Elevate Your Agency: The Impact of Strong OASIS & Coding Practices

Accurate OASIS assessments and coding are essential in home health, impacting both patient care and financial outcomes. As regulatory requirements evolve, agencies must make sure that assessments align with clinical needs while maximizing reimbursement. A structured approach, like the Plan-Do-Study-Act (PDSA) model, can drive continuous improvement and help agencies maintain a high-quality process. By optimizing referral and intake processes, comprehensive assessments and ICD-10 coding accuracy, organizations can improve efficiency, reduce errors and enhance patient outcomes.

The Role of PDSA in Process Improvement

The PDSA cycle provides a systematic approach to process improvement by guiding organizations through four key phases:

1. Plan: Create your team, establish and confirm your goals.
2. Do: Develop what changes you want to implement and identify and deal with barriers.
3. Study: Analyze outcomes and determine whether improvements have been made.
4. Act: Adjust the process based on findings and integrate successful changes agency-wide.

By following this framework, agencies can target improvements in OASIS accuracy and coding that are data-driven and sustainable.

Key Areas for Quality Improvement

1. Strengthening the Referral and Intake Process
   
   A strong referral and intake process lays the foundation for accurate OASIS assessments and coding. Key elements include:
   • Valid face-to-face documentation to avoid returned claims.
   • PDGM-approved primary diagnoses to support proper classification and reimbursement.
   • Comprehensive patient information to accurately capture comorbidities and functional status.

   
   Challenges like staff knowledge gaps, incomplete patient histories and variable information from referral sources can create barriers. Agencies must provide education to intake staff, helping them collect necessary clinical details upfront. This proactive approach reduces the risk of missing critical comorbidities, which can significantly impact reimbursement.

2. Improving Comprehensive Assessments and OASIS Accuracy
   
   Accurate OASIS assessments support appropriate care planning and financial sustainability. Goals for a quality assessment process include:
   • Precise OASIS scoring that reflects the patient’s actual condition.
   • Comprehensive patient documentation to support functional limitations and care needs.
   • Consistency among clinicians to avoid discrepancies that impact quality scores.

   
   Common barriers include clinician competency gaps, rushed assessments and inconsistent documentation practices. With the transition to an all-payer OASIS, agencies must prepare for increased assessment volume and potential impacts on quality reporting. Providing ongoing OASIS training and implementing quality review processes can help mitigate these challenges.

3. Best Practices for ICD-10 Code Assignment
   
   Accurate coding not only supports compliance but also impacts financial outcomes. Best practices for ICD-10 coding include:
   • Assigning the correct primary diagnosis to align with the face-to-face encounter.
   • Capturing secondary diagnoses to maximize comorbidity adjustments.
   • Avoiding overuse of symptom codes without underlying conditions.

   
   A lack of comprehensive patient information can lead to coding errors and missed reimbursement opportunities. By improving coordination between coders and clinicians, agencies can make sure coding accurately reflects the full clinical picture.

Using Analytics to Identify Areas for Improvement

Key performance indicators (KPIs) can highlight areas where improvements are needed. Important metrics to track include:

• Visits per episode: Reviewing appropriate service delivery without unnecessary visits.
• Revenue per period/episode: Identifying trends in reimbursement.
• LUPA rates: Monitoring compliance with PDGM requirements.
• Functional level distribution: Verifying accurate OASIS responses that reflect patient needs.

Analyzing these KPIs helps agencies pinpoint discrepancies in coding, assessment accuracy and patient care, ultimately driving strategic improvements.

Establishing an Effective Audit Program

A structured audit program is crucial for maintaining OASIS and coding accuracy. Key components include:

• Consistent auditing practices to maintain standardization across reviewers.
• Education-driven feedback to correct errors and reinforce best practices.
• Defined accuracy thresholds to maintain high performance.

Agencies should incorporate ongoing audits into their quality improvement framework, using results to guide targeted training and policy adjustments. Integrating coding and OASIS audits with clinician evaluations keeps accuracy a priority at all levels.

Change Leadership and Accountability

Driving improvements in OASIS and coding requires strong leadership. Change leaders should:

• Develop a clear vision and communicate the importance of accurate assessments and coding.
• Foster accountability through regular performance reviews and education.
• Encourage continuous improvement by using data to drive decision-making.

By engaging clinicians and coders in the improvement process, organizations can create a culture where accuracy and quality are prioritized.

Optimizing OASIS accuracy and coding is essential for home health agencies to provide high-quality care while maintaining financial stability. By strengthening referral and intake processes, improving assessments, leveraging analytics and establishing effective audit programs, agencies can drive meaningful improvements. With strong leadership and a commitment to continuous learning, organizations can navigate regulatory challenges and enhance both patient outcomes and financial performance.

McBee experts explored strategies for building a quality OASIS and coding process in a recent webinar. Click here to listen to the full webinar.

About the Author

Karen Tibbs, Director of OASIS Quality Assurance

Karen Tibbs, RN, MS, HCS-D, COS-C, Senior Director, OASIS & Coding Services, is a registered nurse with a Masters of Science in Health Care Quality. She has 22 years of home care experience with extensive knowledge in medical review, regulatory compliance, ICD-10 and OASIS accuracy. Karen has earned the Home Care Coding Specialist – Diagnosis (HCS-D) and the Certificate for OASIS Specialist – Clinical (COS-C).