AI Tech-Enabled Home Health Coding and QA

What we do

AI Tech-Enabled Home Health Coding and QA

Our technology is focused on a critical bottleneck in home health: the slow, manual process of quality assurance. Our QA technology uses artificial intelligence (AI) and automation to review documentation in seconds. It ingests discharge summaries, face-to-face notes, OASIS forms, and other records — and flags potential inconsistencies, missing data, or errors. A human reviewer then verifies the AI’s output. Every reviewer action is tracked, allowing the system to improve continuously.

This approach doesn’t replace the human role — it enhances it. Clinicians remain the final decision-makers, but they’re now equipped with a system that surfaces issues faster, more consistently, and with less cognitive burden. Combined with our team of home health RN coders, our QA services deliver the highest accuracy and efficiency at the lowest price points in the marketplace.

Key Areas of Impact

1. PDGM Coding Support

Extracts and highlights clinical data relevant to case-mix and reimbursement.

Flags inconsistencies or missed opportunities based on historical trends and coding rules.
Helps reduce errors that lead to underpayment or compliance risk.

2. OASIS QA Acceleration

Reviews OASIS forms for completeness and alignment across documentation.

Detects mismatches between clinician assessments and supporting records.
Enables faster turnaround and higher accuracy in submissions.

3. Plan of Care Review

Cross-references narrative Plans of Care with OASIS data and supporting documents.

Checks for alignment with patient goals and clinical standards.
Ensures care plans are personalized, compliant, and actionable.

Why This Matters

3x Productivity Boost: Reviewers can work faster without sacrificing accuracy.
Human-in-the-Loop Assurance: AI accelerates the process; clinicians stay in control.
Learns Over Time: Every correction helps the system get smarter.
Operational Gains: Reduces burnout, delays, and costly errors — while improving reimbursement timelines.

Our Solution

Leading the Future of QA in Home Health

AI and machine learning are redefining what’s possible in healthcare operations. By integrating them directly into the QA workflow, we’re setting a new standard for quality, speed, and scalability — not as a vision for the future, but as a solution being deployed today.

Maintain Compliance with our cost-efficient home health medical coding services.

Guarantee success no matter what stage you are at in starting a home health care agency with our knowledgeable and experienced certified consultants.

Need more help?

(310) 883-8920

LKN Strategies

5 STAGES OF CMS APPEALS

STAGE

Redetermination

When initial review is denied for PCR; PPR; ADR; UPIC; RAC, etc. and providers of the claim is denied, you have 120 days to submit a Redetermination Request (30 days from date of initial decision demand to avoid recoupment). This request is handled by the Medicare administrative contractor (MAC). If the claim is denied you have 60 days to submit an appeal request to level 2 to avoid recoupment.

STAGE

Reconsideration

Reconsideration is step 2 in the appeals process. You have a maximum of 180 days to submit your appeal. You will submit your documentation with the request for reconsideration and a detailed "rebuttal" of the reason(s) you disagree with the decision made at level 1. This review is completed by qualified independent contractors. If denied, you may move to stage 3. You have 60 days from date of receipt of Reconsideration.

STAGE

AU

At level 3 you will have a chance to present your appeal case to an Administrative Law Judge. You will need to submit a request and a detailed rebuttal as to why you disagree with the level 2 appeal decision. Your claim will only be elevated to level 3 if it meets the minimum dollar amount. For 2022, the required minimal amount is $180.00 If denied, you may try stage 4. You have 60 days from date of receipt of AL decision.

STAGE

MAC

The Medicare Appeals Council reviews the appeal decision made by the AU. If the claim is denied, you have 60 days to submit a request for judicial review by a federal district court.

STAGE

Federal Court

To get a judicial review in federal district court, the amount of your case must meet a minimum dollar amount. For 2022, the minimum dollar amount is $1760. You may combine claims to meet this dollar amount. Follow the MAC's decision letter you received at level 4 tafileacomnaint.

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AI Tech-Enabled Home Health Coding and QA

What we do