Why Precision in OASIS and ICD-10 is Your Best Advantage for Home Health Success

Ginny Kenyon • January 26, 2026

In the home health setting, accurate documentation is more than a regulatory requirement—it is the foundation of quality patient care, compliance, and financial sustainability. Two critical components of this documentation are the Outcome and Assessment Information Set (OASIS) and ICD-10 diagnosis coding. Together, they influence clinical decision-making, reimbursement, quality reporting, and agency performance. Ensuring accuracy in both is essential for every home health organization.


Understanding OASIS and ICD-10 in Home Health

As most individuals in home health know, OASIS is a standardized data set required for Medicare-certified home health agencies. It captures a patient’s clinical status, functional abilities, and service needs at specific time points in the episode of care. OASIS data directly affects care planning, quality outcome measures, and reimbursement under the Patient-Driven Groupings Model (PDGM).


ICD-10 coding translates the patient’s diagnoses into standardized codes that describe the medical conditions being treated. In home health, ICD-10 codes must support medical necessity, align with the plan of care, and accurately reflect the patient’s primary and secondary conditions.


While distinct, OASIS and ICD-10 are deeply interconnected. Inconsistencies between them can lead to compliance risks, payment errors, and inaccurate quality reporting. Previous survey findings indicate that the major error in the OASIS scoring is under scoring which leads to the above noted risks.


Impact on Patient Care and Clinical Outcomes

Accurate OASIS assessments provide a clear, comprehensive picture of the patient’s condition. This information guides clinicians in developing individualized care plans, identifying risks (such as falls or hospitalization), and tracking progress over time. When OASIS responses truly reflect the patient’s status, care teams can make better clinical decisions and intervene appropriately.


Similarly, precise ICD-10 coding ensures that all relevant diagnoses, especially those impacting function and care needs, are recognized and addressed. Missing or incorrect diagnoses can result in incomplete care plans, overlooked comorbidities, and suboptimal outcomes.


Reimbursement and Financial Integrity

Under PDGM, both OASIS data and ICD-10 codes play a direct role in determining reimbursement. Functional levels, clinical groupings, and comorbidity adjustments are all driven by the accuracy of these elements. Errors such as upcoding, under coding, or mismatched documentation can lead to underpayment, overpayment, or costly payment reviews and recoupments.


Accurate coding and assessment protect an agency’s financial health by ensuring appropriate reimbursement for the complexity and intensity of care provided—no more and no less.


Compliance and Audit Readiness

Home health agencies operate in a highly regulated environment. Inaccurate OASIS responses or unsupported ICD-10 codes can trigger red flags during audits by Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), or other oversight bodies.


Consistent, accurate documentation demonstrates compliance with Medicare guidelines, supports medical necessity, and reduces the risk of denials, penalties, and allegations of fraud or abuse.


Quality Measures and Public Reporting

OASIS data feeds directly into publicly reported quality measures, such as functional improvement, hospitalization rates, and patient satisfaction. Inaccurate data can distort an agency’s performance metrics, negatively affecting star ratings and referral relationships.

High-quality, accurate data ensures that reported outcomes truly reflect the care provided and the agency’s commitment to excellence.


The Role of Education and Collaboration

Achieving accuracy in OASIS and ICD-10 coding requires ongoing education, interdisciplinary collaboration, and strong internal processes. Clinicians, coders, and quality staff must work together to ensure documentation is clear, consistent, and supported across all records. Regular audits, feedback, and training help reinforce best practices and keep teams aligned with evolving regulations.


Conclusion

Accurate OASIS and ICD-10 coding is not simply an administrative task—it is a cornerstone of effective home health care. It supports better patient outcomes, ensures fair reimbursement, strengthens compliance, and enhances an agency’s reputation for quality. By prioritizing accuracy and investing in education and collaboration, home health agencies can deliver care that is both clinically sound and operationally strong. If your reimbursement rates are lower than the national standard for each diagnosis, it is quite possible that the OASIS was scored inaccurately leading to lower ICD-10 coding, and reimbursement. If you are struggling with these issues, contact Kenyon HomeCare Consulting at gkenyon@kenyonhcc.com or call 206-721-5091. We are here to help.


Results Based Consulting

Did you find value in this blog post? Imagine what we can do for your home care or hospice agency. Fill out the form below to see how we're leading the industry with innovation, affordability, and experience.

Contact Us

chronic disease education
By Ginny Kenyon January 22, 2026
Chronic diseases account for the majority of healthcare utilization and spending with a disproportionate share of hospital admissions, ER visits & long term costs
Interim Management
By Ginny Kenyon January 20, 2026
An experienced interim manager can provide stability, expertise, and momentum- if the right individual is selected during your time of need and transition.
OASIS success
By Ginny Kenyon January 17, 2026
OASIS plays a critical role in care planning, quality, reimbursement, and regulatory compliance and is also key to success and integrity of Medicare Home Health.
policy and procedure manuals
By Ginny Kenyon January 15, 2026
Policies and procedures serve as the foundation for consistent, fair, and effective operations. Your manual should be a living breathing guide for your agency.
chronic disease education
By Ginny Kenyon January 7, 2026
For aides, education in chronic diseases is not just helpful, it is essential for ensuring safety, dignity, and quality of life for the people they serve.
nurse key to HHCAHPS
December 23, 2025
Educate your staff to the HHCAHPS questions so they remember that performance is measured by the patients and will be reflected in the survey findings and payment
success in home health surveys
December 19, 2025
Surveys are heavily focused on data to serve as evidence of your agency's practices. Create a "Survey Book" containing all required documents for immediate access.
December 18, 2025
For home health agencies, a regulatory survey is not just an inspection—it's a high-stakes assessment of your commitment to patient safety, quality care, and operational compliance. Since repeat surveys are unannounced, the goal is to cultivate a culture of "survey readiness every day." Preparing your agency for a successful survey requires proactive planning, meticulous documentation, and full staff engagement. Below are the steps to build for continuous compliance. 1. Develop a Survey Team: Preparation starts with designating a core team responsible for the survey response. Clear roles ensure a calm, organized, and efficient process when a surveyor walks through the door. Each person needs to know exactly what they are responsible for and what metrics they need to track to be sure the agency is always ready for a survey. The Administrator/Survey Lead: Must be present for the entrance conference. This person is the main point of contact, handles high-level questions, and maintains a professional atmosphere for the organization with the agency staff and with any surveyors. Director of Clinical services/ Supervisor: This team member is responsible for assuring all documentation is reviewed and appropriate. This includes OASIS accuracy, that the plan of care matches the OASIS findings, and visit documentation follows the plan of care. ICD-10 Coders: This team member reviews the OASIS and matches it with the discharge summary to assure accuracy of OASIS (along with DCS or Supervisor). The coders also verify the ICD-10 code accurately reflects findings of the OASIS. Clerical Support: Staff is responsible to all personnel records monthly review for required documents and all new employees for same while reporting any missing documents (e.g. updated license, auto insurance, driver’s license etc.). Create plans and have operations in place to communicate at least a month in advance to employees when items need updated. This person is also responsible for managing the logistical needs when the surveyors are on site (e.g., Wi-Fi password, workspace, etc.) to create a buffer for management. They also discreetly communicate critical questions to the Survey Lead. The team member acting as Survey Lead is considered the survey readiness team leader. Promoting survey readiness should include regular monthly meetings with all of the survey readiness team members. Each team member should be ready to report on the status of their responsibilities and any data to support their findings. These findings include: a. Status of OASIS accuracy and any staff who need training. b. Planned OASIS training that provides regular updates on areas where staff continue to struggle. c. Plan of care with matching visit notes d. Personnel files and any updates when employees are not responding to the request for documents e. Status of continuing education per state or federal requirements f. Yearly evaluations with supervisory visits to support evaluation. Supervision needs to pay particular attention to hand washing according to policy and standard infection control procedure when getting in an out of bag, with client contact, or coming in and out of the home. This remains one of the primary findings by surveyors. g. Evidence of yearly required continuing education such as: • Infection control • Patient Rights and Advocacy to uphold dignity and autonomy • Emergency Preparedness with response protocols; evidence of bi-yearly practice drills for a potential emergency • Medication Management and safety to prevent errors • Updated relevant health care regulations and policies • Cultural competency to enhance communication and care for diverse populations. All data collected by the team members may need to be sent to the compliance manager and may become part of a plan of correction for the Quality Assurance program. Should you need assistance with survey readiness, please continue to part 2 of this series and call Kenyon Homecare Consulting at 206-721-5091 to help you get there!
ICD 10 coding and Oasis
November 25, 2025
In the regulated world of home health, OASIS and ICD-10-CM Coding integrity non-negotiable for quality, compliance, and critically, and agency's financial health!
sales strategy
November 19, 2025
"Boots on the ground," emphasizes direct, in-person engagement to build the crucial referral network between your agency and referral sources and it is a necessity.