3 Costly Revenue Leaks Home Health Agencies Overlook—and How to Fix Them This Quarter

Is your home health agency making money but not as much as others in your area? Are your clinical and coding team members making mistakes that cause you to leave money on the table? 

You can lose reimbursement when a case-mix classification is missed or incorrect. If OASIS items are omitted or scored improperly, the patient may be placed in a lower-paying case-mix group, resulting in underpayment for the services you provide. 

One mistake can reduce reimbursement by hundreds of dollars per 60-day episode of care. 

Overlooking a relevant secondary diagnosis or selecting unspecific ICD-10 codes can lead to under-reporting a patient’s overall clinical complexity. 

Since comorbidities influence reimbursements under the Patient-Driven Groupings Model (PDGM), which is Medicare's primary payment system for home health services, you will see lower payments when you fail to specify a comorbidity. 

Here are some examples of common mistakes that agency owners make that cost them big money. 

Incorrectly scoring a patient’s ability to perform daily activities in OASIS can reduce payment and negatively affect quality scores. 

Missing or incomplete data occurs when you fail to document all the relevant, clinical information, including comorbidities that can lead to inaccurate coding and missed reimbursement opportunities. 

The lack of coordination results in the clinical documentation not fully supporting the codes that are assigned by the billing department. 

As a result, you can anticipate coding errors and denied claims. 

What’s worse, lower quality scores from OASIS data can lower your agency’s ratings from CMS, leading to reduced referrals from physicians and hospitals. 

At Kenyon HomeCare Consulting, our experts understand the significance of the appropriate oasis scoring, and the subsequent, ICD – 10 coding. With the help of Berg Data Solutions, we can assess your agencies financial health and identify the causes of decreased financial reimbursements. 

We have a robust ICD-10 coding department with RN home health-certified OASIS and ICD-10 coding experts. 

If you are struggling with reimbursement issues, call us today at 206-721-5091 or email gkenyon@kenyonhcc.com!