Why Every Home Health Billing Company needs proper documentation 

Suppose while providing a home health service instead of specifically documenting wound measurements and the treatment offered, you mention terms like “improving” in OASIS. Now when you are billing the service rendered, such unspecific documentation can lead to claim rejections. Yes, you heard it right, ensuring proper OASIS documentation is a key to fair reimbursement for practitioners.   

It is the primary document using which billers can submit claims for the services practitioners render. However, billing based on such documentation also requires expert help. This is why hiring a professional home health billing company is necessary for the proper revenue cycle management of practitioners.   

What Is OASIS Documentation in Home Health?  

Outcome and Assessment Information Set refers to the standardized dataset used in home health care to plan treatment, determine reimbursement and measure quality. Under the PDGM model introduced by CMS, this documentation plays a fundamental role in determining reimbursement for practitioners based on patients’ clinical, functional, and psychosocial status. However, this dataset cannot be filled by everyone.  Payers require only qualified healthcare professionals like registered nurses, among others, to make such assessments.  

Key points to consider:  

• This documentation helps in ensuring quality care to patients based on their specific medical needs. Further, it determines the reimbursement rate based on the quality of care provided and not quantity.  
• This dataset is mandatory for patients covered by Medicare and Medicaid plans. The dataset needs to be maintained at specific scenarios, including start of care (SOC) of the admission period, resumption of care after a break, transfer, and discharge.  
• The documentation itself includes all data relevant to the patient, including the patient’s demographics, health condition, functional status meaning their ability to perform daily activities as well as the service they require.   
• Additionally, data documented in the OASIS sheet is used to classify patients under the newly introduced PDGM or Patient-Driven Groupings Model. This is basically a classification method that determines the payment amount based on quality care and not quantity, making accuracy crucial to avoid audit findings.  

Why OASIS Is Critical for Billing Accuracy   

This dataset is critical in home health billing as it directly impacts the reimbursement rates for services provided by the practitioners. To begin, the dataset is used to identify the patient’s medical and functional needs; basically, the expected service needs. Based on this, patients are grouped based on the similarity of resource utilization, and payment is set based on the intensity of the care required. Now if there is any gap in the data and care provided, it creates billing discrepancies further leading to claim delays and denials.  

Additionally, this dataset is also important to assign the correct codes like ICD-10 to indicate diagnosis while claim submission. This way, if there are any errors or a mismatch in OASIS data and the services rendered; the chances of claims getting rejected and compliance risk increase. This is why hiring a professional home health billing company is necessary. These companies are experts in managing such complex nuances.   

Common OASIS Documentation Errors handled by home health billing services  

There are various documentation errors that have immense negative repercussions on billing. For example:  

• Mistakes in functional scoring: This refers to underestimating and overestimating patients' ability to perform activities of daily living (ADLs), for example, bathing.  
• Inconsistency in data: This happens when there is a mismatch in scores given between patient’s functionality and medical status.  
• Medication management: Any mistakes in recording patients’ ability to manage medicines, focusing more on knowledge rather than functional performance, can also cause billing inaccuracy.  
• Wrong risk assessment: Unable to document risk of hospitalization for the patient is also considered an error.  
• Vague terms: Any unspecific wording used to refer to patient condition decreases OASIS score.  

This is why hiring the right partner is necessary for practitioners. Expert home health billing solutions providers are adept at ensuring the accuracy of this dataset, which is necessary for proper reimbursement.  

Role of a home health billing company in ensuring OASIS accuracy

Home health billing services help practitioners with ensuring proper documentation. For example, they conduct audits to check for accuracy in functional scores, clinical narratives, and so on. Secondly, these companies ensure proper medical coding to accurately capture the patient’s medical conditions, which is necessary for proper reimbursement. Further, these companies help with timely submission of such documentation. They ensure that the start of care (SOC) and recertification assessments are all included and submitted within time to iQIES, within mandatory timelines. This way such services ensure home health billing compliance.  

Streamline your Home Health Billing with the right outsourced partner  

Home health billing services outsourcing is gaining much traction among healthcare professionals. This could be due to the immense billing expertise and knowledge they carry and their cost-effectiveness as well. For example, RCM solution providers are adept with billing software like athenahealth and CareCloud, which is necessary for home study billing. Secondly, these companies like SunKnowledge ensure 99% coding accuracy in their claims and 97% first pass claim collection rate.   

Here it is further noteworthy to mention that these companies have a high productivity rate. For example, they are known to submit 70-75 claims per day depending on the need. This is a bonus. Lastly, all these services are provided at the lowest cost possible for example, SunKnowledge only charges $7 per hour for their revenue cycle management services.   

If you are also struggling with ensuring such documentation accuracy, then consider hiring a home health billing company.