Coder Competency in Home Health

The Nov.13, 2014 CMS Final Rule announcement projected a $60 million net decrease in payments to home health agencies (HHAs) in 2015.

To better assess the impact of the announcement and the concerns of the Home Health Community, Libman Education and JLU Health conducted a survey of quality improvement and performance improvement (QI/PI) staff; HIM professionals (including coders); and nurse coders (RNs and LPNs) to get their reaction to the announcement.

Essential Knowledge
Participants in the survey were primarily working in home health, but also included other post-acute-care providers such as hospice, palliative care, long term care, and skilled nursing facilities.

Participants were asked what they regarded as “the most pressing professional concerns facing them in 2015?” One or more of the following responses was ranked as most urgent or very important by 97% of the participants:

Accurate and complete coding of diagnoses for post-acute care patients has a significant impact on an organization’s financial success.Coding competency by clinicians in the field, referral/intake staff, and coding and billing staff is critical to ensure clinical documentation supports the diagnoses selected. The increase in oversight in post-acute care documentation requires a new approach to coder training and education.

SEE ALSO: New HIM Roles in Information Governance

Accurate coding is essential to receiving appropriate and timely reimbursement. Individual coder accuracy was considered important as opposed to urgent by survey respondents. How individual coders were to be trained and assessed ranked as concerned to unconcerned.

Staff Training
One of the takeaways from the survey is that agencies need to determine who will provide oversight for the coding program and who will provide detailed training to staff.

Based on our experience consulting with home health agencies nationwide, we recommend that the agency start with training on the fundamentals of coding to ensure that all staff responsible for coding have a thorough understanding of Official Coding Guidelines including coding conventions, definitions and sequencing rules. Additional training, specific to the individual and their role, will help to ensure that the coding is both correct and complete.

Please note that different staff learn by different methods and a combination of mixed media may be required. Determine the best method of learning for each member of your staff: consider online training classes, webinars, or an in-person class. You may also use a “train the trainer” format for other departments that need only limited coding knowledge.

Proper training of agency personnel in ICD-9-CM coding will ensure correct reimbursement and decrease the agency’s risk of external audits and loss of revenues. Well trained staff in ICD-9 will also provide the foundation needed to transition to ICD-10. Investing in the coding function provides assurance that there is documentation in the medical record to support diagnosis selection, that coding reflects the services provided and that reimbursement is appropriate. A well trained coder is a worthwhile investment that will pay for itself time and again.

“Accurate coding of post-acute patients can significantly impact an organization’s success.”

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Coding Exam: A Critical First Step
In addition to identifying current skill gaps, assessment results provide a blueprint for remediating deficiencies. A Home Health Coding Competency Exam can help your agency:
Standardize the performance of anyone responsible for coding throughout your agency by training and evaluating them on the same set of core competencies.

Measure proficiency of new hires and existing staff to validate each individual’s competency and understanding of current guidelines.

Identify knowledge and skills gaps that need improvement and access a personalized learning path to ensure future success.

Avoid citations and comply with federal and state regulations by maintaining accurate documentation of clinician competencies.

Save time tracking each individual’s competencies online 24/7.

Home Health Coding Assessment
We recommend Home Health Agencies assess their staff’s competency in the five essential elements of home health coding:

  • Chapter Specific Diagnostic Information
  • Code Structure & Conventions
  • Coding Guidelines
  • Sequencing
  • Reimbursement Principles

Accurate coding is essential to receiving appropriate and timely reimbursement. The Home Health Coding Competency Exam is a critical tool to evaluate and document the quality of coding in your agency.

Joan L. Usher is president of JLU Health Record Systems, a leader in Health Information Management and ICD-9 and ICD-10 coding solutions. Contact JLU Health Record Systems at

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