Kenyon HomeCare ConsultingGinny Kenyon, Author at Kenyon HomeCare Consulting (206) 721-5091

Kenyon Connects

Strategies For Educating Staff On ICD-10 Coding

Coding education is as important as coding itself. And with the periodic updates to ICD-10 coding, the eventual arrival of ICD-11, and the frequent industry changes, you cannot afford to fall “behind the 8 ball” on staff education.

Remember when ICD-10 was first implemented? Industry experts warned that all staff, not just coders, would need to adjust and learn the new system. Coders, clinicians who handle documentation, and managers who oversee the whole process need ongoing coding/documentation education to optimize coding and improve care.ICD-10 Coding

Options for Training and Re-training Your Homecare Staff

Whether updating coders on new codes and ICD-10 manual changes, training Medicare field staff on OASIS, or finding fun but effective ways to approach documentation training, staff education is a multi-faceted enterprise.

Some of your main options for an optimal staff training program include:

  • Regular staff meetings/ announcements generating awareness and and basic procedural training.
  • Hands-on practice coding sessions for coders, using common codes as well as newest changes to ICD-10.
  • In-depth documentation instruction where coders and clinicians closely collaborate.
  • Distance education seminars on coding, documentation, OASIS, and other related topics.
  • Developing your own “arsenal” of high-quality training and staff education tools that address industry and organizational needs.

Lighten the Coding and Training Load With Outsourcing

You cannot eliminate continually training and re-training your staff. Documentation, for example, will always be an integral part of proper client care. However, outsourcing all coding will greatly reduce the training load. After all, you will no longer have to keep in-house coders up to date or training new hires when applicable. Your outsource partner can take care of it for you. Outsourcing ICD coding can produce extra revenue. You can reinvest the savings in training nurses, managers, and all other staff in a more thorough manner. Staff will likely appreciate the attention and concern for improving their skill sets, which typically leads to happier, more productive, and more loyal staff members. This can translate to improved client care, enhanced agency’s reputation, improved client retention, and new growth.


Staff education helps your homecare agency provide better care which facilitates increased revenue with improved cash flow if you have efficient ICD coding. Investing in coding education is one path, while outsourcing all coding is another. Each homecare situation is different, and the solutions will vary accordingly.

To learn more about coding and staff education or coding outsourcing services offered by Kenyon HomeCare Consulting, contact us today at 206-721-5091 or via our online form.

Technology and Artificial Intelligence, An Age of Disruption Part III

Technology and Artificial Intelligence, An Age of Disruption Part III

Last month I wrote about the rapidly growing use of technology and AI (Artificial Intelligence) in our industry.  From Carebots to nanobots, we are seeing an evolution that human kind has never experienced.  We are told that the hunter/gather age lasted for several million years, the agricultural about 2 thousand years, the industrial age two centuries and the technological age about 4 decades.  We are now moving into an augmented/AI age much of it already upon us.

We all have heard of and now seen self-driven cars.  Groceries and other stores are beginning to experiment with cashier-less store.  Grocery delivery will also play a large part in the coming changes that allow compromised individuals to remain in their home and be as independent as possible.  Imagine the near future where your patient can call a self-driven care to take them to their appointments. They can order their meals or groceries from their phone, have an app on their phone that will call them with the results of their tests, and explain what they are, and if necessary make an appointment with the appropriate care provider.

“Artificial Intelligence “is rewiring our modern conception of healthcare delivery,” according to a new Accenture report that shows an array of clinical AI applications are already well on their way to saving the industry $150 billion over the next 10 years.”  Healthcare news 2017

The technology represents “a significant opportunity for industry players to manage their bottom line in a new payment landscape,” according to the report, which examined 10 different AI applications, ranked by their potential for cost savings:

  • Robot-assisted surgery – $40 billion
  • Virtual nursing assistants – $20 billion
  • Administrative workflow assistance – $18 billion
  • Fraud detection – $17 billion
  • Dosage error reduction – $16 billion
  • Connected machines – $14 billion
  • Clinical trial participant identifier – $13 billion
  • Preliminary diagnosis – $5 billion
  • Automated image diagnosis – $3 billion
  • Cybersecurity – $2 billion

“As these, and other AI applications gain more experience in the field, their ability to learn and act will continually lead to improvements in precision, efficiency and outcomes,” said Accenture researchers.

Click Hear To learn more in-depth about some of these changes.

How Do I Evaluate My Agency On ICD Coding?

Like a ship without a compass or carpenter without a tape measure, homecare agencies often have no way to evaluate ICD coding performance. By optimizing ICD coding for accuracy, specificity, turnover time on submission to CMS, your agency stands to both boost its revenues and improve cash flow.

OK… So, how does your agency know if it is doing this well or not? And in light that evaluation, how do you decide between in-house and outsourced coding?

Use KPIs to “Score” Your Homecare Agency on Diagnosis CodingICD Coding

Key Performance Indicators (KPIs) are provided by CMS to help you measure and track how well you are doing with ICD-10. Do a “self-test” of your agency, and test again after efforts to make improvements and meet quantifiable goals has been determined. Here are some questions based on the CMS KPI system:

  • How many days between service date and claim submissions?
  • What percentage of claims/claim-dollars are typically denied, diminished, or delayed?
  • What is the average reimbursement for each specific service? how does that compare to the industry average? How does it compare to the maximum possible reimbursement?
  • How productive are my coders? How many records are coded per hour?
  • How often must coders return documentation to clinicians because it is inaccurate, non-specific, or incomplete?
  • How often do coders fail to link clinical documentation and Oasis to proper code? How often do they struggle to do so?

Pros and Cons of Outsourcing vs. In-house Coding

Once you have evaluated the agency’s diagnosis coding, the question is how to improve? There are ways to improve in-house coding, but on the other hand, outsourcing might make more sense in your situation. Here are the pros and cons:

In-House Coding: Pros and Cons

Coding in-house gives more direct control, lets you work directly with employees, and allows managers to quickly interact with the coding office whenever it is needed. However, risks of sudden loss of coder, neglect of appealing denials, and sloppy submissions squelching your revenues are all higher in-house. Cash flow problems often occur in smaller offices during busy periods or when even one employee is sick or on vacation. Though some money may be saved upfront, in-house is generally less cost-effective overall in the long run.

Outsourcing: Pros and Cons

Some homecare managers may see outsourcing coding as a “loss of control” or fear it will be more expensive. In reality, a good outsource partner is able to increase reimbursement rates making out-sourcing more cost-effective than coding in-house. A client-focused outsourcing agency keeps you informed as well. A poor outsourcing group might “leave you in the dark,” but this need not be the case. Many ICD-10 coding providers are highly transparent about your billing and take time to answer all your questions. Outsourcing takes the coding “monkey” off clinician’s backs. This allows management a focus on case management instead of coding and clinicians to focus on client care.


Diagnosing your performance on ICD-10 diagnosis coding is a first step to optimizing coding. Follow-up action involves continuing education for in-house coders, documentation training for clinicians, or simply outsourcing all coding. At Kenyon HomeCare Consulting, we offer top-of-industry coding outsourcing and on-site training to homecare providers. To learn more about our services, call us at 206-721-5091.

An Age Of Disruption Part 2


An Age Of Disruption Part II

In the previous blog I discussed one of the major changes coming in our world of home health because of the integration of technology and AI [Artificial Intelligence].  That discussion focused on the creation and beginning use of “Carebots”.

Today I want to discuss another major change; integration with AI and memory.  In the link below Tom Gruber discusses what he is calling Humanistic AI.  While this is in its infancy, it will not take long before it is a reality.  He invasions using AI to remember for us so that indignity of dementia and Alzheimer’s will be a thing of the past. Please see the link below.

Additionally, on the horizon is the use of integrated biology, gene therapy and AI to repair the disorders caused by disease so that in the future diseases that are so disabling right now will not exist in the future.  That will be discussed in future blogs.


Ginny Kenyon


Starting Up A Home Health Agency?

Home Health

Starting Up A Home Health Agency?

Starting a home health agency is no small undertaking. In fact, there are several things to consider before your dreams can become reality. Being an agency that offers medical services poses additional concerns that need to be addressed.   Some of the steps that you must accomplish in order to be successful are

  1. You must have a business plan.  Your dream will never become reality if you do not write it down and make sure that what you have written is really what you want and where you want to go.
  2. You must have a plan for how you are going to get competent staff to help make your agency become the agency of choice.  Quality staff are hard to find and keep, so plan, plan and plan some more.

There are many more steps and areas to consider.  Visit Kenyon Connects to find out more.

Help Me Start Up A Home Health / Hospice Agency

There are well over 12,000 home health & hospice agencies in the US, and the industry grew some 4% annually between 2010 and 2015 due to a rapidly aging U.S.. population. For someone with an entrepreneurial spirit to meet the real healthcare needs of people, the homecare industry represents a real opportunity. But, how do you get started? What is involved in a successful homecare agency startup? Seven key areas of concern for every new homecare agency startup are as follows:

1. Vision and Business Plan

Home Health

The first step in starting up your new home health organization is formulating a clear vision of meeting community needs. A detailed community assessment gives you direction and your own background and focus will play into the decision.

There are many types of home health & hospice agencies, some focused only on non-medical daily living assistance for seniors and disabled persons, others equipped with nurses and therapists to take care of medical needs. To make your vision a reality, you need to think and put into writing a detailed business plan and find effective ways of marketing your vision to the community.

2. Licensing Issues

Step two in getting your homecare agency startup off the ground is obtaining all necessary licenses. A good consulting firm, will guides you through this complex legal process and uses experienced senior consultants to expedite the process to licensure.

Your agency will need to be incorporated with a Tax ID. You will also need to obtain a NPI (National Provider Identification) number with Medicare/Medicaid. There are differences in licensing from state to state. Expert guidance helps you properly prepare for successful practice.

3. Medicare Accreditation

Next, as a large portion of your reimbursements will come through Medicare (Parts A and B), you must go through the certification process. This involves a three-day Medicare survey in which your policies/ procedures, record keeping, and clinical practice will be evaluated. Consulting trains and prepares you to pass the first time.

Often times, agencies will choose accreditation from CHAP, ACHC, or JCO instead of the Medicare certification every three years. Accrediting bodies hold agencies to all Medicare Conditions of Participation as well as standards of excellence above and beyond Medicare/ Medicaid.

4. Software Selection

Today’s healthcare industry requires advanced medical equipment and computerized record-keeping. An existing agency may update software systems as needed, however, a homecare startup agency should carefully select the most effective software program to meet their needs. Senior level consultants help with making sure agencies do not make the costly mistake of choosing the wrong software.

5. Preparation of Manuals

To run your agency smoothly from day one, you will need to develop customized administrative policy and procedure manuals, employee handbooks, forms manuals, and other important organizational tools. Optimizing your manuals can save you valuable time and money.

6. Staffing Your Agency

So far, we have defined goals, removed legal barriers, and provided an organizational structure. This is like a naked skeleton. To put flesh and bones on this plan, you next develop effective recruitment and retention strategies. Hiring the well-trained and reputable staff members dedicated to providing top-quality care is key to fulfilling your mission. If you fail to fill your ranks with conscientious staff members, you could retain staff but fail to retain clients. On the other hand, retaining good managers may be a function of your overall policies and standards.

You can hire some staff directly full-time, some part-time, and contract out other specialists as needed. But you must do a thorough background check on anyone who will be working under you agency’s name, to protect patients, to avoid a possible lawsuit, and to protect your agency’s reputation.

7. ICD-10 Readiness

Finally, you should realize cash flow and reimbursement rates depend on efficient, accurate, and complete ICD medical coding practices. You need to train in-house coders or use a 3rd-party ICD-10 coding partner. Your clinicians need extensive documentation training to back up coders and keep everyone on the same page.

Do your homework before starting hiring your consultant. Look at the background of your consulting agency. Do they have expertise in all the items you need to begin your agency? Find the agency that offers specialists in all areas of the process. Are you obtaining access to one individual or a team of individuals working for you?

To accomplish all of the above and more for a successful homecare agency startup, you should invest in homecare consulting services such as those offered by Kenyon HomeCare Consulting. To learn more about Kenyon’s start-up packages, which cover everything from A to Z and are run by senior administrators with 20-plus years of experience, contact Kenyon online or call 206-721-5091.



Kenyon HomeCare Consulting is pleased to announce that we have partnered with Heffernan Insurance Brokers to enhance our Agency start up packages.  This partnership offers General and Professional Liability Insurance at a remarkably reduced rate; of which Kenyon HomeCare Consulting pays the first year and guarantees through Heffernan Insurance that the reduced rate will remain the same for 3 years. This partnership is another example of Kenyon HomeCare Consulting’s commitment to our customers.

Call for more information:

Kenyon HomeCare Consulting – (206) 721-5091

Heffernan Insurance Brokers – (925) 942-4619


The Future Of Home Health

Home Health

I would like to let you know what I heard and how the future of home health will look.  About eight years ago a physician out of John Hopkins did a demonstration study called Hospital at Home.  Though the number in the study was low the outcomes and the savings to Medicare were significant.

So far I have seen very little movement toward implementing this as a standard for home health until the 2017 CAHSAH conference.  In one of the networking meetings, I met a gentleman who said that he wanted to start up a Hospital at Home. Finally!!  My vision for the future of the home health industry is that all home health agencies will have three divisions; the Acute team, the sub-acute team, and the chronic team.

Acute Team

The Acute team will be made up of acute care nurses, specially trained aides, emergency level physicians, pharmacists, and therapists. Infusion and respiratory services will be available if needed patients will be referred from the emergency room to the team who will meet the patient back at home after the ER has done the stabilization of the patient.  The nurse and the MD will do a joint assessment that establishes the plan of care.  The first two to three days will have around the clock nurses, gradually passed off to hourly aides a week or less.

Sub-Acute team [currently the home health team]

If the patient is stable and reasonably self- sufficient, they will be pass to the sub-acute team which will see daily X two and every other day for 4 days.   If not a chronic condition dc if patient is managing and acute issue is resolved.  If the patient has a chronic disease that has resulted in repeat ER or hospital stays, the patient is referred to the chronic team whose job is to prevent any further emergent care issues.

Chronic Team

The Chronic care team has a Geriatric Care Manager, a physician and aides.  All aides are assigned based on their preparation and the needs of the patient.  Some patients will need ongoing aide support and others will need only the skilled nurses and physician oversight.  Services will be dependent upon need and may vary over time.



Electronics And Apps For The Universal Home

Electronics and Apps

Last week we talked about the design elements that are being incorporated into home designs and remodels that make a home livable for all ages and needs.  Today we are going to discuss the emerging electronics and apps that will be incorporated as part of the new Universal Home.

Currently there are what I call general use apps that are applicable regardless of age or disability.  These already exist and are in current use.  In the future, these apps will be incorporated as part of the home and will be either voice directed or motion directed.

Most of this technology already exists, but with the rapid advance of technology there will be many more added in the future.

“We’re no longer in the realm of future tech — today you can control and automate your home right from your smartphone without spending a fortune and without a centralized home automation system” Grant Brunner

In the future, these “apps’ will be part of the home construction.  The Universal Home will be “wired” with what we currently can only get through a smartphone app.

Current Apps Available:

Phillip Hue:  This is a lighting system that has the ability to dim, brighten, and change the color of its bulbs on command

Nest Thermostat:  Once you have it installed in your home, you just treat it like a normal thermostat. You turn it up when you’re home, down when you leave, and up again when you wake up. Soon it will learn what your pattern is and you’ll always come home to a house that is the perfect temperature. This kind of learning system is a huge step forward in the smart home.

Wemo:  This is a combination of a switch, a motion sensor, and an iOS app. Once this devices installed in your house, you can control any device you have plugged in right from your iPhone. Did you leave the light on downstairs? Do you want the TV to be on for you when you come home from work? Put it on a timer. With the motion sensor, you can even have everything turn on when you enter a room, and turn off when you leave.

Video Intercom or Smart Door Bell:  A video intercom is great for your house because you can see who’s at your front door before you open it.

Smart Alarm:  The installation of a smart home alarm system will provide security levels at home alerting to potential emergency situations in the home.

Smart Leak Detection:  Detects water leaks from a number of sources ranging from leaking pipes to refrigerators.

Smart Energy Control:  The IL 2.0 paradigm supports a number of energy saving devices ranging from motion sensors and wireless light switches to smart thermostats and energy monitoring units.

Smart Cameras:  cameras allow you to view live video images on your smartphone. Additionally, they can be configured to record live video when an alarm is detected.

 Current apps specifically for seniors that in the future will be a standard part of the Universal Home:

  • Smart stove alarms alert older adults to potentially dangerous situations in the kitchen. More than just smoke detectors, which only sound when smoke is actually present, new stove alarms sound alerts before toxic gases are produced, helping older adults prevent potential fire hazards.
  • Smart medication pillboxes offer audible or visual cues for older adults to prompt them to take their meds. at the proper time.
  • motion-activated lights that can be installed in the homes of those wishing to live independently. Motion-activated reminders can be installed and customized to the routines of older adults.  For instance, a motion-sensitive device by an entrance way can be set to trigger a reminder for an older person to lock the door or check the identity of the person knocking before opening the door

motion-sensitive device by an entrance way can be set to trigger a reminder for an older person to lock the door or check the identity of the person knocking before opening the door

  • Smart thermostats that can be activated by remote control or even by voice command, thereby eliminating the need to get up to adjust temperature settings. Such devices can also be monitored remotely by caregivers to ensure that temperatures in the homes of older ones remain comfortable and safe.
  • large, high-visibility displays that are both easy to see and manipulate with stiff fingers; key-less entry locks for those with arthritic hands, and curtains or blinds that can be operated with remote control devices.
  • Safety and security features that allow an individual to activate an emergency call to emergency systems
  • ADL Systems: An ADL system will help you age in place by continuously providing key information to your loved ones and caregiver.
  • Health monitoring Wearable: Monitors health status and can report to an emergency provider of family member if there is an identified issue

Our world is changing rapidly. The home of the near future will allow all of us regardless of age or degree of disability to continue to live in our own homes.  Truly aging in place

Ginny Kenyon

Why you want to Blueprint your ACO path

Accountable Care Organizations (ACOs) are networks of doctors, hospitals, home health and providers serving Medicare Fee-For-Service patients. Any Medicare provider can join if measures defined by the ACO and Medicare are met.

An ACO has benefits for providers and patients, but is challenging for providers to successfully execute. In this article, we’ll discuss why it’s crucial to create blueprints for successful ACO participation.Accountable Care Organizations

Benefits of ACO Participation

The goal of ACO’s is improvement in care with decreased cost. With healthcare providers working together, patients experience complete, seamless care alleviating unnecessary emergent care and hospitalizations. Successfully collaborating in an ACO benefits your agency from an organizational and financial standpoint. Medicare gives ACO members with positive outcomes additional reimbursement.

Preparing for ACO Participation

ACO membership isn’t simple and agencies must evaluate process measures. There are quality measures and outcomes required for participation. Once you’ve joined, the ACO must maintain and improve benchmark data to receive financial perks. Here are criteria of an ACO.

Eligibility Requirements

To participate, agencies should know how Medicare defines an ACO. Here are a few stipulations:

  • See at least 5,000 Medicare Fee-For-Service patients;
  • Three year participation minimum;
  • Be in good standing with Medicare;
  • No other participation in shared reimbursement plans with Medicare.

ACO’s also require a governing body responsible to promote use of evidence-based medicine, patient engagement, and quality and cost reporting.


Once your agency meets initial outcome measures, the ACO as a whole must exceed Medicare benchmarks to maintain additional financial reward. Benchmarks developed by CMS measure ACOs for outcomes and cost savings . If savings are discovered, Medicare shares a portion with participating providers. This means you must ensure staff is well-trained and communicates with other providers in the ACO. Successful collaboration decreases duplication of care and testing, emergent care visits, hospitalizations, and ultimately cost.

Kenyon HomeCare Consulting

It’s clear joining an ACO benefits your agency, but getting there is a challenge. At Kenyon HomeCare Consulting, we know the steps you’ll take to succeed in an ACO. Schedule a consultation to get started.