Tag Archives: home health coding errors

Top Four Fall Priorities for Home Health Agencies

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Where is your home health agency’s focus this fall?
Smart home health agencies are focusing their efforts on housekeeping,  trying to shore up bottom lines by rectifying errors and inconsistencies that result in costly claims denials, and scheduling crucial training for all agency staff.
The four cornerstones for success in today’s home care market are  training, internal reviews and audits , preparation and streamlining operations, according to Home Health Solutions owner and president J’non Griffin.
If your agency isn’t working on at least one of these areas right now,  it’s losing ground in the effort to stay abreast of industry regulations and maintain clinical and financial success.

Training

Did you know home health agencies lose, on average, $200 to $300 per episode to coding and OASIS errors?
The money agencies spend on staff training is more than recouped in improved performance of its employees. Home Health Solutions provides convenient online training courses available through our online store for continuing education credits.
But we realize not every agency has the same training needs, so we also work with agencies to provide customized training and education.
Our goal is to provide the solutions your agency needs. Contact us today to talk about how we can help you.

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Self audits and review

The goblins and gremlins may not getcha  this Halloween season, but the glitches sure will.  Errors and inconsistencies are the hobgoblins of the home health field, resulting in costly claims denials , Survey issues and more.
Smart home health agencies are conducting self reviews and analysis on every level to find glitches before surveyors do.  But there’s only so much time in a day — and it’s often hard to be objective about self evaluation.
Our Mock Audits are the resource agencies need to experience firsthand the same thorough investigation a real Survey would bring, allowing agencies to clean up errors before there are costly consequences.  Click here for details about the value of a Mock Audit.

Preparation

When CMS suspended rollouts of pre-claim reviews after a disastrous initial experience in Illinois, home heath agencies breathed a collective sigh of relief.
But the reprieve is only temporary, and smart agencies are using the extra time to get prepared.
From Value-Based Purchasing to pre-claim reviews,  a new way of doing business is on the horizon for home health agencies, and meeting the new requirements is going to take a strong commitment to adequate preparation.
Here’s an easy and inexpensive first step for agencies looking ahead to pre-claim reviews:
Order our DIY Pre-Claim Review Preparation Kit for just $25.  It’s the compass your agency needs to get started on the road to preparation.

Outsourcing

Compliance is costly.
It takes time, manpower and relentless commitment on the part of home health agencies to stay up-to-date on current regulations — and it can’t come at the expense of an agency’s primary focus on patient care.
More and more agencies are determining that the most cost-effective means of doing business is to outsource all or some portion of operations.  And we’re not just talking about coding, OASIS or billing.  Some agencies need help with specific aspects such as developing POCs, handling ADRs or service specific probe reviews.
We can help.
No matter what your need is, we have the solution.
Give us a call today at 888-418-6970 and see what we can do for you.

Don’t get sidetracked by other codes

Editor’s note: Today’s post concludes our four-part series on common home health coding errors. If you’d like to receive more home health coding tips in your Inbox each week, sign up for our free email, The Monday Fix.

Seeing existing codes in a patient’s medical record can sometimes be distracting to home health coders, particularly novice coders who don’t yet feel confident in their own judgment. It’s tempting to look at the codes someone else has assigned, and use those codes as a starting point.

coding errors blog post art smaller 1But those codes can be misleading — especially if they were assigned prior to the patient’s admittance to home health, during treatment in an inpatient facility, where the coding rules may be different.

Home health coders need to be wary of any previously assigned codes encountered in the medical record, focusing instead on assigning new codes directly from the M.D.’s written notes.

Codes from skilled nursing facilities, wound care centers or clinics may have little bearing on the home health episode. Coding guidelines for those facilities can sometimes differ in important ways from coding guidelines for home health — and in some cases, codes from facilities may not be specific enough.

As an example, if a patient with Type 2 diabetes and peripheral neuropathy has been referred to home health, the skilled nursing facility where the patient was treated may have selected E11.9 (Type 2 diabetes without complications) as the code. If documentation from the M.D. during the patient’s hospital stay establishes that the patient has peripheral neuropathy due to diabetes, E.11.9 would not be the correct code. The coder would need to select E11.42.

Written notes from the M.D. supercede any code selected by any facility. Keep your eyes on those written notes, coding only from what has been documented there, and it becomes easier to avoid a coding error.

This was the fourth in a series of blog posts about common coding errors. Did you miss any of these other posts?

Click here to read about coding an uncertain diagnosis.

Click here to read about coding signs and symptoms.

Click here to read about coding previously treated conditions.

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 Absolute Beginner course guides you through the basics of ICD-10, while our Absolute Auditor workshops for intermediate level coders offer training in both ICD-10 and OASIS.
HHS is excited to announce that the May 17-20 session of Absolute Auditor in Bessemer, AL, will be available via Live Stream as well.
To register, click here.
To read details about 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.

 

Four home health coding errors to avoid

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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.