ICD-9 Coding Errors That Are Costing Your Home Health Agency
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The document discusses common ICD-9 coding errors made by home health agencies that can significantly reduce revenues. These include failing to account for a patient's status in the past 30 days, leaving diagnoses unspecified rather than providing specific details, and ignoring specific diagnosis codes. Outsourcing coding to certified professionals can help agencies avoid these errors, improve cash flow by increasing accurate billing and payments, and prepare for the upcoming ICD-10 transition.
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ICD-9 Coding Errors That Are Costing Your Home Health Agency
- 1. ICD-‐9 Coding Errors That Are Costing Your Home Health Agency While the conversion to ICD-‐10 has been postponed to October 2015, many home health agencies are still making ICD-‐9 coding errors that can be extremely costly (if not devastating) to their bottom line. Codes are complicated and even a minor coding error can result in billing rejections, delays, and/or decreased revenues. When you add these simple errors to not providing the required details regarding a specific diagnosis, the lack of reimbursements can cripple your agency and even put you out of business. What follows are just a few of the common ICD-‐9 coding errors we see on a regular basis— errors that unnecessarily reduce home health agencies’ precious cash flow and critical income. With your financial future hanging in the balance, you’ll want to avoid these mistakes that can make or break your agency. Accounting For the Last 30 Days Most home health agencies review their files before billing but, when billing, they do not account for the past thirty days. For example, for patients who have extended care in the last
- 2. thirty days, the assessment documentation may not reflect current acuity or decline in functional status of the client because the clinician has relied on the patient’s self-‐report. Without accurate reflection of current status you will have difficult time reflecting improvement by the time you discharge and/or the care is medically necessary. Leaving Debility Unspecified The current status of the patient is imperative for ICD-‐9 coding. Medicare and other payers need to know the current status of the patient before accepting any new billing. If you cannot identify the root cause of why a patient is receiving care or the cause of his current decline, you may find more rejections with Medicare and other insurance companies. Ignoring Specific Diagnosis Even if you can define the debility or specify to payers how a client became debilitated, you also need to offer a specific diagnosis. For example, if you have a client listed in a broad category such as heart disease, you are not being specific enough for insurance companies and other payers. The more specific you can be when defining a patient’s diagnosis, the more accurately you can report the reasons why the services were provided. ICD-‐9 coding errors in this area are extremely costly, resulting in lost or delayed reimbursements. When you implement the right billing practices and are not only accurate, but also as definitive as possible, you drastically improve your cash flow and ability to effectively run your agency. For some home health agencies, having the right billing practices means hiring their own certified coders or outsourcing ICD-‐9 coding to a home health consultant with certified coders. Hiring these highly trained professionals ensures that you remarkably reduce if not eliminate the possibility of ICD-‐9 coding errors, which leads to improved revenue per case and increased cash flow. It all adds up when you consider that the difference between valid and inadequate codes can amount to hundreds of dollars per episode. The Easiest Way to Prevent ICD-‐9 Coding Errors and Increase Income A simple example of why outsourcing ICD-‐9 coding to a certified home health consultant may be the right answer for your agency: If a home health agency assesses 20 new referrals a week, or 80 cases a month, it can mean a potential gain of up to an additional $96,000 per month from accurate review and coding. The cost of outsourcing the ICD-‐9 coding and OASIS review for that number of cases is approximately only $3,600. That’s a pretty simple equation. Plus, agencies don’t have to waste internal resources on coding activities, freeing them up to focus on other areas of the business.
- 3. With ICD-‐10 on the horizon, there’s simply no margin for error. You need to make sure your agency’s billing is accurate and compliant, not to mention ready to make the transition. Kenyon HomeCare Consulting is experienced with OASIS and ICD-‐9 best practices, along with the new ICD-‐10 rules. Our home health consultants can evaluate your current billing practices and find more efficient ways to ensure you don’t lose revenue due to simple, but critical, ICD-‐ 9 coding errors. Schedule an appointment at www.KenyonHCC.com today to learn more about the benefits of outsourcing your home health agency’s ICD-‐9/10 coding.