Coding Audits - Prepare for PDGM

Don’t let incorrect coding lose money $$$$$ for your agency

This review will provide valuable information to the organization regarding completeness, accuracy and regulatory compliance of coding & clinical documentation. Recommendations will be provided regarding diagnosis selection, orders and clinical documentation. An overall summary will be provided to identify trends and any areas of weaknesses that the agency should address in order to receive appropriate reimbursement. Customized ICD classes can be developed for to assist with any areas of deficiencies.

 

Accurate coding is essential in the home health PPS system to receive appropriate reimbursement. With the new PDGM system beginning January 1, 2020, proper coding takes on an even greater significance. 
Monies are easily lost due to incorrect or incomplete coding. An average coding mistake can cost an agency between $400 and $1,800 an episode.

• If the average agency employs 30 clinicians with just two mistakes per year, lost revenue could amount to approximately $108,000.
• Example: Sequela of CVA with dysphagia. This diagnosis requires two codes to receive full payment under the PPS System. If staff codes only the sequela CVA and omits the dysphagia as a separate diagnosis, payment is lost. This is solely a coding issue. The plan of care and visits do not change. The way it is coded directly impacts reimbursement.

JLU will review a statistically significant sampling (20-30%) of ICD-10 coding of medical records to determine the appropriate completion of the OASIS document and the correct use of ICD coding for forcasting in PDGM. 
 

Documentation Review includes the following documents:
 

• Intake/Referral
• OASIS
• Physician Orders
• Clinical Visit Notes and other applicable documentation from the first week of service
• Sampling of records includes review of the PPS diagnostic categories & the agency’s top 10 diagnoses