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The 3-Step Review Architecture

Cliniqon's Clinix platform runs a layered quality framework designed to pair operational speed with clinical precision.

Step 1 — Clinix AI Engine Pre-Screening: Patient files are ingested automatically. The engine flags documentation gaps, identifies inconsistencies in OASIS responses, and builds pre-coded work items so low-level errors are cleared before any human review.

Step 2 — Licensed RN / PT Coder Review: A certified home health coder who is also a licensed Registered Nurse (RN) or Physical Therapist (PT) evaluates every chart. These reviewers check OASIS responses against clinical visit notes and physician records, finalize ICD-10-CM diagnosis sequencing, and confirm PDGM clinical groupings.

Step 3 — Two-Tier QA Audit: Before final EMR return, completed charts go through a structured second-level audit inside the Clinix platform, holding the work to a strict quality bar.

Core Service Capabilities

PDGM-Compliant ICD-10-CM Coding: Primary diagnosis sequencing is prioritized to establish accurate functional impairment groupings and reimbursement tiers, with comorbidity capture supporting precise HIPPS code generation.

Complete OASIS Review: All assessment types are covered—Start of Care (SOC), Resumption of Care (ROC), Recertification (RCT), Transfer (SCIC), and Discharge. Every M-item is cross-verified against progress notes, therapy evaluations, and physician documentation.

Discharge OASIS & CMS Star Rating Optimization: Discharge outcome items are audited within qualified measurement timeframes to protect HHCAHPS scores and Care Compare Star Ratings.

Plan of Care (CMS-485) Review & Creation: Patient-specific Plans of Care are developed with individualized interventions, goals, and discipline frequencies, delivered within mandatory CMS 5-day timeframes.

Concurrent Document & Discipline QA: Admission consents, H&P notes, face-to-face evaluations, physician orders, and multi-discipline visit notes are audited across Skilled Nursing (SN), Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Medical Social Work (MSW), and Home Health Aides (HHA).

Pre-Claim Review (PCR) & RCD Support: Audit-proof chart packages are prepared for Medicare Administrative Contractor (MAC) scrutiny, with a documented 99–100% affirmation rate across demonstration states (Texas, Illinois, Florida, Ohio, North Carolina, and Oklahoma).

QAPI Oversight & Survey Readiness: Structured clinical audit cycles aligned with agency Quality Assessment and Performance Improvement (QAPI) plans are provided, along with documentation pattern analysis and mock survey preparation.

Scale, Speed & EMR Integration

Operational Scale: A workforce of 500+ certified coders processes 20 million charts annually with a 98% overall accuracy rate. Cliniqon maintains a 96% client retention rate across partner agencies.

Turnaround Baseline: All coding and OASIS QA reviews operate at a 12–24 hour baseline turnaround, with 97% of charts delivered in under 24 hours.

EMR Native Integration: Native integration is available for major home health EHR platforms, including Homecare Homebase, WellSky, Kinnser, MatrixCare, and Axxess.

Risk-Free Trial & Onboarding

5-Chart Trial: Agencies can test coding accuracy, OASIS review depth, and turnaround speed through a risk-free trial of 5 charts reviewed at no cost, with zero setup fees or binding contracts.

Rapid Setup: Operational onboarding is typically completed within 5 to 7 business days.

https://www.cliniqon.com/leading-home-health-coding-and-qa-services-in-us

#Homehealthcoding #Medicalcoding

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