Category Archives: home health documentation

The value of a Mock Audit: Why home health agencies need to do this


It may be the season for goblins and gremlins, but in an era of unprecedented regulatory scrutiny for the home health field, it’s the glitches home health agencies really need to worry about.
solutions-october-main-artErrors, oversights, and inconsistencies are the hobgoblins of the home health industry, carrying high price tags in the form of claims denials – or, even more frightening, fraud investigations and hefty fines.
And, to frame things in the spirit of the season, the  scary shadow of scrutiny is looming larger.
The future of home health is filled with quality improvement requirements that have not yet been fully determined to be either tricks or treats, but home health professionals know they’re coming, sooner or later. From value-based purchasing to pre-claim reviews and a proposed new Condition of Participation for Medicare, agencies are feeling the squeeze to reduce errors and improve performance.
There’s pressure to become faster as well as better. While the Centers for Medicare and Medicaid Services has temporarily delayed rollouts of pre-claim reviews to give agencies more time to prepare, home health experts agree, by and large, that the eventual implementation will force agencies to speed up as well as fine-tune their processes.

Let’s go glitch hunting

This season, Home Health Solutions owner and president J’non Griffin recommends agencies who are serious about success take a broom, figuratively speaking, to the cobwebs and shine a light into every dark nook and cranny, to ferret out the vulnerabilities in the operation and take corrective action.
“Smart agencies are doing everything they can right now to mitigate risk,” J’non says. “They’re honing in on the quality of their documentation, reviewing clinical notes made by nurses and therapists, prioritizing internal audits and quality reviews, and following up with extra training measures to address any shortfalls.”
Done well, self-assessment takes extra time, and for an agency already struggling under clinical and operational demands, creating the time for self-evaluation can seem like an overwhelming task. It’s hard to remain objective and easy to overlook crucial details that surveyors won’t miss.
Many agencies are finding the solution is to rely on outside firms to provide the thorough and objective assessment needed to identify compliance risks and provide a plan of remedy.

What does a Mock Audit entail?

From identifying expired items in an agency’s supply closet to revealing inaccuracies in its personnel files, a Mock Audit can be a comprehensive tool for determining exactly where an agency is headed for trouble.
It’s conducted exactly as surveyors would conduct the real thing; once scheduled, there’s no advance notice given to staff.
A team spends 1-3 days on site, depending on the size of the agency being audited, with some team members remaining in the office to audit charts and personnel files while other team members conduct home visits in all disciplines.
An exit interview concludes the process, and the findings are shared with the administrator along with recommendations for improvement so that a plan of correction may be implemented. Education tailored to address specific deficiencies can be arranged.
“A Mock Audit gives the agency staff an opportunity to practice for the real thing so that they will have an idea of the survey process, whether it be state Survey or advanced accreditation,” says Heather Calhoun, Director of Special Appeals and Project Management at HHS.
She recommends agencies schedule an annual Mock Audit to help control compliance risks.
“There’s no better way for an agency to determine areas of weakness and potential risk,” Heather says.
Jason Lewallen, Director of Sales and Marketing at HHS, agrees.
“With the rapid pace of regulatory change, agencies face an uphill battle when preparing for a survey,” Jason says. “This industry is fortunate that there are programs in place that can minimize the risk of penalty before the surveyor arrives.”
Findings can result in financial gain to agencies, because audits often identify specific areas of improper documentation that result in claims denials.
“Mock Audits offer agencies the opportunity to fix errors before the organization is negatively affected by claims denials as well as accreditation or state Survey,” Jason says.
The cost of the audit, like its duration, depends on the size of the agency and a few other variables.  Give HHS a call today to discuss how a Mock Audit can help shore up your operation, and put your agency on the road to success this fall.
   

Four home health coding errors to avoid

avoid icd potholes 3
Even proficient home health coders sometimes find themselves skidding into ICD-10-CM “potholes,” caught unaware by confusing or misleading circumstances.

The risk can be even greater for beginning or less experienced coders.

The Home Health Solutions team has identified four common trouble spots for inexperienced home health coders. Think of them as ICD-10 “potholes” that novice coders will need to take care to avoid.

We’re reviewing these trouble spots all week long on the blog, in posts specifically designed to help home health coders navigate issues such as handling a vague or uncertain diagnosis from the physician when to code signs and symptoms, when to code conditions that have previously been treated, and how to avoid getting sidetracked by codes from facilities where a patient may have been treated.

Today’s post looks at the uncertain diagnosis, and what home health coders should do if they run up against the lack of a definitive diagnosis in documentation from the physician.

Never code an uncertain diagnosis

Vague, uncertain diagnoses are the unicorns of home health coding. Even if you’re a believer, your coding won’t stand up to scrutiny without “proof” in the form of a specific, documented diagnosis.

Any diagnosis documented as “probable,” “suspected,” “questionable,”  or as “a working diagnosis” is, like the fabled unicorn, still a myth for home health coding purposes, and should never be coded.

This is true even if the physician has prescribed medication almost always prescribed for a particular condition or disease, and even if the patient is experiencing multiple symptoms associated with a  particular disease or condition.

Until or unless the physician documents a definitive diagnosis, it cannot be coded.

For coders transitioning to home health from some forms of inpatient coding, where signs and symptoms are coded, this can be an important change.

In many cases, querying the physician can solve the problem and obtain the necessary documentation. Sometimes, however, a physician isn’t ready or willing to make a definitive call.

Without a specific diagnosis, how should the primary reason for home health care be coded? Guidelines  instruct coders to code “to the highest degree of certainty.”  This means that under circumstances, when there is no specific diagnosis, you may be able to code specific signs and symptoms, abnormal lab results or other problems necessitating home health care.

If a patient has been admitted to home health with physician’s orders to monitor or treat specific symptoms, those symptoms are the focus of care, and may be coded in lieu of a definitive diagnosis.

Remember, however, that this is not the preferred solution, that it is best to query first, and that documentation from the physician regarding signs and symptoms will be required to establish the focus of care. In general, it is always preferable to code a specific diagnosis.

(Our four-part blog series on common coding errors continues Tuesday, when the HHS team will review some of the specific circumstances under which home health coders may be able to code signs and symptoms — and when to avoid coding them.)

Do you need ICD-10 training or review?

Home Health Solutions can help you develop your home health coding skills, whether you are just starting out or an experienced coder needing CEUs.
Our next session of Absolute Auditor, a training workshop for intermediate coders, will take place May 12-20 in Bessemer, AL, and will be available via Live Stream as well.
For details on our classes, click here.

Are you a member of our growing community of coders who subscribe to The Monday Fix, a free weekly email delivering home health coding tips to your Inbox? Click here to sign up.