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ICD Coding

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.

ICD 10 Coding In Today’s Home Care World: Making Something Complex And Complicated Much Less Frustrating And More Cost-Effective All In The Same Breath!

OutsourceIn ICD 10 coding for home care, you know Oasis and documentation must match the diagnosis to be valid.  If you don’t appropriately document, then you miss out on the benefits of proper coding.  Let’s look at how outsourcing your coding can help you manage the day-to-day a whole lot easier.

Eliminate The Coder To Clinician Struggle:

Have you had on-site coders in your agency in the past? You are not alone if you have had a tough time between nurse and coder.  Nurses are often offended when a coder recognizes discrepancies in documentation.  Certified Coders are tuned into the Oasis tool.  And, it is in a different way than nurses are programmed to understand it.  It is a data collection tool.  This is a pure and simple fact.  Yes, nurses make the judgment while in the home, but the pieces of the Oasis tool fit together not as an independent systematic nursing assessment.  Certified coders are trained on the puzzle pieces that must fit together.  Nurses are educated to assess each person according to each body system.  The two are different.

If you outsource, then you eliminate the tug-of-war that can happen between coding and clinicians.  Time and resources go into personnel management are a realistic thing to consider here.

Improve Turnover Time:

Outsourcing is important when talking turnover time.  If you only have one or two coders on staff, you are behind the eight ball with extended illnesses or other efficiency issues.  These agencies should always have a back-up plan in place to assist if this happens.  Outsourcing from a back-up standpoint is smart in times increased census or long absences.  Outsourcing coding companies often have a guarantee on turnover time.  Look at your coders in-house.  Have you measured turnover time? If you can submit the RAP sooner, then you improve cash flow and have more time to get orders signed.

Financial Savings:

Having Certified Coders in-house is expensive.  You are not just paying for the direct cost of labor, but everything else for the employee.  There are your typical direct and indirect costs, but ongoing education is a biggie.  Coding rules are ever-changing.  What is correct today will not be down the road.  So, staff must have time to keep updated and educated along the way. Coding is not being completed for your agency during this time.  When outsourced, this is not your responsibility.

Many times, in-house ICD 10 coding employees are not certified. If you have those employees doing your ICD 10 coding who have been to a seminar or two, then you are missing out financially.  Most agencies will see hundreds of dollars difference in the episode reimbursement from a certified coder versus the alternative.  It is not uncommon to see up to a thousand dollars difference just from the use of unspecified codes.

Let Us Help Be Your Coding Solution:

At Kenyon Homecare Consulting, we have certified coding experts with significant home health experience.  We can help with on site and virtual training. We can be your coding solution as well as your coding back-up.  Call 206-721-5091 or contact us online today to see how we can help you.

ICD 10 Coding Is The Holy Grail Of Home Care. Why, You Ask? Transitioning Your Home Care To Coding The Way It Was Intended. And, How To Be Thrilled With It both Clinically And Financially.

icd 10 codingIn home care, ICD 10 coding is not just about having a number in the box on a 485.  It should be about what that number means for the rest of the care plan.  Here we look at how to make the two items mesh to improve clinical and financial outcomes.

Getting The ICD 10 Coding Right:

Having the right code here cannot be understated.  The wrong code hurts you financially and sets you up for care plans that don’t match a diagnosis. Or, you can have very generic care plans that don’t address the specifics of the diagnosis attached to the patient.  Either way, care plans are not optimized.  Proper coding starts you on the road for where you need to be.

Look At Your Current System:

Let’s take a look at the pros and cons of in-house versus outsourcing your coding program.

1: In-House:

It’s really nice when you have certified coders in house that work directly with staff.  However, often times, agencies send an employee to one or two coding classes and that is the extent of the education.  Coding expertise is ongoing education.  It is complex and ever changing.  A good in-house coder will help clinical staff improve overall documentation. A certified coder in house should also know Oasis well to be effective in linking documentation. If you have that, it is great!

Sometimes, agencies have a coder on staff that is not coding certified.  Small agencies that don’t service as much Medicare often dismiss the importance of coding if it doesn’t hold a high percent of revenue.  This is a problem.  In these cases, little to know Oasis education is present for clinicians and coders are mostly self-taught.  The problem is the patient picture is not accurately reflected in the Oasis or the care plan and money always gets left on the table.  You deserve to receive the money for the care you are expected to provide.  Don’t cheat yourself out of what you should receive.

2: Outsourcing:

Outsourcing ICD 10 coding and Oasis portion has a lot of pros for multiple types of agencies.  If an agency is large with many locations, outsourcing all the coding and Oasis becomes an efficient way to get a 485 processed and out the door.  You should make sure your outsourcing is done by agencies that provide certified coders with home health experience.  Home Health coders understand that it is not just about the code, but the Oasis and other documentation that goes along with it.  If an agency is small with a smaller Medicare census, it may not make sense to employ and maintain a full time certified coder.  Outsourcing becomes the more cost effective way.  Outsourcing is also really good for those that have staff coders in need of back up for vacations, medical leave or increases in census.

The cons of outsourcing are that the “person” on staff is someone the nurses can talk with about potential discrepancies.  Outsourcing doesn’t have that tangible person there to work though trouble spots or certain clinician blind spots in documentation.  So, the advice would be that in an outsourcing situation, make sure you have the ability for the company to always make coding and documentation review a teachable moment for staff.  Everyone gets better in a system like this.

Now, Regardless Of Which System You Use:

You need to fully grasp why ICD 10 coding is the holy grail.  They should drive everything you do within your care plan for all disciplines involved in care.  A full understanding of what a code means for a patient clinically allows those in the home to best intervene during and between on-site visits.

Not Sure What Way Is Best For You?:

At Kenyon Homecare Consulting, allow us to help you with your ICD 10 coding needs and education.  An organizational assessment will allow a top to bottom look from clinical to administrative operations and show how to best maximize your agency.  Call us today at 206-721-5091 or contact us online to schedule your free 30 minute consultation so we can help you find the right coding solution for you.

Master Your ICD 10 Coding And You Master Your Home Health Program! Maximizing Your Reimbursement And Outcomes All At The Same Time!

ICD-10 CodingICD 10 coding is complex.  It is detailed and specific.  So are the patients that have the diagnoses attached to those codes.  Make sure you take a look at how better coding makes your program better overall.

5 Ways Maximizing ICD 10 Coding Can Mean A Better Overall Program:

First and most important you need coding done by those certified in ICD 10. So, that being said, here are 5 ways to make the most of your diagnosis codes.

1. More Specificity:

A good example of this is congestive heart failure.  ICD 9 used to use a more generic code, but now ICD 10 coding requires the specificity of what type. Looking at the type and patient specific causes means that the clinicians can have a better understanding of what to expect from the patient.  This would include the classes of the disease that determine severity.  This leads into our next reasons for improvement in your program.

2. Patient Specific Intervention:

By knowing the specific diagnosis, clinicians can better make patient specific care plan interventions.  Your interventions for someone with a class 1 CHF are different than those for a stage 3.  Realistic care planning is the only way to improve patient outcomes based on what is specific to that patient.

3. Patient Specific Goals:

Along with intervention, goals need to fit the diagnosis attached to that individual. A class 3 or 4 heart failure patient is not able to complete physical activities without shortness of breath. This may seem like common sense, but it is not uncommon to see goals that are not attainable for a patient regardless of compliance to care plan.

4. Painting A Clearer Picture:

In order to be able to code properly, documentation needs to be clear.  Certified coders know what needs to be present to justify codes as well as Oasis information.  ICD 10 coding requires more information and collaboration between home health and other providers.  Having the proper information in the patient record leads to painting a clearer picture for each clinician that enters the home.

5. Getting the Proper Reimbursement:

Don’t ever leave money on the table you are entitled to receive.  If you have the documentation and use the appropriate coding, you will receive what you need to care for the patient.  If you don’t, you will provide proper care and go in the whole every time.  That is not the intent.  Proper care planning and coding should provide what is needed to take care of the patient and keep you in the black at the same time.

Many agencies have the nurses coding while doing everything else.  Nurses cannot be the experts in coding and be expected to focus on patient care too.  Coding done by non-certified coders can mean up to $1,000 less per episode of care dependent upon the individual patient.

Let Us Help Turn It Around:

At Kenyon Homecare Consulting, we work with agencies on organizational assessments and process changes to maximize overall operations.  We provide coding services and in-depth on site education to nurses both in and out of the homes to help with Oasis accuracy and documentation.  Call 206-721-5091 or contact us online to receive your 30 minute free consultation.  Let us make a difference for your agency.