Specific services we offer.
Auditors who are coding certified will review history and physical of the patient as well as pertinent OASIS questions and the medication profile. The OASIS will be coded with a primary diagnosis and then correctly sequenced with other co-morbidities impacting the Plan of Treatment for the patient.
Auditors who are OASIS and coding certified will review the OASIS to include history and physical of the patient, intake and referral notes and all OASIS answers to discern the focus of care for each episode. The auditor will then review the 485 to determine if diagnosis is correctly sequenced in care needs of the patient and will ensure accuracy between OASIS and the 485 for appropriate reimbursement for the care rendered each episode. In addition, the auditor will review all additional areas that may be integrated in to the OASIS visit (Braden Scale, Fall Risk Assessment) and will integrate all answers into the review of the entire plan of care for that patient during that episode. THIS REVIEW INCLUDES CODING AS LISTED ABOVE.
Discharge OASIS Audits
Auditors who are OASIS and coding certified will review the OASIS to ensure the “look back” was done and completed and is accurate. Audits ensure that the “value added” benefit of home care is captured in the data analysis.
Clinical and experienced auditors will review medical records to ensure the Conditions of Participation are being met. Custom questions can be added to this audit per agency preference. These can be presented to your QA Committee and to the Professional Advisory meetings.
Review documentation to determine whether it meets Coverage Determination Criteria for the home care benefit to ensure reimbursement from Medicare. The review will be returned with a worksheet that provides guidance on the appropriate documentation to be sent back to Medicare.
Pre Bill Audits
Clinical and experienced auditors will review documentation in the medical records to ensure that the episode of care is appropriate to bill.
An agency specific questionnaire will be designed in consultation with your staff to focus on a specific subset (i.e. diagnosis, team, wound care)
Review of charts to ascertain strengths and challenges with documentation and clinical judgment within the agency. Includes a review of the OASIS/485 and coding with a pre and post HHRG report with a total documentation review.
Coding Quality Verification
Assess agencies in house coders proficiency. The agency sends a sample portion each month to be reviewed for coding accuracy, medical verification to justify coding, coding for maximum ethical reimbursement and checking for any Oasis errors by the admit nurse.
Short Term Supplemental Review
Auditors who are OASIS and coding certified will complete an integrated OASIS/485 review for a short term overflow project for agencies to relieve any back log of cases they might have.
Auditors who are OASIS and coding certified will provide web based OR on-site training to your staff. The agency is responsible for expenses relating to travel to and from the site and will be billed at an hourly rate.