How to Choose a Home Health Coding Company: 10 Factors to Consider

Selecting the right coding firm for your home health agency is an important decision. A coding firm offers several benefits. One major benefit of an efficient partnership is faster, more accurate claims and agency billing, which in turn supports efficient patient records. There are many regulations involved in home health, such as ICD-10-CM coding, that your coding firm must also be well-versed in. They also need to know the inner workings of OASIS assessments and PDGM.

Not all firms provide similar services, pricing, quality, and turnaround. For instance, there are coding firms that only provide services for diagnosis coding. However, there are others that offer services including coding and audit, medical billing, and OASIS reviews.

Why Is Choosing the Right Home Health Coding Company Important?

Home health coding needs an understanding of records, choosing the right diagnoses, following ICD-10-CM rules and meeting the rules from insurance companies. A home health coding company can help your agency in many ways.

• Support diagnosis coding: The codes used should show the health problems that're important for the patients home care.
• Support PDGM accuracy: Diagnosis codes and evaluation information help decide how much money the agency gets. Mistakes can hurt payments. Create extra work.
• Improve workflow efficiency: Fast coding helps cut down on delays. Makes it easier to move papers through the billing system.
• Prepare for quality checks: Regular checks can help find repeated coding and documentation problems.
• Free up resources: Sending some work outside can help agencies handle changing numbers of charts without depending on their own staff.

Outsourcing does not always mean rejected claims or more money. The results depend on how good the recordsre how the agency works what the insurance companies require and how well the outside company does. Agencies should also keep control over coding and billing choices.

What Services Should a Home Health Coding Company Provide?

Before you compare vendors first identify which services your agency needs.

Some home health coding services can be purchased separately while other services are bundled together in a support package.

Common services include:

1. ICD-10-CM diagnosis coding: Review documentation and assign the correct diagnosis codes based on current coding guidelines.

2. OASIS review: Check assessment records, for missing information, inconsistencies and responses that may not be supported by the existing documentation.

3. PDGM Coding assistance: Analyze the information used for selecting diagnoses for PDGM grouping to ensure it is accurate. 

4. Coding review: Review a sampling of coded patient records to identify potential documentation, sequencing, and condition errors.

5. Documentation questions: If clarification is needed, send a query to the patient care provider, but do not include the answer in the query.

6. Recertification and resumption-of-care Coding: Check to ensure that the vendor you are selecting can work with the type of documentation your facility uses and will support the workflow of your organization.

7. Medical billing support: Depending on the contract services may also cover claim preparation, submission support, denial follow-up or broader revenue cycle management.

When you compare home health coding services ask which activities are included in the quoted price and which are billed separately. Do not assume that coding automatically includes OASIS review, audits or claim management.

How to Choose a Home Health Coding Company: 10 Factors to Evaluate

1. Confirm Experience in Home Health Coding

Pick an agency that can manage your charts that are high volume with complicated documentation. An agency needs to be proficient in home health, ICD coding, OASIS and PDGM workflows. 

2. Ask Coder Training and Certification

Inquire about the coder’s credentials and training. Verify the coders’ knowledge and proficiency in ICD-10-CM is up-to-date and that coders know when they need support.

3. Review Coding and OASIS Review Services

Check if they offer both services, coding and OASIS review. Verify their process for missing and/or contradictory documentation and verify that they don't edit the documentation without reason.

4. Evaluate PDGM Knowledge

Find a vendor who has knowledge in diagnosis coding and documentation and the role they play in PDGM payment grouping. Avoid companies that offer to recommend diagnoses or suggest they can guarantee higher payment levels.

5. Quality Assurance Review

Assess audits, errors and their subsequent corrections. Ask for a quality report example. Use a pilot batch of records before contracting with the vendor for the long term.

6. Examine Turnaround and Query Policies

Find out the vendor’s policies for both standard and rush turnaround requests. Verify that the vendor has processes to manage document queries, the status of document requests, and reporting delays.

7. Assess EMR Integration

Verify the proposed document sharing and EMR systems are compatible. Use the proposed systems in your own environment, to discover bottlenecks and/or access problems.

8. Confirm HIPAA Compliance and Security Policies

The processes for securing information must be understood, as well as the protocols for when security and/or access violations occur. Verify a BAA is in place and signed, before the release of Protected Health Information (PHI).

9. Analyze Price and Contract Terms

Evaluate pricing structures and verify coding, OASIS review, audits and follow ups are included. Review billing and payments, volume, payment and termination terms before signing.

10. Verify References and Reporting Capabilities

Ask for referrals from home health agencies. Assess the vendor’s reporting and communication capabilities. Ensure the vendor can manage changing chart volumes as your home health agency grows.

Key Questions to Ask When Choosing a Home Health Coding Company

Use these questions during vendor discussions:

• How much experience do you have with home health agencies and PDGM-related coding?
• What qualifications do the coders assigned to our account hold?
• What turnaround time do you offer for each chart type?
• How do you manage documentation queries and unresolved issues?
• Can you work securely with our EMR system?
• What privacy safeguards and contractual agreements apply to PHI?
• Which services are included in the quoted price?

How Much Does It Cost to Outsource Home Health Coding?

Many home health agencies opt to outsource their coding due to a variety of factors. This process can be determined by the size and complexity of records, how fast they need the coding, and how many records are in need of coding. Services may have different pricing models, including hourly and monthly pricing. In addition to coding, many services will offer different pricing options for additional features, such as auditing of coding or review of OASIS documentation.

What Red Flags Should You Watch for When Choosing a Coding Vendor?

Watch for these warning signs before signing a contract:

• Guaranteed payment boosts: Billing shouldn’t be supported by guesses about payment bonuses, only on documentation.
• Unknown coders: The company will not reveal what training or experience the assigned team has.
• Coding checks missing: No coding process is in place to verify the coding accuracy.
• Unreasonable coding timeframes: The vendor will not say how it controls coding time or how it manages record completion.
• Payment alterations: The vendor suggests making diagnosis changes or altering medical information in order to get higher payment.

Why Consider Gravita Oasis Review for Home Health Coding Support?

Gravita Oasis Review offers comprehensive services to support your home health agency. From clinical chart review and medical coding, to medical billing, prior authorizations, and data entry, Gravita Oasis Review has all your administrative and operational home health needs covered.

When considering Gravita Oasis Review for home health coding support, talk to us about the specific needs and goals of your agency, and we’ll explain the exact services we provide for your unique situation. Turnaround time and pricing expectations should be discussed along with our reporting capabilities and the dispute resolution process for your coding related issues before beginning an engagement with Gravita Oasis Review.

A strong partnership with Gravita Oasis Review means that your coding needs will be met consistently while meeting the compliance requirements of your home health agency. You need to assess what your agency needs, not just what a prospective vendor is telling you.

Conclusion: Choose a Home Health Coding Partner That Fits Your Agency

Selecting the right home health coding firm means more than just finding the best price. Key factors you need to examine are the firm’s experience in the field, staffing credentials, expertise in the Patient-Driven Groupings Model (PDGM), the quality and timeliness of the coding review and its accuracy, how easily the company can be reached and how quickly and securely information is transmitted, and finally the quality assurance systems the company uses.

After deciding how best to support your home health coding, whether it is in-house staffing or outsourced medical coding, remember that final responsibility remains with you. An optimal partnership will fit your company's workflow, clearly communicate the needs and expectations of a coding partnership, and support your need to produce the most accurate and compliant coding possible.

FAQs on How to Choose a Home Health Coding Company

Q1.How do I choose the best home health coding company?

Compare coding expertise, qualifications, PDGM and OASIS knowledge, turnaround times, quality assurances, pricing, security, and home health experiences. Review potential coding company references and consider a short trial.

Q2.What should I look for in a home health coding company?

Find coders who specialize in home health. Ensure the organization has an effective process for tracking and monitoring coding and query performance. Find a secure service, has transparent pricing, and regularly reports their performance.

Q3.How much do home health coding services cost?

Pricing for coding services is based on chart volume and complexity, the scope of services needed, and how quickly work needs to be turned around. For an accurate quote, be sure to request separate pricing for reviews of OASIS documentation, audits, recertifications, and any urgent coding.

Q4.Why is OASIS review important when choosing a coding company?

OASIS reviews provide value by helping to identify missing information, inconsistencies, and documentation concerns prior to submission. Diagnosis coding is supplemented by the reviews, however they do not take the place of clinical judgment or required documentation.

Q5.Is outsourcing home health coding better than hiring in-house coders?

It comes down to a case by case basis for an agency, considering workload, budget and staffing. Coders hired externally add capacity, while coders employed within an agency provide increased availability to facilitate close, on-the-spot collaboration. A number of agencies use a mix of both.

Q6.How does accurate home health coding affect PDGM reimbursement?

Coding diagnoses impacts PDGM groupings and can affect payment calculations. Documentation and coding guidelines must be followed; however, correct coding doesn't ensure any specific payment outcome.