Have A Small Medicare Footprint? Think You Don't Need To Worry About ICD 10 Coding? Think Again!
December 2, 2021
After years of being in the business of homecare consulting, we have seen importance of accurate ICD 10 coding increase. However, those who primarily focus on Medicaid services in their area tend to dismiss the importance of the ICD 10 code. We consistently see these agencies doing coding internally by non-certified coders. Sometimes it's nurses who did the admission or better yet, another staff member such as an office manager who does the codes when needed. Let's talk about why this hurts your from a compliance level and big time when it comes to your financials.
But We Only Do A Small Amount Of Medicare:
Here's the thing: The method of your ICD 10 coding should not be determined by the size of your Medicare footprint. That's right. Whether you do in-house or outsourced ICD 10 coding is a matter of clinical accuracy, compliance and proper reimbursement. Let's look at each one of those items and why have the proper ICD 10 code is so important.
- Proper Reimbursement: In our experience, most small Medicare agencies complete in-house coding and it is done by someone with more than one role in the organization. The reality is that when people function in multiple roles within your organization, the individual gravitates to the role he or she most enjoys. In cases where your coder does multiple roles, how many will say coding is what they enjoy the most? Therefore, ICD 10 coding is normally a small task with not much time spent on accuracy. When we see non-certified coders completing this task, it is not uncommon for us to see errors from as small as $100 per episode up to $1,000 per episode missed in potential reimbursement. If you only do 2 Medicare admission per month, then you have lost up to $24,000 of reimbursement with poor coding. While it is understood that small Medicare agencies may not want to invest in the cost of an in-house employee for a small number of codes, it makes sense to outsource the task and get it right.
- Clinical Accuracy: Whoever completes your coding needs to understand the documentation provided both by the nurses within the assessments but also from outside sources. The individual must understand the Oasis tool and how it fits together to determine the complexity of the patient. The coder must understand what specificities must be present in the coding not only for reimbursement purposes, but also to help guide the care plan.
- Compliance: This one encompasses everything. You have to make sure the person in charge of your coding isn't doing it improperly. The industry has dealt with case mix creep over the years because CMS thinks this is what happens. If your coder is going to use a specific code, then there must be evidence in the chart to support use of the diagnosis that has more reimbursement attached. We have been asked to evaluate operations in struggling agencies and have seen this happen. The non-certified coder picks the code that will provide the agency more reimbursement without the documentation to back it up. Your agency get set up for takebacks, ADRs, and potential non-scheduled surveys. We also see agencies where the coder tends to stick with the same few codes and you miss out on a ton of reimbursement routinely because the time and attention is not put into coding.
Ultimately, ICD 10 coding is so important and not to be dismissed regardless the size of your Medicare footprint. What do you potentially lose both on the clinical and financial side with bad coding? If you have a small Medicare footprint, just make the call and outsource your Medicare coding. It isn't worth the loss of money or risk of non-compliance. If you aren't sure about your agency's coding grade card, call Kenyon Homecare Consulting at 206-721-5091 or contact us online . We will complete 5 free recodes to see if your ICD 10 coding is on point or if it misses the mark!
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In the rapidly evolving landscape of healthcare, the burden of care is increasingly shifting from clinical facilities to the home. As the population ages, the prevalence of chronic conditions—such as heart disease, diabetes, and respiratory disorders—has reached unprecedented levels. For home care agencies, the quality of service is no longer just about assistance with daily living; it is more and more defined by the clinical competencies and disease-specific knowledge of your field staff. Chronic disease education for home care staff is not a luxury, is a strategic necessity that directly impacts patient outcomes, caregiver confidence, and the business’s bottom line. 1. Enhancing Clinical Outcomes and Safety Home care staff are the "eyes and ears" of the healthcare system. When aides and clinicians are highly educated on chronic disease processes, they can identify subtle shifts in a patient's condition before they escalate into emergencies. · Early Intervention: An educated caregiver can recognize the early signs of fluid retention in a Congestive Heart Failure (CHF) patient or skin changes in a diabetic patient, allowing for proactive adjustments rather than reactive ER visits. · Medication Adherence: Understanding why a medication is prescribed for a specific chronic condition helps staff reinforce the importance of adherence to the patient, reducing the risk of complications. 2. Reducing Hospital Readmissions Hospital readmission rates are a primary metric for home health success. Chronic diseases are the leading cause of "revolving door" hospitalizations. By providing specialized education, agencies empower their staff to implement Evidence-Based Practices at the bedside. When staff can effectively manage symptoms and educate patients on self-care, the likelihood of a patient staying stable at home increases dramatically. This not only benefits the patient but also strengthens the agency’s reputation with referral sources like hospitals and physician groups. 3. Boosting Staff Confidence and Retention The home care industry faces significant challenges with staff turnover. Often, burnout is fueled by the stress of feeling unprepared for complex patient needs. Knowledge is Empowerment: When staff members receive robust training, they feel more confident in their roles. This professional growth fosters a sense of value and belonging within the organization, leading to higher job satisfaction and lower turnover rates. 4. Improving Documentation Accuracy In an era of increased regulatory scrutiny, clinical documentation must be precise. Education on chronic diseases ensures that staff members use the correct terminology and focus on the most relevant clinical indicators during their assessments. · OASIS Accuracy: For Medicare-certified agencies, a deep understanding of chronic conditions leads to more accurate OASIS scoring, which directly influences reimbursement and quality ratings. · Audit Readiness: Well-educated staff produce notes that clearly reflect the necessity of care, making the agency much more resilient during regulatory surveys or audits. 5. Bridging the Communication Gap Effective chronic disease management requires a multidisciplinary approach. A caregiver who understands the nuances of a disease can communicate more effectively with: · Physicians: Providing clear, clinical updates that help doctors make informed decisions. · Family Members: Offering clear explanations and peace of mind to stressed family caregivers. · The Internal Team: Ensuring a seamless transition of care and consistent messaging across all disciplines. Conclusion Investing in chronic disease education is an investment in the agency’s future. By elevating the knowledge of the frontline workforce, home care providers can transform from basic service agencies into high-value clinical partners. In the end, the goal is simple: providing the highest quality of life for patients in the comfort of their own homes, a goal that can only be met through a highly trained and knowledgeable staff. If you do not know where to get comprehensive education for Chronic diseases, contact Kenyon Homecare Consulting at gkenyon@kenyonhcc.com or call 206-721-5091. We are here to help
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