Coding quality for large-sized home health service provider reached >98%

The Client

Large-sized home health service provider based out in the US

The Challenges

• Missed revenue opportunities 
• Coding and billing integration 
• Certified and experienced coders
• Payer specific nuances

Plutus Health Plan:

Plutus Health’s dedicated team of coding managers, quality experts, and certified coders thoroughly analyzed the coding process of the client and detected the following issues:

Issues Detected

• Missed calibration between Oasis and Medical record
• Incorrect sequence results in HIPPS reimbursement
• Inappropriate resumption of care information
• Non compliance 

After detecting the coding issues, Plutus Health’s coding experts create a personalized plan to provide an end-to-end coding solution.

Our coding experts helped the client review H&P (History and Physical), doctor’s note, medications, and assessment to determine the correct diagnosis codes.

Plutus Health Solutions

• Plutus Health’s certified coders (OASIS, AAPC, RHIA, HCS-D) identify hidden trends in lost revenue, clean claim rate, lost-revenue performance, and revenue performance to get maximum reimbursement. 
• Plutus Health’s experts helped the client with regulatory requirements like OASIS-E, PGDM, and ICD-10 codes.
• Our specialists helped the client with all the complaint-related issues by conducting timely compliance audits and working on the audit findings.  
• Plutus Health’s professionals helped the client accelerate reimbursement, reduce costs, and improve accuracy.

Results

• Improved Revenue
• The coding quality of the client improved.
• Fully compliant coding process
• Coding denials minimized

Achievements

• Coding quality for the client reach >98%
• Coding denials for the client reached <2%
• $ 200 improved per episode per patient 
• OASIS responses in line with MR