Kenyon HomeCare Consulting#1 Way To Cure An Anemic Bottom Line: Correct Diagnosis Coding - Kenyon HomeCare Consulting (206) 721-5091

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#1 Way To Cure An Anemic Bottom Line: Correct Diagnosis Coding

On March 5, 2016, CMS released a new tool to help those still struggling with optimizing their ICD-10 coding: ICD-10 Next Steps For Providers: Assessment & Maintenance Toolkit. This only underscores the fact that many, though not all, are still falling short of where they would like to be with their diagnosis coding.

The new CMS pamphlet highlights the importance of monitoring your progress in various Key Performance Indicators (KPIs). These areas include reimbursement rates, denial rates, and days between submissions and payments. Problems in every KPI, however, fundamentally stem from incorrect or inefficient diagnosis coding. Correct that, and an “anemic” bottom line will recover it’s health.

diagnosis coding

Correct Diagnosis Coding Is The Cure

Below, we look at some of the most effective ways to improve your diagnosis coding and your bottom line.

  1. Make sure all codes are correct and complete. ICD-10 requires up to 7 coding characters and is far more specific than past codes. There are now 70,000 individual codes to select from instead of 16,000 under ICD-9. It is imperative, therefore, to use coders specifically trained for home health & hospice coding, which differs widely from hospital or physician coding. These certified coders ensure codes are entered correctly the first time. Otherwise, there will be costly delays and denials, and your reimbursements will not be optimized.
  2. Verify consistency with other providers. Coding and sequencing must now match that of other providers enabling agencies to score an OASIS integrity rate of 70%. Soon, the requirement will be 80%. This means better communication between clinicians and physicians. A verbal order for additional visits will not be enough. Clinical documentation must include the need for treatment, its frequency, and measurable goals. Providers must “be on the same page” with matching diagnosis codes and sequencing or your reimbursement will suffer the consequences.
  3. Target old coding habits that must be broken. Nurses, do a lot of high-level overview charting, but they must learn to document comprehensively and specifically for each particular episode. Therapists, on the other hand, excel at setting specific, measurable goals, but often fall short on documenting corrective actions. All disciplines must improve their clinical documentation and include measurable goals, projected outcomes and corrections implemented to back up your ICD coding.
  4. Prevent recertification denials. Recertifications, under ICD-9, were rather simple – make a few notes on a client’s progress and ask for the additional visits to be covered. With ICD-10, you will need to submit 60-day care summaries that detail the need for continued care. Each specific action must be listed and aligned with specific, measurable goals. Recertification is a much more stringent process than in the past!
  5. Get feedback and monthly reports. Knowing where you stand is a prerequisite to getting where you want to be. Assess your current diagnosis coding adeptness with monthly reports and clinician feedback systems that identify problem areas and reveal who is in need of additional training.
  6. Update without delay. ICD-10 updates and clarifications will regularly occur, and it is imperative to implement these changes rapidly to avoid harming your bottom line.

Outsource Your Diagnosis Coding

While all of these improvements can be attempted in-house, many healthcare agencies have found, it is more efficient to outsource their diagnostic coding. Outsourcing to Kenyon HomeCare Consulting through the Coding Plus program, often results in a reimbursement rate surge of 29% to 48%. The experienced, certified coders at Kenyon HomeCare are simply better equipped to process claims quickly and correctly. Denials and delays are virtually eliminated, and you get “extra plus” with Coding Plus. These benefits include documentation assistance, OASIS integrity reviews, monthly management reports, and more.

Schedule an appointment or call 206-721-5091 for more information!

Category: ICD Coding

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