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Home Health Care Audits: Is Your Revenue Protected?

charts-at-risk.pngHome Health agencies have dealt with the ongoing level of scrutiny on documentation or many years. Leadership are relieved when no external home health care audits have been implemented for their agency over the past few years and cringe at the thought of someone asking for charts. Others believe that no news is good news and not being selected means that everything must be OK.

With ever shrinking reimbursement, it is not enough to have a positive revenue stream. Agencies MUST protect that revenue against denial risk that has sometimes struck 3 years after the care was provided. Consider the following examples of home health care audits:

Agency A has a robust therapy program with 60% of their patients being seen by at least one of the therapy services. Their current census is 250 Medicare patients. A sample of 20 records with therapy visits were audited and there were issues found in 80% of the charts. In all cases, the therapy provided was not completely denied as not necessary but the total amount per patient was not supported by the level of documentation content. The average risk per record for the entire sample was calculated to be $2000. Expanded to the current census, this means that 150 patients are getting therapy and with a $2000 risk each, the total risk is $300,000. If documentation patterns of therapy do not change, the risk continues to build with each new patient treated.

Agency B has been diligently educating and monitoring the required therapy reassessments. There data analysis shows they have only missed these requirements 3 to 4 times per month resulting in an average loss of $3500. During a routine review of records the content of the reassessment visits was incomplete with very repetitive information and no clear support for ongoing therapy in 50% of the cases reviewed. This translated into a total of 150 cases impacted in the past month. Calculating the removal of visits due to the reassessment not meeting intent, the average revenue loss per record was $3000. Total potential loss was $450,000 in one month. Considering that reassessments have been required for more than 2 years, the agency estimates cumulative risk to be $16,000,000.

Documentation expectations are not the favorite topic for many clinicians and those who work to improve the situation may feel like it is falling on deaf ears. Kornetti & Krafft Health Care Solutions provides specific home health care audits and analysis with detailed follow up plans and tools to ensure accountability that have been proven to decrease risk and protect the revenue agencies have worked hard to secure.

 

In Depth Home Health Care Audits - Therapy Records

What is reviewed? 

  • Recently discharged patients who received any combination of physical and/or occupational and/or speech therapy over the course of an episode of care. If there is a recertification involved, the initial episode will be the focus of the review and additional episodes will be evaluated to determine if continued care is supported.
  • The sample for the home health care audit should represent all three therapy services in some capacity with total visit numbers throughout the range of practice patterns. If physical therapy or speech therapy complete admissions, several of those cases should be included.
  • The Start of Care OASIS is part of the review, regardless of the discipline that completed the form, from the perspective of supporting the inclusion of therapy in the episode and consistency of responses between the admission and the therapy evaluation(s).
  • The Plan of Care / 485, all therapy visit notes, all orders related to therapy services and any communication notes will be reviewed to determine if there is sufficient information to support the number of visits provided.

 How are the records submitted for review? 

  • If the agency is paper based, copies of all documents mentioned above should be gathered and shipped on a mutually agreed upon date.
  • If the agency is on an electronic system and has the ability to grant access, the documents can be reviewed electronically and no paper copies are needed.
  • Faxing of documents is not recommended due to the size of some of the documents. 

What does the agency get once the audit is complete? 

  • Each episode reviewed will result in a detailed audit tool pointing out strengths and weaknesses found in the documentation with specific examples provided.
  • The trends seen from the sample are pulled into a written report that explains the concerns, examines the financial implications of a denial and provides strategies to improve the documentation based on the findings.
  • A one hour conference call will be scheduled after the agency receives the report for individualized consultation on findings and next steps. This allows any remaining questions to be addressed directly. Staff that review records are strongly encouraged to attend in order to assist with follow through.
  • The audit tool used is given to the agency for use on an ongoing basis if that is desired. 

What is the cost of a home heath care audit like this? 

  • The average financial risk per episode in the hundreds of documents already completed is just over $1000. That means the 20 record sample is reflecting a $20,000 risk – so think about how many patients are receiving therapy from the agency at any given time. Being proactive in decreasing risk can pay for itself very quickly and keep agencies focused on the necessary components of therapy documentation.
  • Cost can vary based on your agency size and needs. We have package discounts available as well as pricing for standard audits and/or reviewing your current reviewer. See products below or contact us to discuss a customized package for your agency.

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