Gateway clients confirm that Diagnosis Coding can be a primary factor in CMS’s Review Choice Demonstration, specifically the Pre-Claim choice. We have received feedback that providers currently receiving affirmations under this program contribute a large part of their approval odds to appropriate Diagnosis Coding. One ADR and Appeals client confirmed that initial denials under Pre-Claim were related to improper Diagnosis coding by Agency staff. That client has since expanded their services with Gateway to perform ALL Coding tasks.
These denials stem from Coding staff misinterpreting Physician documentation found within the Face to Face encounter, Physician progress notes and/or Inpatient discharge documentation. Home Health providers need to understand there is more to Coding than just identifying the primary reason for Home Health services.
By utilizing experts that focus solely on ICD-10 Coding and Quality Assurance of OASIS assessments, an Agency can facilitate a stable foundation of clinical documentation. More importantly they can ensure success and focus their efforts on patient care.