASIS C2 revisions include:

– 3 new standardized items (M1028, M1060, GG0170c)

– Renumbering of items (M1311, M1313, M2001, M2003, M2005)

– Consolidating checkboxes from multiple check boxes to a single box for data entry

– Changes the look-back period

– Changes the numbering system used for pressure ulcer staging from a Roman to Arabic numerals

HOW TO COMMENT

 Here is a link:

www.regulations.gov/#!documentDetail;=CMS-2016-0047-001

 In the SEARCH box at the top of the page, type OASIS-C2 to go to the appropriate menu.  Look for the Comment Now button and follow the prompts.

Would you like to subscribe to our free weekly email delivering home health coding tips and news of interest to home health coders? Click here to read more about The Monday Fix.