Clinical Services

ICD-10 Coding

Home health agencies are required to electronically submit OASIS assessments to CMS within 30 days of the completion date of a patient assessment or they risk a 12-month and 2% penalty for failing to submit timely. Of 4.6 million claims submitted each day, roughly 10% of ICD-10 claims are rejected, according to CMS.

You’ll never have to worry about up-coding or down-coding with our ICD-10 Coding Services.

• The goal of our ICD-10 Coding Service is to ensure you are paid the highest and most appropriate reimbursement.
• After a superficial review of the supporting documents is complete – Referral, History, Physical, Medication Profile, Doctor Orders, Visit Notes, etc. – our Clinicians will apply the most appropriate and compliant code or codes using the latest Coding Guidelines.
• Our Coders are Clinicians who are licensed and certified in ICD-10 Coding and have years of experience working within and adapting to ever-changing industry rules and regulations.
• A complimentary Coding Audit is available to help determine any risks your agency might have with upcoding and down coding.
• Available for Home Health and Hospice.

OASIS Review

Allow our licensed and OASIS-certified Clinical staff to ensure your OASIS assessments and supporting documentation are clinically accurate and in compliance with Medicare Conditions of Participation.

• The goal of our OASIS Review Service is to ensure your clinical documentation is accurate and in compliance.
• After our Clinicians provide a comprehensive review of the entire OASIS document, including the Non-OASIS clinical items, they report all inconsistencies and provide regulatory guidance and justifications for documentation requiring change.
• Once the OASIS and supporting clinical documents are deficiency-free and passed final review, our Clinician provides the most effective code or codes directly to the OASIS assessment.
• A complimentary OASIS Audit is available to determine and address any inconsistencies with Medicare Conditions of Participation.
• We also offer consultation and training to agency staff to eventually help eliminate inconsistencies over time.

Plan of Care Preparation

The goal of our Plan of Care Preparation Service is to ensure the Plan of Care is not only patient-specific but also meets homebound status and medical necessity through accurate representation of orders and goals, interventions, visit frequency, and more in the patient chart.

• With their proficient knowledge and use of Medicare rules and guidelines and Conditions of Participation, our Clinicians are trained to review the OASIS and other supporting documents to make sure all clinical documentation is consistent with one another.
• Once all the inconsistencies have been identified and corrected, our Clinician generates the patient-specific Plan of Care.
• We provide a complimentary Plan of Care Audit to assist agencies in determining their risks for ADRs and Targeted Probe and Educate.
• We also offer consultation and training to agency staff to help create patient-specific and Medicare-compliant care plans.

Chart Review

Rest assured your patient charts are survey-ready every day!

• Our Clinical staff are professionals who keep up-to-date with Medicare rules and guidelines and Conditions of Participation.
• They perform a real-time comprehensive review of the entire patient chart: Start of Care to Discharge, all supporting documents such as Referral, History and Physical, Medication Profile, Physicians Orders, Visit Notes, Communications, and more.
• Our Clinicians then identify all inconsistencies within the chart and begin the task of providing regulatory guidance and justifications with an emphasis on compliance with Medicare Conditions of Participation.
• Upon request, Plan of Care Generation can be included for no additional fee.
• Available for Home Health and Hospice.
• A complimentary Chart Review is available to help agencies with determining their risks for ADRs and Targeted Probe and Educate.
• We also offer consultation and training to agency staff to help avoid ADRs and the Targeted Probe and Educate Program.

Review Choice Demonstration

Optimize the management of your revenue cycle by increasing the chance of having each of your claims paid on time. Since 2016, we’ve successfully received 100% affirmation for our Pre-Claim, Post-Claim, and Minimal Review clients in Illinois, Texas, Florida, Ohio, and North Carolina.

• Through our Claim Review processes, Clinicians ensure the items and services billed to Medicare are medically necessary and appropriately documented.
• Our Clinicians thoroughly go through the clinical documentation to make sure compliance with Medicare Conditions of Participation is established for proper claim submission:
  • Choice 1: Pre-Claim Review
  • Choice 2: Postpayment Review
  • Choice 3: Minimal Review with 25% Payment Reduction
• A complimentary Chart Review is available to help agencies with determining their risks for claim denials associated with Review Choice Demonstration.
• We also offer consultation and training to agency staff to help avoid future claim denials related to the agency’s review choice.

ADR Review

When claims are selected for review and Additional Documentation is Required to complete the claim, our Clinical Staff performs a review of the full chart and the 60-day summary of the episode requested.
 

• The Physician’s Orders and Progress Notes, Face-2-Face, History, and Physical, and other important clinical documentation are examined to ensure consistency with each other and the Plan of Care.
• Suggestions and recommendations for corrections will be provided for each deficiency identified based on the Condition of Participation and Medicare clinical guidelines.
• Once everything is in order, our Clinicians assemble a packet for the agency to submit back to Medicare.
• Available for Home Health and Hospice

Targeted Probe and Educate

“When performing medical review as part of Targeted Probe and Educate (TPE), Medicare Administrative Contractors (MACs) focus on specific agencies that bill a particular item or service rather than all agencies billing a particular item or service. MACs will focus only on agencies that have the highest claim denial rates or who have billing practices that vary significantly from their peers. TPE involves the review of 20-40 claims per agency.” – Center for Medicare/Medicaid Services

• Our Clinicians will review the letter from the MAC auditor that requests the 20-40 claims reviewed during that round.
• Research and review of the supporting documentation is performed within the affected charts and deficiencies and billing errors are expressed.
• Our Clinical staff provides appropriate corrections using our proprietary process in checking against Medicare Conditions of Participation.
• A complimentary Chart Review is available to help assist agencies in determining their risks for future participation in Targeted Probe and Educate Program.
• We also offer consultation and training to agency staff to help avoid future ADRs and denials.