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ICD Coding

Oasis And Coding Are More Important Than Ever. What Are You Doing To Make Sure Every Oasis Counts? Or, Are You Just Sitting Back Hoping For The Best?

ICD-10 CodingWith the approach of PDGM, homecare agencies work to understand and fit in a new payment system. If this is where your thought process ends, then it is time to go back to basics. Oasis and coding are the basis and the beginning of everything from your care plan to reimbursement. If you do not optimize both, then you miss the mark moving into PDGM. 

OASIS Accuracy: 

Many agencies dismiss Oasis training with the thought process that “nurses are sick of Oasis training”. This may be true. However, training and evaluation of Oasis accuracy are key to care planning and proper coding. You may be a small agency that does more Medicaid than Medicare. This should not decrease your effort to train and evaluate accuracy. With PDGM, it reality that certain agencies will not survive. This may increase your Medicare census. As the Oasis tool changes, it’s frustrating for long-term clinicians. The way a question was answered 5 years ago is not the way it is answered today. This causes a need for some de-programming of that previous knowledge. Don’t assume staff is answering things correctly. Now, this doesn’t minimize the value of long-term staff in any way. You know the invaluable leadership and experience these staff bring to the table. It just means you must evaluate the accuracy regardless the years of experience. 

Coding Appropriately: 

Coding needs to be evaluated on several levels. Whether you code in-house or outsource, make sure your coding system optimizes the dollars you deserve. A good way to determine whether you are on the right track is by doing a side-by-side comparison. If your current in-house provider evaluated the same for OASIS and coding as an outside source, then you can feel good about what is in place. You may also find out from the outside source that you do not have the documents you need to justify codes that could lead to higher reimbursement. Let me explain this. Many times, it may be clear to the clinical reviewer of Oasis and coding that the patient qualifies for certain specific codes, but the agency has not sought out the documents from outside agencies to prove it. This leaves you agency at risk for losing hundreds or up to a thousand dollars for an episode of care.  It is worth the time and effort to make sure you are on the right track.

Let Kenyon Homecare Consulting Be Your Side-By-Side Comparison:

At Kenyon Homecare Consulting, we always offer 5 free re-codes to work as a check-and-balance to your current system. Whether you need someone to cover your in-house coding during times of high census or medical leave, we can help. Maybe you have been a provider that outsources but haven’t seen improvements in accuracy or coding specificity. Call us today at 206-721-5091 or contact us online to see if we can help with education, coding, or evaluate your current system. 

ICD 10 Coding: Understand How Coding And Documentation Can Keep Your Agency Out Of Hot Water At Audit Time!

ICD 10 CodingSometimes, home health agencies don’t give ICD-10 coding much thought. Maybe you are a home care that provides mainly Medicaid services, so you don’t focus on Medicare specifics. Either way, we are coming up on big changes to payment reform. It is important on both a compliance and financial standpoint to get it right to thrive in a PDGM world. Let’s look at why you should code confidently and not dismiss its role in the auditing process.

Are You “Just Being Safe”?

Often times, agencies will avoid code specificity for multiple reasons. It can be a lack of knowledge, lack of supporting documentation, or fear of the dreaded “upcoding”. Let’s address each of these and what needs changed.

  • Lack Of Knowledge: Who is your coder? Many smaller agencies have office staff or the nurses coding. Nurses have so many responsibilities. It is unrealistic to think that the nurses can spend the time to properly code along with everything else. An office manager who also works to code isn’t a good option either. There is no question a certified coder needs to do your codes.
  • Lack Of Supporting Documentation: In the previous bullet point, think about whether or not your nurses or office staff would be able to take the time and follow through to hunt down extra documents. The answer is no. Those individuals already have other specific job roles. What takes precedence for them? The difference in hunting down the documentation could mean the difference in hundreds to a thousand dollars an episode.
  • Fear Of “Upcoding”: Many agencies fear code specificity for fear of “upcoding” or getting in trouble for picking a code with higher reimbursement. This does an injustice for your agency. If you have the documentation, there is no upcoding. As Medicare uses the data derived from agencies to determine ongoing reimbursement rules, you must show the level of care by the diagnosis you address.

How Does ICD 10 Coding Affect Me At Audit?

If CMS sees ongoing uses of non-specific codes, it may trigger audit. It could be that there is an ongoing number of therapy visits attached to a certain non-specific diagnosis that doesn’t support it. As an agency, you don’t want to trigger an audit. Maybe you didn’t trigger one, but an audit demonstration hits your state. Ultimately, use of non-specific codes is often unsupported by face to face documentation and can immediately have your episode denied. Without certified coders, you don’t really know if your charts have the documentation needed to even get past the first part of your audit.

Let Us Help!

At Kenyon Homecare Consulting we have ICD-10 coding available along with billing programs if you need the assistance. If you are unsure, then let us do a free side-by-side code demonstration and see what the potential difference in revenue and compliance is for your agency. Call us today at 206-721-5091 or contact us online to see if our coding program is the solution for your agency moving forward.

ICD-10 Coding Moving Forward Into PDGM: Does Your Program Have What It Takes To Thrive Or Are You Setting Yourself Up For A Big Fall? You Can’t Build Your House On A Weak Foundation.

OutsourcingICD-10 coding is crucial for today’s home health world. However, agencies still do not accurately reflect patient care with the specificity of codes. This leaves money on the table and leaves CMS to wonder about things like case mix creep. In the world of PDGM, you cannot afford to miss out on proper coding and development of visit protocols to go with it.  

Common ICD-10 Coding Mistakes: 

Many agencies do code on-site. If you are one of those agencies, then make sure your coders have the skill to do justice to your coding. Here are common errors with ICD-10 coding: 

Knowledge: So many smaller agencies have someone code that is self-taught. You cannot afford this regardless of the number of Medicare admissions you do.  

Fear: Yes, that is exactly right. Sometimes, coders will stay away from higher specificity coding due to lack of the knowledge. This leaves money on the table. Ultimately, you do not need to fear repercussions from audits if things are properly completed. Upcoding is not ok but making sure you receive proper reimbursement is.  

Time: Many agencies have coders that fill multiple roles within the agency. Coding properly is a significant job. Often, coding properly can become secondary to other work functions at your office. If your coder is also an admin assistant, then does he or she really have the time to give coding its due? Or, will you see common non-specific codes because it is quicker and easier.  

Operations Based On Medicare Census: Your coding needs to be correct regardless of how much Medicare business you do. Many agencies that focus mainly on Medicaid do not worry as much about coding since it is not tied to reimbursement the say way. This is not the way to do things. CMS compiles this data and then “sees” a picture with less acute patients. So, filling out the Oasis and codes properly is more important than ever rolling into a PDGM world.  

PDGM and Beyond:

Along with correct Oasis, ICD-10 coding with be crucial in development of visit protocols to sustain you in a PDGM world. Business as usual will not work. You have probably heard that many times this year. But, if you are struggling with how to change things, then the time is now. Consider outsourcing your coding in small agencies. It is not fiscally sound to have someone trained and to maintain competency of coding skills in a small agency. Moving into PDGM is a great time to transition the coding outside. Choose coding only from certified coders that make sure you have the data needed in your chart to justify your codes. If you have proper documentation to justify your codes, then auditing may be cumbersome, but ut usn’t scary. 

Kenyon Homecare Consulting ICD-10 Coding Program:

At Kenyon Homecare Consulting, we can help with all your coding needs. Whether you just need the coding done or need assistance with billing, the services are here. We have certified coders who can help make sure you get the dollars you deserve for care of the patients you see.  Call us today at 206-721-5091 or contact us online to see how we can help you!  

What’s Really In ICD 10 Coding? Let’s Pick Your Clinician’s Brains To See Their Perspective. Will It Be The Same As What You Think?

Ask StaffIn the world of ever-changing home health and hospice, clinicians have so much to put together.  The pieces of the home care puzzle can often leave clinical staff feeling like a mouse in a maze.  When you consider ICD 10 coding, it needs to be much more than some numbers on a piece of paper.  To get the most from your coding solution and your care plans, you need to assess how your clinical people view those codes as a part of care.

How Do You Assess Clinical Perspective Of ICD 10 Coding?:

That is a loaded question. You have to talk to skilled disciplines about what different diagnoses do to change a care plan.  Whether it is a nurse or a therapist, the pathophysiology behind the diagnosis is very important in determining the care plan.  If the specificity of the diagnosis is not considered when clinicians work with patients, then how do you optimize a care plan? You really can’t. A knee replacement is not the same care plan as a knee replacement for someone with a history of uncontrolled diabetes. If that seems basic to you, it may not be in what you see in a care plan.

Here’s A Challenge For Your Agency:

Consider the example in the previous paragraph and find different charts that would be comparable to it.  Then, compare the care plans.  There should be a difference in how the patient is assessed and interventions are carried out based upon the addition of that chronic disease.  It needs to be more than just recording a blood sugar.

Now, compare several charts that both have knee replacements with diabetes.  Can you tell the difference in those or do the care plans mirror each other?  Can you tell the difference between patient “A” and Patient “B”?  If the answer is no, then clinicians need to dig deeper into making the care plan fit the diagnoses specific to the needs of the patient.

How Does My ICD 10 Coding Fit In To Make This Better:

Your coding solution and care planning can be a well-matched couple if you structure the two working together as a team.  The silo of coding to clinical is problematic.  A well-trained certified coding expert who also is certified in Oasis or as an Oasis instructor can make a big difference to bridge that gap.  Your Director Of Nursing or Supervisor can work directly with field staff on taking the information from the coder into the next level of care plan development.  You know why the two are so important, but make sure your field staff are on the same page.

Let Us Help Be Part Of Bridging The Gap:

Whether you outsource your coding or have certified coders yourself, Kenyon Homecare Consulting can help bridge the coding and clinical portion together.  If you would like us to become your ICD coding solution, call us at 206-721-5091 or contact us online.  We can be your entire solution or bring the educational support to improve your current system.

Are You Making Sure You Are Good Enough Now Before ICD 11 Comes At You Like A Ton Of Bricks? Streamline Your ICD 10 Coding So You Are Prepared.

Coding AccuracyRemember when ICD 10 coding hit?  Wow, what a huge change for clinical as well as coding staff.  Since the industry is not far away from ICD 11, make sure your ducks are in a row now.  Functioning well in ICD 10 coding will make everything easier for the transition.

What? ICD 11?:

ICD 11 is the next update from the World Health Organization in diagnosis coding.  It has been years in the making.  The timeline for implementation is January, 2022.  This may seem like forever away, but the industry is almost a year into the new COP’s.  It is just around the corner.  It is important to look ahead to what is coming with the changes in the coding system to know how it will impact your agency.

Are You Good With ICD 10 Coding?:

We have spent a significant amount of time writing about the importance of doing ICD 10 coding right. Coding and documentation are important from a regulatory standpoint, but the financial is just important.  Your agency should never leave money on the table for the care you provide.  You earn those dollars.  If your documentation is there and you don’t code properly, you can easily lose hundreds of dollars per episode.  Claim the money your agency is entitled to receive.  Now, if you don’t know whether or not you are on target this way, you need to find out.

How To Evaluate:

There are many ways to keep your agency up-to-date on in-house coding practices and here are just a few:

  • Provide ongoing education including resources to your coding staff
  • Do a side-by-side comparison with staff coders with an outside source
  • Certify your coding staff
  • Tighten your documentation guidelines with clinical staff; make sure all clinical data is there
  • Educate clinical staff on coding where coding guidelines and clinical documentation meet; Connect those dots in a clear way

What If You Currently Outsource?

The guidelines on being up-to-date don’t change regardless of whether or not coding is done by your staff.  Your outsourced coding provider should be able to communicate what resources are used to keep coders functioning at a top-notch level.  Side-by-side comparisons are still a good thing.  It is not uncommon to see that one type of service is not equivalent to another.  You may think your provider is doing well only to see you are not getting your money’s worth.  Your documentation guidelines to staff still need to be clear and the dots connected.  If you do not see clinical documentation improve with coding and Oasis review, then internal education is needed.

Kenyon HomeCare Consulting Can Be Your Help!:

At Kenyon Homecare Consulting, we can be your side-by-side comparison or your full coding and billing provider.  You may just want additional teaching online to staff from the coders that connect the dots between clinicians on a daily basis.  Call us at 206-721-5091 or contact us online today to see how we can help make sure your ICD 10 coding is ready to move forward when it is time for ICD-11!

Does Your ICD 10 Coding Need A Check Up? Why A Scheduled Side-By-Side Comparison By An Outside Source Can Tell You So Much!

back upToday, if you know how important a back-up plan for ICD 10 coding in your home health agency is, then you also know how important it is to consider the right one for your agency. Let’s look at some simple factors and why you need to pick the outsourced company that best works with your home care.

5 Things To Consider When Choosing Your Back-Up Or Full Coding Provider:

There are reasons why all home care companies are not created alike and the same rings true for coding solutions.  Here we take a look at the important things to consider in ICD 10 coding outsourcing:

  • Education: Consider the requirements you have for your own coders.  Make sure you look at companies employing only certified coders.  How do the coders keep themselves educated on changes?  These are questions your provider needs to answer before you sign on board.
  • Oasis Training: Oasis training is not only a necessity, but consider whether or not your coders are certified in Oasis.  Are they certified to instruct in Oasis?  This type of credibility in knowledge of the Oasis tool is important.  It not only justifies the knowledge base of the coder, but the ability to communicate with the clinical staff who complete the Oasis in the home.
  • Experience: You know that home care is in a whole different world than other types of healthcare.  If you want someone to be your back-up coder or outsourced solution, then you need someone who knows how to code specifically for home care.
  • Format/Information Provided: Reality is, not all ICD 10 coding formats give an agency the information they really want and need to make the staff better.  Your coding solution should make your clinicians better at filling out Oasis properly.  The report you receive from ICD 10 coding should provide teachable information for clinical staff.  You should see changes in error rate decline over time.  If you don’t, then you need to figure out why.
  • Ability To Teach Clinical Staff: You may not be a clinical administrator and need an objective teacher for your clinical staff.  Those coding solutions that have certified Oasis instructors can be invaluable to your ongoing educational needs.  These coders can provide one-on-one, class based, or online learning solutions to advance your clinical staff.  If you are a new start-up, then you may want to have those certified coders go on-site with clinical staff as admissions are completed.  This allows education to be patient based and not just in the classroom.

Let Us Help Be Help Your ICD 10 Coding Program As The Solution Or Back-Up:

At Kenyon Homecare Consulting, we can complete any or all your coding needs.  Our coders are certified and we have Oasis Certified Instructors.  Call 206-721-5091 or contact us online to receive your free 30 minute consultation with a senior associate.

To Infinity And Beyond! ICD 10 Coding That Is More Than Numbers On A Care Plan. Make Sure It Is the Difference In Your Home Health Course To The Next Generation Of Care!

ICD 10There is a lot of focus on ICD 10 coding and its importance in the last several years. But, if you don’t look at your entire clinical practice, then you can easily miss the big picture.  This can cause both a negative clinical and financial impact.

Looking Forward Often Means A Look Back First:

Coding used to be something that was done by the nurses as part of the admission process.  It was much simpler in the days of ICD 9.  And, if you ask nurses who have done home health for years, then most will still be able to quote frequently used codes by memory.  The codes were added to a form with interventions and goals and administrative staff transcribed info to the 485.  No one paid as much attention to the coding sequences or how many were listed on the 485. The process of ICD 9 can’t work effectively in the world of ICD 10.

ICD 10 Coding Should Drive The Care Plan:

Today, with the complexity of ICD 10, the diagnosis is not a box that needs filled in on the 485 or Oasis, it should be the basis for the care you provide.  It starts with your process.  Do your nurses create the entire care plan before coding is completed? What would the care plan look like if interventions were considered based upon the correct ICD 10 code first? Agencies need more and more information for admission today, but how sure are you that it impacts the way your care plans are created or executed? If your agency has the correct codes in the proper sequence prior to completion of the care plan, it could make a big difference in how the care plan is executed.

It All Begins With Education:

Look at your current coding system.  Now, whether you complete coding in-house or by outsourcing, education to staff is key.  It is important to educate staff as to why the diagnosis codes need to drive the care plan.  If nothing changes with the clinical process in your coding, you can get the proper diagnosis and sequences from your coding system, but not achieve the clinical excellence to accompany it.  It should complete a circle that ends in clinical outcomes you want for the patient and your agency.

Let Us Help:

At Kenyon Homecare Consulting, we offer a wide spectrum of coding services.  Whether you need Oasis education to clinicians, on site visits with staff, or all you coding outsourced, we can help.  Call 206-721-5091 or contact us online for your free consultation and let us explain how our coding programs can help achieve your goals.

ICD 10 Coding: How Good Is Your Internal Program? Prepare Yourself For Staffing Changes And Surge Without Blinking An Eye. Evaluate Your System And You Won’t Regret It!

HelpBecause of changes in the COP’s, you have heard the words emergency preparedness more in the last two years than what you ever thought.  Now, consider how you look at your in-house ICD 10 coding.  Have you prepared it for an emergency?

What You Have Now:

You have invested in certified coders.  That is great.  And, if things have been rolling pretty smoothly for you, that is even better.  This industry continues to be pressed with more auditing to make sure reimbursement is correct.  You cannot afford to have anything slow down your progress.  Here are some things to consider when evaluating your current system:

  • Surges: How much additional coding and Oasis review can your current coders handle? Maybe you are already at maximum capacity.
  • Medical/ Family Leave: If your current coders are very reliable and only miss work for the occasional short term illness, then what would you do if any of them were suddenly out for months unexpectedly?
  • Turnover: The home health industry is extremely competitive and long term coders may want to leave for better salary, hours, or flexibility to work from home.  What happens if your one and only long term coder leaves in two weeks? If you think it cannot happen, then you need to think again.
  • Termination: What if you suddenly need to terminate a coder for policy violations or lack of performance.  You have to consider the time it takes to hire and train someone new. What if you don’t have that person to train the new hire?
  • Accuracy: You know the importance of coders being certified, but have you evaluated accuracy.  It is important with any agency to have a check and balance to make sure you get the most bang for your buck.

Consider Your Back-Up Plan:

You need to always consider having an outsourced ICD 10 coding system in place for all the reasons listed.  If you get a reputable coding company on board, you can have a solution for all your coding needs.  Whether you have a termination, surge, or medical leave; you can continue without missing a beat.  CMS is expanding pre-claim review. This means more states will be pressed for time to move forward with coding and documentation review so RAP payments don’t slow down.  If you don’t have someone reviewing your codes and documentation until weeks down the road, you will inevitably deal with cash flow problems.  If you find that your current documentation does not yield reimbursement equal to state or national averages, then maybe you need additional education to get your agency receiving the dollars you deserve for care you provide.

At Kenyon Homecare Consulting, We Have Your Coding Solution:

Kenyon Homecare Consulting takes a comprehensive approach at helping agencies succeed at ICD 10 coding.  We can educate, go on-site with clinical staff, and provide off site ongoing support for your needs.  Whether you need us to cover in times of surge or turnover or you want us to take over your coding; we can help.  Call 206-721-5091 or contact us online to see if we can help be your back-up plan or ongoing coding partner.

Working With ICD 10 Coding Can Be Frustrating, But It Can Also Be A Game Changer. Are You Making The Most Of The Agency’s Hard Earned Dollars Spent On Your Coding Program?

ICD 10 CodingThere is a lot of focus on home health ICD 10 coding today.  There are many ways to complete coding in your agency.  However, if you want to maximize what you get from your program, then you have to make sure your agency follows through with the process.

Do You Code In-House?:

There are many benefits of having in-house certified coders on hand.  It allows communication directly within your agency between the coder and the nurse completing documentation.  This can work very well in some agencies.  In others, you may have all the tools, but all the parts don’t fit together.  Break down each part of the clinical process to determine its efficacy:

  • Intake Information/ Referral
  • Admission Documentation
  • Time Frame From Admission To Coding
  • Communication Between Coding And Clinicians
  • Percentage Of Changes After Coding Review

In this scenario, the most important part lies in the last bullet point: Coders are the experts in the ICD 10 coding and the documentation that must go with it.  If the coders makes suggestions, but the documentation does not improve, then your agency loses.  Coders are trained to the ins and outs of Oasis.  So, if the Oasis has discrepancies, then something must be altered to paint the correct picture.  Is this a process you assume happens? Make sure you check.

Do You Outsource:

Outsourcing has many benefits.  In small agencies, hiring someone for the amount of coding you have may not be cost-effective.  It is also not effective for nurses to do coding.  Coding is too complex today to expect nurses to complete it effectively along with everything else. Often times non-specific codes are used because it is the path of least resistance.  When you outsource, you are dealing with those that complete coding and Oasis review 100% of the time.  It is the coder’s niche’.  You can maximize your reimbursement as well use the coder’s findings as an educational tool for clinical staff.

Education And Improvement Is The Key:

So, whether you code within or outsource your ICD 10 coding, the important part is knowing what is done with the information you receive.  If you do not get the outcomes from in-house coding you want, it may be time to consider outsourcing. Try to change and improve your internal processes before you make a decision.  You should see fewer errors in Oasis completion over time with proper staff training and education.  If you do not have the reimbursement equivalent to state or national averages, it is time to consider changes.

Let Kenyon Help Be Your Coding Solution:

At Kenyon Homecare Consulting, we can be your outsourcing solution for ICD 10 coding.  We can complete on and off site education with clinical staff to improve Oasis accuracy and make sure you have elements in documentation to back up your care plan.  Contact us online or call 206-721-5091 for your free consultation.

Mastering ICD 10 Coding In Home Health: Is It Like A Trip To The Thunderdome For Your Home Care Agency Or More Like Mission Impossible?

CodingOK, so you have talked and talked about why ICD 10 coding is important.  If you aren’t seeing the outcomes and optimal coding, then consider a change in your process.

What Is Your Current Process?:

Here are a few things commonly seen holding home health agencies back:

  • Coding Completed By Non-Certified Coders
  • Nurses Complete Coding
  • Weak Documentation Process
  • Non-Specific Coding Used

Why Nurses Should Not Complete Coding:

Smaller agencies often have nurses complete ICD 10 coding.  It is also very common with a small Medicare census in an agency.  Nurses have a focus on patient care and over the years, documentation has shifted to be much more complex.  There are so many things nurses must focus on from physician orders, coordination of care, and Oasis on a daily basis.  It is not a realistic expectation for nurses to be coding experts.  Often times, it becomes a “safer” process for nurses to choose non-specific codes to avoid the hassle of hunting down additional info.   This leads to significantly reduced reimbursement.

The Dreaded “Coding Creep”:

As CMS sees agencies become more proficient at proper coding and documentation, the words case mix creep and coding for money have been suggested. Doing ICD 10 coding right doesn’t mean you have to apologize for the additional dollars that come with optimized codes.   If you have the documentation that supports the code, then you are entitled to receive the proper reimbursement for the care.

Consider Additional Staff Education:

If you educate staff to how the whole process works together, then it will be easier to transition to different documentation expectations. Link the documentation and coding in a clear way so staff understands it is more than just some numbers at the top of a care plan. Help your agency understand that the coding should drive the contents of the care plan.

Let Us Help You Make Your Coding An Asset:

At Kenyon Homecare Consulting, there are multiple solutions to assist both on and off-site to improve your coding process.  Call us at 206-721-5091 or contact us online today to maximize your coding potential.