The Current Environment
Mandatory compliance programs, ever-changing regulations and heighted scrutiny requires Home Care executives to proactively focus on the OIG’s seven pillars of compliance — and the priority elements of documentation, coding, billing and reimbursement for the Agency. The OIG believes compliance risks exist in delivering medically unnecessary services, insufficient OASIS and visit documentation, inadequate supervision, billing for services not actually rendered, and duplicate billing.
How We Can Help You Succeed
Our experience proves that periodic reviews of compliance program elements result in the most effective programs. Effective compliance programs eliminate, reduce or mitigate an organization’s risk, and build awareness of compliance efforts, and ensure income is captured, billed and kept. KHC and Client personnel work together as a team to plan and perform the compliance programs reviews, resulting in an effort that is cooperative, as well as efficient. Risk exposure is assessed based on known areas of potential fraud and payment risk trending in the Home Care industry.
Our Home Care review can be customized to your specific needs including:
- Review of the OIG’s seven elements of an effective compliance program to identify and prioritize compliance and non-compliance risk.
- Provide targeted medical record and process reviews to focus exclusively on HOME CARE HOTSPOTS:
- Home Health Certification/ Plan of Care/ CMS485
- Referrals/ Authorizations
- Validity of Physician Order and Homebound Status
- Oasis Content and Reporting
- Face-To-Face Documentation
- Visit Cycles/ Frequency/ Duration/ Lupas
- Skilled Care Assessment
- Therapy Assessment / Reassessment
- On-Going Clinical Progress Documentation To Support Service
- Supervision of Care Delivered By Aides
- Billing and Coding Review
- ICD-10 Transition: Training/ Implementation
- Improve and develop internal compliance controls and standards.
- Create and implement necessary policies and procedures for the Home Care Agency’s compliance program.
- Provide assistance in the development and implementation of the Agency’s operational action plan for improvement.
