Home Health & Hospice Week

Watch out for simple mistakes that endanger your episode reimbursement.

Sloppy OASIS coding could be making you miss out on hundreds of dollars per episode under prospective payment system revisions for nonroutine supplies.

Eleven OASIS items including diagnosis coding determine your NRS payment level. Revenue for NRS is "totally dependent upon the accuracy of OASIS scoring and the actual billing of supplies," said consultant Lynda Laff said in a March Eli-sponsored audioconference, "A Closer Look at Supply Management in the 2008 PPS Era."

That means you should start scouring your OASIS records for inaccurate scoring and educate your clinicians accordingly.

Skin 1 example: Your agency could be missing out on hundreds of dollars per episode based on your placement of a non-healing surgical wound diagnosis code, warned Laff with Laff Associates in Hilton Head Island, SC.

Say you get a referral for physical therapy, then get to the patient's home and discover a non-healing surgical wound that becomes the focus of care. If your clinician leaves therapy as the primary diagnosis and places the non-healing wound, which is contained in PPS' new Skin 1 category, as secondary, you're agency will lose more than $425 on that episode.

That's because the non-healing wound as a primary diagnosis increases the clinical dimension score from a C2 to a C3 and adds 15 NRS points, bumping the NRS severity level from a 2 to a 4, Laff explained.

"You can see how incredibly important it is to have the accurate code and have the code in the right spot," she told conference attendees. "These are things you really need to be careful about because it makes a lot of difference in your revenue."

Pressure ulcer example: It's not just diagnosis codes that make big case mix differences. Pressure ulcer wound staging also matters, Laff said.

Look at a real-life case study of a patient with a decubitus sacral ulcer as the focus of care, but by mistake the clinician did not record the ulcer in M0450 and therefore it didn't get staged in M0460, Laff offered.

The agency lost more than $342 in clinical dimension revenue and more than $36 in NRS revenue. The HHA gained nearly $380 "just because we went back and staged the wound," Laff reported.

Tip: Don't forget the basic rule that only pressure ulcers get staged, Laff added. Stasis, diabetic and arterial ulcers do not.

"I can't stress enough the importance of the whole organization really understanding this particular piece" Laff said of NRS payment. This is "found revenue."

"It's a very important process that we need to understand," she stressed.