Outsourced Coding & OASIS Services: Key Questions to Ask Your Coding Services Partner

Not all outsourced services companies are created equal. You want to ask questions related to your future partner’s staff qualifications and experience, both in the industry and in your specific system(s).

•        How long have you been providing OASIS review and coding services?

•        What is the background and certification(s) of your coders/reviewers?

–       Coding Certifications ( HCS-D, BCHH-C)

–       OASIS Certifications (HCS-O, COS-C, COQ-S)

•        Do your reviewers have clinical experience in home health?

•        Are your staff familiar with PDGM, VBP, and OASIS-E requirements?

You want to make sure that your outsourced services provider is following the most current coding and OASIS changes, is aware of the Medicare COPs, and that they are regularly auditing their own work (so you don’t have to!)

•        How do you ensure coding and OASIS reviews are compliant with coding guidelines and CMS regulations?

•        How do you stay updated with changes in regulations and guidelines such as OASIS updates and Coding updates?

•        Is there a quality assurance process? Who performs the QA and how often are coders audited?

Coding and OASIS are not only a crucial part of your revenue cycle, but they are also tied to your timely submission of OASIS and claims. Don’t let your Outsourced Services Provider add unnecessary days to the process, but also make sure you understand their process enough that they are not just “pushing charts” through for timeliness vs. accuracy.

•        What is your average turnaround time for OASIS and coding reviews?

•        Do you offer expedited reviews when necessary?

•        Are your services available on weekends or holidays?

•        What is your process and turnaround time for charts that go on hold?

Outsourcing your Coding and OASIS review doesn’t mean you don’t need to actively participate in the process. You, as the agency, should have a dedicated staff member(s) to oversee the communication process and ensure that your outsource service provider is meeting your expectations. 

On the other hand, you should also have a point person you can contact.

 •        How do you communicate with our staff when questions or clarifications are needed?

•        What is the expectation of turnaround time once that information has been provided back to the coder/reviewer?

•        Do you assign dedicated reviewers to maintain consistency and develop a relationship with the agency staff?

•        Will we have a point of contact or account manager?

•        Do you, as the agency, have a point of contact available to your outsourced services provider?

As part of the implementation process, you should map out a clear procedure that both sides are going to follow, and know who is responsible for which part of the process.  This will reduce or eliminate any confusion as you get started with your new partner.

 •        How do you access our documentation (e.g., EMR integration, secure upload)?

•        How do you determine which charts are ready for review?

•        Are you familiar with our EMR system? (e.g., HCHB, WellSky, DeVero, Netsmart)

•        What is your process for submitting completed coding and reviews?

•        Do you provide documentation of rationale for coding decisions and/or OASIS and POC updates?

One of the main benefits of using an outsourced service provider to do your Coding and OASIS review is to take the pressure off of your field staff, and have someone else “connect the dots” for them within the documentation. However, it should also serve as a learning tool for your clinicians. You want the clinicians to understand the recommended changes, play an active part in the review process, and learn from the feedback.

•        Do you provide training or feedback to clinicians to improve documentation?

•        Do any recommendations or changes you make to the documentation come with an explanation, rationale or reference to the documentation supporting the change?

•        Can you assist with ongoing clinician education for OASIS accuracy?

•        Do you offer resources or alerts for regulatory changes?

You want to ask your outsource services provider questions around how they are keeping your PHI and other data safe and secure. You should also ask your partner about training and HIPAA compliance, secure workspaces, and ensuring that logins are kept safe and secure.

•        How do you ensure HIPAA compliance?

•        How often are your staff trained on HIPAA compliance?

•        How do you secure your staff’s workspaces, equipment (such as laptops) and logins?

•        Do you have a way to communicate with us that is secure (such as encrypted email, or messaging with the EHR platform)?

•        What data protection measures are in place for patient information?

•        Are you willing to sign a Business Associate Agreement (BAA)?

Want to have a conversation about outsourced services? Contact us today!