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ICD-9 Coding and OASIS Review: A Case for Medicare Home Health Outsourcing

Zero Insurance PaymentWhen conducting organizational assessments for Medicare home health agencies, it’s not uncommon to discover that the case weight is low and the revenue stream less than what is expected from a home health agency of similar size and length of time in operation.  One of our most frequent findings is the field supervisor doing all of the OASIS review and ICD-9 coding.  This means that there is not a certified coder doing the work and the supervisor, who is the team leader, frequently does not have time to lead or supervise.  The operational and financial impact on your home health agency in this situation can be damaging.

Although the assigned supervisory staff has some training on ICD-9 coding and OASIS review, it’s likely they are not current with recent changes. Consequently, they fall into a rut of most frequently used codes. Unfortunately, they are not necessarily the most accurate codes and/or the ones that would generate the proper amount of revenue.  Even more of a challenge is when the “Coder” is someone in the billing department who has taken a course or two and uses a reference manual to select codes. In both of these situations, neither of these individuals has the background or the training to adequately and accurately conduct OASIS Review and ICD-9 coding in a way that provides the agency with the full revenues they are due.

Coding errors and patterns of using common codes that the coder is comfortable with cost Medicare home health agencies revenues to which they are entitled. One of the common coding patterns is using the same code for two diagnosis. For example, an Orthopedic surgery post-op rehab where the coder uses the same one or two diagnosis and severity codes, and thus are not capturing co-morbid impact so you have very flat value – safe from billing perspective but could leave significant reimbursement on the table.

Over the past 12 months, numerous code revisions have been released. Along with the revisions come an increase in errors using codes no longer allowed. The most recent is the Hospice Debility NOS. All similar therapy code issues create denials and costly consequences to the agency.

Our final concern is when the designated Home Health “Coder” is not looking at OASIS and referral information to address potential inconsistencies.  Failure to identify inconsistencies creates a mismatch between the physician or hospital diagnosis which leads to reduced reimbursement or outright rejection. Can your home health agency afford that?

With the increased complexity of the ICD-9 coding, it is apparent that home health agencies must have a certified coder who stays up to date on the frequent changes in order to fully capture the revenue that the agency is due and to identify OASIS scoring errors that are costly to the agency. We recognize that most small- to-medium agencies cannot afford a full-time Certified Home Health Coder.  That’s why we’ve launched a new division with Certified Coders that provide the needed services without incurring the cost of a full time Certified Coder.

There are many benefits to your home health agency including:

  • You only pay for work time on your cases.
  • Our Certified Coders review all OASIS data to ensure complete and accurate representation of patient condition to maximize revenue gain.
  • Our Certified Coders are more accurate at OASIS/coding. This means  potentially boosting quality scores with more accurate reflection at SOC and comparison at end of care which more accurately reflect gains while on service.
  • Our Certified Coders provide the expertise for timely consultation, as well as, staff training for any error trends noted.
  • Our Certified Coders stays current on coding changes as applicable to Medicare/Medicaid reimbursement.
  • Our Certified Coders review visit patterns in individual cases or by teams for assessment of efficiency/effectiveness in case management/positive outcomes and provide a written report to the management team.
  • Our Certified Coders turn your case around in 2 working days with a 485 developed and ready for the physician’s signature.

If you are a small to medium sized Medicare home health agency and are struggling with reimbursement and coding issues, outsourcing to the experts is your answer. To discuss your ICD-9 and OASIS review needs, and how we can help, stop by our online calendar and schedule an appointment today.

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Category: Finances, ICD Coding, Specialized Support

2 responses to “ICD-9 Coding and OASIS Review: A Case for Medicare Home Health Outsourcing”

  1. Donna Goodwin says:

    Hi, How do I set up a time with Pat to discuss how this works?

    Donna Goodwin

  2. Ginny Kenyon says:

    Go to my web site. there is a place on the landing page for you to subscribe to our blogs and posts. if you have trouble please contact

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