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The medical record comes to the coder and OASIS reviewers, which contains a large amount of data. While that’s normal, it’s no less daunting. The home health coder receives multiple documents from different providers and settings, often in multiple formats, and with voluminous amounts of pages that must all be reviewed.
To properly and fully obtain appropriate reimbursement, the care provider needs confidence that their coders can accurately review and find all of the necessary information around patient needs and potential services. The burnout and mental fatigue of such an assignment, especially on repeat, can affect the coder’s ability to do the job at all.
This was true in 2022. And on Jan. 1, 2023, two new elements entered the fray: OASIS-E and VBP performance year.
This change plus looming payment rate cuts have made outpatient coding more important than ever. Add to those the continued challenges of navigating PDGM, managing Medicare’s face-to-face requirements and fending off the ongoing threats of audits, and your clinical staff might quickly become overburdened in the new year.
As such, home-based care providers are increasingly turning to coding tools that are powered by artificial intelligence. As a result, these tools can reduce review time.
That’s what users of SmartCare™ from Select Data are gaining: a decrease in review time mixed with up to a 19.9% increase in high comorbidity adjustment and a 7.0% increase in low comorbidity adjustment. All of this leads to improved job satisfaction, decreased turnaround time and greater reimbursement.
“There is so much going on in the home health care industry,” says Julie Doyle (RN COS-C), Chief Clinical Officer of Select Data. “We have staffing challenges that are being worsened due to things like vaccine mandates and the COVID pandemic that we just went through. The agencies are just facing a lot of scrutiny.”
As 2023 gets underway, here are 3 tips for coding and OASIS accuracy — get trained coders, add AI, find your technology partner — and the 6 benefits that follow.
3 tips for coding accuracy
Tip #1: Get trained coders
A lack of coding accuracy can lead to a host of problems for both staff and patients, including unnecessary patient rehospitalizations or a failure to deliver the best clinical care. ICD-10 coding increased the knowledge base a coder must have, and with that brings ongoing education and a twice-annual ICD-10 coding update.
“It’s difficult to find the staff that carries those necessary credentials and then can maintain them,” Doyle says. “Pair all of that with the ongoing audits, ever-changing requirements like face-to-face documentation, ICD-10 code updates and reimbursement changes, and if someone doesn’t know what they’re doing, they can cause a very costly mistake for the agency as well as for the patient.”
The foundation of proper coding, therefore, is the team itself. Finding the right team, whether going in-house or using a third-party agency, is essential.
Tip #2: Add AI
As noted, the ability to review these hundred-plus-page documents and extract the correct patient information can be a massive undertaking. Select Data’s SmartCare ™ helps home health providers find that data faster.
Utilizing AI-empowered coding and OASIS review that filters the relevant data quickly can bullet-proof your patient’s plan of care, leading to the best patient outcomes and, critically, the ability to withstand the scrutiny of the industry.
TIP #3: Find your right technology partner
“This is so important,” Doyle says. “Many people might just look at the cost, but the cost is a small portion of what you should consider.”
Instead, Doyle says, care providers that consider outsourcing their coding should be asking a host of questions about that potential partner agency, including:
- Do they have the backing of AI technology?
- Do they maintain coding and OASIS credentials for all of their staff?
- Do they have a proven track record of accuracy?
- Do they have a solid quality review process?
“There are a lot of things to look into,” she says.
6 benefits from AI-enabled coding
The benefits to AI-enabled, accurate coding are numerous. Doyle points specifically to six:
- A decrease in staff burn out
- An increase coder productivity
- An increase in comorbidity adjustment
- The ability to weed out inconsistencies in the medical record
- Giving clinicians more time to focus on the patient and build the most accurate plan of care
- A decrease in unfavorable industry audits
For agencies that outsource this coding, there is a seventh benefit, Doyle says: substantial cost savings compared to maintaining a full-time coding staff.
“For clinicians to read through this massive referral document, it takes a lot of time and attention,” she says. “We can extract this data for them, and they can then go into the home armed with what’s going on with this patient. They can do their assessment faster and create the best possible plan of care, all of which allows them to truly focus on the patient.”
That’s better for the patient and their families, for your staff — and for your bottom line.
This article is sponsored by Select Data, which is committed to excellence, integrity and innovation that empowers clinicians to deliver better patient care and agencies to achieve desired outcomes. To learn more, visit selectdata.com.
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