Home Health Coding FAQs Flashcards
What’s the difference between L1, L2 and L3 Coders?
L1 Coder
- Has the ability to review Evals, Visit Notes, PO, etc…
- Has the ability to code charts according to the latest ICD-10 standards.
L2 Coder
- Has the ability to review Evals, Visit Notes, PO, etc…
- Has the ability to code charts according to the latest
- ICD-10 standards.
- Able to perform a full OASIS review.
L3 Coder
- Has the ability to review Evals, Visit Notes, PO, etc…
- Has the ability to code charts according to the latest ICD-10 standards.
- Able to perform a full OASIS review.
- Able to create a Plan of Care.
What do you mean by reviewing the OASIS and reviewing the plan of care?
Review the entire OASIS, from start to finish, including M and GG items. Changes are made based on client preference.
For the plan of care, we follow the agency’s guidelines and create it entirely according to the client’s specifications.
M and GG items are a set of assessment questions specifically to determine the patient’s functional ability including, but not limited to, activities of daily living, instrumental activities of daily living, medications, etc.
Do you code based on reimbursement or the clinician’s charting?
We typically prioritize the physician’s referral for the primary diagnosis. If the referral is too general or includes multiple diagnoses, we apply the PDGM ranking to determine the most appropriate diagnosis, considering reimbursement factors.
Traditionally, how many codes do you code out?
Depends on the patient’s case and on how many diagnoses they have.
How current are you with updates regarding Medicare PDGM and value-based purchasing changes?
How do you stay informed and updated on this evolving information?
Do you initiate a 485 or a plan of care?
Yes
If a diagnosis needs modification in the current template, do you handle that?
Yes, it’s better if the agency provides a template for the diagnosis. For example, if the agency focuses on disease management like COPD, we would replace the generic section with the specific diagnosis and modify it accordingly.
Do you utilize QIP and stuff when doing or auditing the chart?
Yes
What chart entries can you make that don’t need to be returned to clinicians?
If a case requires recommendations, does your team provide goal recommendations?
Do you mark “coded” once you’ve completed coding?
Yes, if the agency requests it, we add a note indicating that coding and OASIS review are completed.
In technical QA, do you review everything from demographics down?
Yes
How do your reviewers stay updated with OASIS changes?
Stay updated through research, using sources like Google and the CMS website.
Are your OASIS reviewers OASIS certified?
Some of them are, but all have expertise and stay updated with OASIS guidelines.
Do they verify missing information from the Oasis on the H&P?
This depends on the agency guidelines. If the agency allows it, we manually add missing OASIS information from the H&P to avoid returning it to the clinician.
How do you ensure all missing information is added to the charts without returning it to the clinicians?
If a medication is missing and not on the med profile, can your team add it?
Yes, if there is a basis and no risk involved. If physician approval is needed, it will be referred back.
What are the things that you could put on the chart that don’t need to be returned to the clinicians?
Can you revise the diagnosis within the current template when creating a plan of care or completing the Oasis, if needed?
