Regulatory

It Takes Skill to Navigate Changing Regulations

Keeping current in the dynamic home health environment can be a challenge. Regulations are changing. Intensified compliance is on the horizon. Accurate coding is a must for optimal reimbursement.

Pathway Health is here to assist providers, and encourage our industry to achieve this new level of care. Our Home Health Team can help your facility develop new operational systems or better utilize current processes. We also provide unbiased reviews of your current operations and compliance performance, for audit and survey preparedness.

Performance-Based Services to Meet Your Patients’ Needs

Increases in OIG, ZPIC, and RAC audits have resulted in a growing number of denials. Pathway Health assists in the development of meaningful and effective controls and operating practices, to support staff knowledge and skill in maintaining regulatory compliance, managing risks, and avoiding denials and penalties.

Pathway Health’s Home Health Team specializes in clinical and operational consulting services, to effectively position your organization to realize quality, clinical and operational outcomes. We provide on-site and off-site clinical consultation, quality process and performance improvement, interim management, OASIS review, coding audits, compliance preparation and response, home health license audits, startups, education, training and more!

1. Pre-billing audits to evaluate compliance with all technical requirements, including:

  • Documentation of clinical eligibility.
  • Compliance with Medicare Conditions of Participation (CoPs)

2. Comprehensive on-site assessment of agency documentation, including:

  • Specific documentation review and audits, related to the most current focus of ADR, RAC, ZPIC auditors.
  • Education of proper documentation practices.
  • Focused areas of analysis for consistent and accurate OASIS-C documentation.
  • Therapy utilization and documentation accuracy, demonstrating reasonable and necessary care.
  • Data trends in length of service and percentage of patients who are re-certified.
  • Average case mix trends and HHRG scores, related to reimbursement.

Apply Our Expertise to Your Regulatory Strategy

How is your agency managing quality, clinical and financial outcomes, as well as compliance and staffing, while providing excellent patient care?

Strategic planning and operational efficiency is essential. Pathway Health has the expertise and depth of resources to provide you a tailored approach.

  • Pre-Survey Preparation

    • Medicare mock survey/compliance assessment — On-site review of agency compliance status for a specific survey (federal, state, CHAP, ACHC, or The Joint Commission)
    • Review of client records for completeness and accuracy, documentation of reasonable and necessary care for all disciplines, and compliance with CoPs
    • Assess emergency preparedness plan at staff level (including in-home services)
    • Review of HIPAA program
  • Post-Survey Response

    • Survey recovery support — Develop plans of correction, in response to surveys
    • Evaluate practices, in relation to risk areas identified by the Office of Inspector General
    • Review of agency compliance history, focusing on Statement of Deficiencies (SOD) and Plan of Correction (POC)
  • Corporate Compliance Program

    • Audit of employee personnel files, to ensure regulatory compliance with necessary requirements
    • Review of performance improvement systems, including incidents, complaints, infection control, customer satisfaction and other areas as required
    • Assess system for on-going monitoring and improvement, to appropriately address problems
    • Conduct audit of contractor files for compliance
    • Evaluate the Corporate Compliance Program at the agency level

Our experts provide a clear understanding of current agency compliance culture, risk profile analysis and provider data benchmarked with national and regional data, in order to identify ‘red flags’ that need to be addressed or remedied.

Follow our path to better clinical, financial and operational home health outcomes.