Are you experiencing fatigue with the all the “ICD-10 crisis alerts?” As much as you dislike the bombardment, we are concerned about your survival! CMS has estimated that as high as 50% of the existing home health agencies will be out of business after the implementation of ICD-10. There is valid concern for the industry!
When implemented on October 1, 2015, ICD-10 requires an entire reorganization of your company, from the way assessments are done in the field to how you run your internal operations. Gone are the days when you could wait 5 days for a completed OASIS so that it could be checked for integrity issues and then code.
Organizational Assessment Uncovers Common Problems Affecting OASIS
When conducting organizational assessments, we continue to find problems. First, managers are overloaded. So much so that it is taking them two – three days to find time to review OASIS assessments and documentation to support the diagnoses. This means the case is now two weeks past the day it was opened. By then, it is too late to correct any errors on the OASIS scoring and to establish an appropriate visit frequency.
Secondly, in-house staff assigning diagnosis codes have little training. One or two webinars a year does not prepare that individual to accurately code. This position requires extensive certified training with constant monitoring of changes as CMS disallows codes and adds new ones. Even when the coder is certified, they are getting the case long after the OASIS is completed to adjust coding and assist with 485 development. This will lead to complications when ICD-10 is implemented.
Finally, if your home health agency is part of a hospital system, and the coder is not a home health coding specialist but a general coder doing the hospital and physician coding, the coding may, in principle, be correct. Unfortunately, the coding is conservative and leads to under-coding, thus agencies do not receive the full reimbursement to which they are entitled.
Help Your Agency Survive
So what are the changes your agency needs to make in order to survive ICD-10? Three major changes need to be added to your current process:
- Develop an upfront system that catches all errors and issues before the assessing clinician leaves the client’s home.
To catch errors up front means the person doing the coding needs to be available to receive phone calls from the clinicians in the field who have just completed their OASIS. The coder and the clinician need a “cheat sheet” to review the scores on each of the 18 OASIS elements that drive the HHRG weight. This allows for any errors of scoring to be corrected immediately. Because this call occurs in the client’s home, the clinician can obtain additional information to ensure documentation supports the coding of the primary and any active secondary diagnosis.
Additionally, the “cheat sheet” should include the number of visits, the frequency of planned visits, the goals for the episode, and the top three planned interventions. This helps the staff connect the diagnosis with the care plan and leads to appropriate documentation.
- Use clinical pathways to assist in developing a plan of care with appropriate visit frequencies.
To assist the clinicians in the development of the plan, we highly recommend the use of clinical pathways. If you’re developed or are already using clinical pathways, kudos to you! You are ahead of the pack. There are currently several sets of updated clinical pathways available for purchase on the web.
- Manager’s oversight of all visit notes and cases.
When ICD-10 arrives, managers must be free to do their jobs of providing adequate clinician oversight including a monthly caseload review. They will return to the “good old days” when a manager was assigned to read and initialed every visit note. This will ensure documentation is appropriate for the diagnosis and sufficient to support accurate coding of the primary and other active diagnosis.
In order to prevent CMS from disallowing visits and having inadequate documentation matching diagnosis, these three basic systems must be in place. By applying these critical actions, your agency is positioned to be successful under ICD-10.
Announcing Coding Plus
The workload for the organizations after the ICD-10 changes, is going to greatly increase. For agencies to survive, there must beKenyon HomeCare Consulting is proud to announce Coding Plus, a comprehensive coding service for home health and hospice organizations.
Our certified coders provide upfront review with the clinicians at the time of assessment, assure the integrity of the OASIS scoring, and validate visit frequencies. The client goals are reviewed and the top three problems and interventions identified for the current episode of care.
Our clients report this process has increased their average HHRG weights anywhere from 20% to 40% higher than the quarter prior to using Coding Plus. Cash flow also increased due to timely submission of the OASIS. Staff report that the planning process is shortened because the focus is on the primary issue for the episode and not scattered trying to plan for all diagnosis.
If you want these results for organization, please call Kenyon Home Care Consulting at 206-721-5091. We are here to help!