Posted on Monday, December 12, 2016 4:57 PM
In the summer of 2016, CMS implemented the Pre-Claim Review Demonstration (PCRD) in the home health sector. The goal of the PCRD is to ensure agencies are following Medicare eligibility requirements, payment, coding rules, and at the same time reducing fraudulent claims. Shortly after CMS implemented the PCRD in Illinois, further education needs were identified as delaying expansion of the demonstration to other states.
Even with the suspension of the demonstration, agencies should feel an urgency to improve processes that ensure regulatory requirements are being met. Educating staff on the importance of complying with documentation requirements can do several things: it provides evidence of care, supports eligibility, ensures proper reimbursement, and most importantly it serves as a communication tool to show other disciplines on the healthcare team what treatment has been given, and that it is consistent with the patient’s needs.
One of the most common denials is not providing documentation to support medical necessity. Agencies should equip clinicians with the resources they need to assure proper documentation is being done. Resources like the Chapter 7 Home Health Manual and the OASIS Guidance Manual should be given to all employees. It is not enough to just give staff these resources, but to also carry out frequent education sessions on what is considered good documentation practices and what leads to denials. It also helps to have a healthy Quality Assurance team conducting frequent audits to catch documentation errors and intercede quickly to avoid potential denials.
Corridor’s Coding Services offers ICD-10 coding, multi-level OASIS reviews, clinician documentation review, as well as trends and reporting. Contact us to learn more.
Written by Amanda Gartner, RN, BSN, MSN, COS-C, Corridor’s Manager of Compliance and OASIS Education.
Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!
For additional information, please contact Corridor at 1-866-263-3795.