Home Health Care programs under scrutiny by the Office of the Inspector General

June 29th, 2016

Now is the Time to Improve Your Home Health Coding & Documentation

Home Health has long been recognized as a program area vulnerable to fraud, waste and abuse, but now the Office of the Inspector General (OIG) has made it clear – they are cracking down on these issues in a major way.

In an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, the OIG recently announced that its investigations have resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in healthcare fraud schemes involving approximately $900 million in false billings.

Previous reports from OIG and the Government Accountability Office have raised concerns about questionable billing patterns, compliance problems, and improper payments in home health in the past. But now the OIG seems to be really cracking down on these issues – and for good reason – as demonstrated by this most recent takedown, which was the largest in history, both in terms of the number of defendants and the loss amount.

Among factors cited by the Office of the Inspector General (OIG) is clinicians’ failure to correctly identify primary and secondary diagnoses or omission of information necessary to support the services rendered.

With the rate of improper coding in Home Health increasing – up from 51% in 2014 to nearly 59% in 2015 – coupled with the fact that these issues are under the OIG microscope, there is no better time than now to ensure your organization’s coding and documentation in the area of Home Health is up to par.

Luckily, Elsevier has created the EduCode® Home Health Coding Curriculum, a complete package of Home Health clinical and administration education and tools that address the complexities of Home Health and the specific needs of consumers served.

This Home Health curriculum provides detailed instruction on the documentation necessary for accurate and compliant diagnosis coding on the Home Health claim form, the Outcome and Assessment Information Set (OASIS) and the care plan, as well as for performance improvement and quality reporting. In addition, it provides:

  • Scenarios and issues specific to Home Health.
  • Timely information on OASIS reporting.
  • A focus on key coding and documentation concerns related to Home Health.
  • Guidelines, conventions and sequencing instructions for coding Home Health diagnoses in ICD-10-CM.
  • Pre-approved Continuing Education credits.
  • Free webinars to complement education.
  • Availability on Elsevier Performance Manager platform for robust reporting.

The timing couldn’t be better. Make sure your Home Health organization is up to speed on the latest – there is no room for error! Learn more about Elsevier’s Home Health curriculum and to view detailed course and lesson listings.