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13 Unlucky Coding Errors Distressing Your Revenue

A man with holes in his pockets who walks down the sidewalk spreading coins on the pavement with every step, might blame his “unlucky trousers.” And a traveler who stays in a low-quality hotel may credit his lackluster experience to the fact that his room is located on the 13th floor. But, lost home health revenue is far more likely the result of common coding errors than a case of “bad luck.”

Coding Errors Affecting Your RevenueCoding Errors

Below, we outline 13 “unlucky” and very costly coding errors that plague home health agencies. Each error is then followed by a viable means of correction.

1. Incorrect Code Selection

With literally tens of thousands of ICD-10 entries to choose from, it is easy to mistakenly select a code belonging with a similar but different diagnosis. Using only certified home health experienced coders with a stellar “coding record” will eliminate this kind of erroneous coding.

2. Insufficient Coding Specificity

ICD-10 is extremely detailed, and CMS expects claims to be coded consistently and match the client’s specific diagnoses. Hiring certified home health coders and providing re-training as needed and will consistently get you to the required specificity level.

3. Incomplete Coding

Although the 7th ICD-10 character is reserved for later expansions, all relevant alphanumeric characters must be complete to receive accurate reimbursements. Without complete documentation, however, this is impossible. But, retraining clinicians and having an excellent documentation plan will cause positive ripple effects.

4. Not Coding Comorbidities

List on the claim form not only primary diagnoses, but all client comorbidities to get maximum reimbursements. Have managers verify all client comorbidities to ensure both adequate clinical documentation and correct coding before submission.

5. Hiring Non Certified Home Health Coders

The false belief in a “one size fits all” type of coder affects your bottom line. However, certified home health coders are familiar with the complex CMS home health specific billing requirements and realize the importance of OASIS documentation.

6. Copying and Pasting

When unsure of what to code or are simply pressed for time (or lazy), some coders resort to copying codes from past medical records. This practice is ill-advised because when context of care changes, often so does the proper code. Plus, past coders make mistakes. Basing codes on current physician notes produces fewer coding errors.

7. Not Matching Other Providers

You must code consistently with other providers to achieve the required 80% OASIS quality score. Therefore, compare clinical documentation to recent physician’s notes and communicate with other providers.

8. Outdated Coding Practices

Be aware of annual and triennial changes to ICD-10 and remember ICD-11 preparation is right around the corner. Utilize CMS resources to keep your coding constantly up to date.

9. Poor Recertification Submissions

To avoid recertification denials, educate staff to outline specific, measurable goals and outcomes. And ensure that in the 60-day summary, all continued home care is justified.

10. Managerial Overload

If your managers are spending time coding instead of managing, your revenues will suffer. Consider coding outsourcing to free up your managers to do what they do best.

11. Slow Claim Submissions

Are you experiencing cash flow problem caused by backed-up claims? Finding and hiring a certified coder is a solution. However, outsourcing will immediately correct this error!

12. Inability to Measure Progress

A professional assessment of your coding efficiency and continued monthly reports allows you to evaluate your coding progress. After all, you can’t manage what you can’t measure!

13. Paying too Much

While many assume outsourcing is more expensive, in-house coding has many “hidden costs” and generates less revenue. Take time to do a detailed financial comparison to determine if outsourcing is right for you.

Next Steps To Prevent Coding Errors

In conclusion, remember only by eliminating persistent coding errors can you expect to boost your agency’s distressing revenue. Waiting for “good luck” to solve coding problems will likely end in only disappointment!

Kenyon’s Coding Plus program can raise your reimbursement rates by 29% to 48%! To learn more about outsourcing or other services offered by Kenyon HomeCare Consulting, call 206-721-5091 or schedule an appointment here.

Category: ICD Coding

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