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How we work
In the PDGM payment model, coding and OASIS scoring determine what an agency is paid. Small errors lead to lost revenue, denials or compliance problems.
What accuracy means in each area
Coding
Correct diagnosis sequencing and specificity support the right PDGM grouping.
OASIS
Functional scores, clinical severity and comorbidity adjustments are validated for correct case-mix classification.
Plan of care
Medical necessity, visit frequency and services are checked against payer requirements.
Where charts go wrong
| Coding | OASIS | Plan of care |
|---|---|---|
| Wrong diagnosis sequence. | Inconsistent functional scoring. | Incomplete care plans. |
| Missed specificity. | Missing clinical documentation. | Missing physician signatures. |
| Undercoding. | Inaccurate severity ratings. | Frequency mismatches. |
| Outdated codes. | No medical necessity documentation. |
Coding
Wrong diagnosis sequence. Missed specificity. Undercoding. Outdated codes.
OASIS
Inconsistent functional scoring. Missing clinical documentation. Inaccurate severity ratings.
Plan of care
Incomplete care plans. Missing physician signatures. Frequency mismatches. No medical necessity documentation.
These errors lead to denials, and they carry into prior authorization and claim preparation.
Four steps
Document collection
We receive the agency's charts and supporting documents.
Expert review
Coders, OASIS reviewers and QA staff review each chart.
Feedback and corrections
Findings go back to the agency with the corrections needed.
Ongoing support
We stay available for queries, follow-up and trend review.
