Coding & OASIS QA

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Accurate, Timely Coding and OASIS QA

Hoolime's Coding and OASIS Quality Assurance (QA) service offering brings dedicated and expert resources to help offload your OASIS Coding and QA tasks. Our 24-hour turnaround expedites the process from patient care to billing and reimbursement. More accurate Coding means fewer payor rejections, improved quality Star Ratings, and positions your agency for audit readiness.
Our QA team reviews the Start of Care (SOC), Resumption of Care (ROC), Recertifications (RCT), appropriate assignment of diagnosis codes, and finally performs an OASIS review for quality, inconsistencies and opportunities for improvement. We also work with your clinical staff to make necessary edits for a clean submission to the payor.
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The Need for Outsourced OASIS Services

Our Home Health agency is likely facing increasing challenges, including recruiting qualified clinicians and maintaining compliance with frequently changing regulations and varying payment models by Payors (FFS, PDGM, and HHVBP).
Often, the task of Coding and reviewing OASIS documentation falls on overwhelmed nursing or therapy staff. Lacking OASIS-D1 experience and certification can lead to submission errors, resulting in poor Star Ratings and potential reimbursement penalties.
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How we Optimize Cash-Flow and Revenue

Documentation and compliance errors that impact reimbursements are expensive. They can cause delayed payments or claw-backs, both in the PDGM payment model for Medicare or Fee for Service (FFS) for Medicare Advantage, Medicaid, and Commercial Insurers. The new Home Health Value-Based Purchasing (HHVBP) model adds additional complexities.
Hoolime assures an accurate and clean OASIS document. This leads to timely submission and payment of claims reducing delays and the time spent on rejections. Utilizing internal staff – often not specialized – can be costly. They are less productive, taking longer to finish similar tasks, they encounter frequent interruptions, and their time is taken away from growth-oriented essential duties. Furthermore, additional costs include employee churn, and ongoing expenses for OASIS training programs.
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Client Communication and EMR Integration

We integrate our processes and workflows with your existing EMR (e.g., WellSky Home Health/Kinnser, Homecare Homebase, or others) and your agency practices. After your clinicians submit their OASIS draft (SOC, ROC, RCT or Discharge), Hoolime's QA team begins their work. We start by reviewing the referral package, seeking clarifications from the clinician if needed, and making relevant corrections before sending the chart back to the clinician for their approval, signature, and submission to the Internet Quality Improvement and Evaluation System (iQIES). All work can be tracked in a secure on-line spreadsheet.
We provide weekly and monthly summaries to our dedicated point of contact including clinician-specific feedback for their learning and to address recurring.. mistakes. At Hoolime, information security and confidentiality are a top concern. We use HIPAA-compliant encrypted and authenticated communications and patient data storage methods.
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Hoolime Coding and QA Service Offerings

We offer four levels of services with options for additional add-ons, all tailored to your specific needs:

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Service Provided
Level 1
Level 2
Level 3
Level 4
Add-Ons
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Basic review & recommendations of admission OASIS
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Capture the correct primary and secondary ICD-10 codes based on a review of the physician note, discharge summary, and clinician's narrative
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OASIS (admission, transfer, and discharge) review for inconsistencies focusing on parameters (specific M-items) that impact Star Ratings
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OASIS (admission, transfer, and discharge) review for inconsistencies and accuracy of all M-items and G-codes
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Creation and cross-checking of Plan of Care (POC) / CMS 485 to validate all information is captured correctly
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Pre-billing review to reduce claims rejections
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Audit-readiness including mock-audits to review accuracy and completeness of patient medical charts in compliance with regulatory requirements
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Audio capture of clinician's narrative for additional efficiency and accuracy
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Clinical pathways (plan of care development, frequency of visits, discharge vs. recertification) based on patient's diagnosis and condition
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Orders management
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Clinician education and learning
All Levels
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Basic review & recommendations of admission OASIS
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Capture the correct primary and secondary ICD-10 codes based on a review of the physician note, discharge summary, and clinician's narrative
Level 2, 3, 4
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OASIS (admission, transfer, and discharge) review for inconsistencies focusing on parameters (specific M-items) that impact Star Ratings
Level 3, 4
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OASIS (admission, transfer, and discharge) review for inconsistencies and accuracy of all M-items and G-codes
Level 4
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Creation and cross-checking of Plan of Care (POC) / CMS 485 to validate all information is captured correctly
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Creation and cross-checking of Plan of Care (POC) / CMS 485 to validate all information is captured correctly Pre-billing review to reduce claims rejections
Add-Ons
arrow
Audit-readiness including mock-audits to review accuracy and completeness of patient medical charts in compliance with regulatory requirements
arrow
Audio capture of clinician's narrative for additional efficiency and accuracy
arrow
Clinical pathways (plan of care development, frequency of visits, discharge vs. recertification) based on patient's diagnosis and condition
arrow
Orders management
arrow
Clinician education and learning