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CASE STUDY

At Kupono Solutions, our reviews go beyond coding alone

We evaluate how ICD-10 coding, OASIS, and the Plan of Care work together — identifying gaps, inconsistencies, and areas that require alignment.

Each case below reflects real scenarios across Start of Care, Resumption of Care, Recertification and Discharge. These examples highlight the types of findings that can occur throughout the home health episode and the level of detail applied during our RN-led reviews.

CASE STUDY 1 - Start of Care (SOC)
Coding & OASIS Alignment for a High-Risk Patient

Completing Coding and Ensuring Clinical Consistency from Referral Documentation

A partner agency submitted a complex Start of Care without diagnoses, relying on Kupono Solutions to complete ICD-10 coding and perform a structured clinical review based on referral documentation.

Patient Complexity
  • Diabetes with neuropathy
  • Heart failure
  • Chronic respiratory failure with hypoxia
  • Obstructive sleep apnea (CPAP)
  • Morbid obesity (BMI 45–49.9)
  • Epilepsy
  • Electrolyte imbalances
  • Pacemaker presence
What Was Identified
  • Diagnoses were not listed and required full extraction and structuring
  • Comorbidities were not fully captured
  • Respiratory history was inconsistently documented
  • Oxygen use was not clearly reflected across the chart
  • Functional scoring did not fully reflect fall risk and endurance
  • Medication reconciliation gaps between referral and MAR
  • Advance directive documentation inconsistencies
  • Plan of Care did not fully reflect patient complexity
RN-Led Review Approach
  • Extracted and sequenced diagnoses from referral documentation
  • Established appropriate primary diagnosis
  • Ensured OASIS responses aligned with clinical documentation
  • Reviewed medication profile against referral
  • Strengthened Plan of Care alignment and skilled need
CASE STUDY 1 - Start of Care (SOC) CASE STUDY 1 - Start of Care (SOC)
How We Helped
Reviewer Insight & Outcome

As I worked through this chart, the biggest gap was not just missing diagnoses — it was how disconnected the documentation was across sections. Once everything was aligned, the patient’s full clinical picture became much clearer.

  • Diagnoses fully structured and supported
  • OASIS responses aligned with patient condition
  • Documentation consistent across the chart
  • Plan of Care better reflected complexity and needs
Complete Coding with Confidence from Day One

Turn incomplete referrals into fully coded, clinically aligned Start of Care documentation with RN-led review.

Complimentary Chart Review
CASE STUDY 2 - Resumption of Care (ROC)
Resumption of Care (ROC)

Post-Hospitalization Review & Alignment

Ensuring Accuracy Following a Change in Condition

What Was Identified
  • ROC timing did not align with hospitalization
  • Diagnosis profile incomplete
  • Code status unclear
  • Cognitive and respiratory documentation inconsistent
  • Functional scoring did not reflect SOB and fall risk
  • Duplicate/conflicting interventions
  • Medication discrepancies between discharge and MAR
  • Missing diabetic management intervention
RN-Led Review Approach
  • Corrected timing and diagnosis alignment
  • Ensured consistency across OASIS sections
  • Reconciled medications and identified risks
  • Cleaned up and strengthened interventions and goals
CASE STUDY 1 - Start of Care (SOC) CASE STUDY 1 - Start of Care (SOC)
How We Helped
Reviewer Insight & Outcome

This chart showed how quickly things can become misaligned after a hospitalization. Small inconsistencies across sections made it difficult to clearly understand the patient’s current status until everything was brought back into alignment.

  • Documentation aligned with post-hospital condition
  • Medication and Plan of Care consistency improved
  • Functional and clinical data more accurate
  • Compliance risks reduced
Bring Your ROC Back Into Alignment

Ensure post-hospital documentation, coding, and OASIS data accurately reflect the patient’s current condition with RN-led review.

Complimentary Chart Review
CASE STUDY 3 - RECERT
Recertification

Continuity of Care & Skilled Need Support

Strengthening Documentation for Ongoing Services

What Was Identified
  • Incomplete summary of prior certification period
  • Nursing and therapy not fully reflected
  • Medication changes unclear
  • Hospitalizations not clearly documented
  • Plan of Care did not fully support continued services
  • Goals and interventions misaligned
  • Functional status not trended
RN-Led Review Approach
  • Clarified prior episode progress
  • Updated Plan of Care and goals
  • Ensured all disciplines were reflected
  • Strengthened documentation supporting skilled need
CASE STUDY 1 - Start of Care (SOC) CASE STUDY 1 - Start of Care (SOC)
How We Helped
Reviewer Insight & Outcome

The biggest gap here was not the care itself — it was how the story of the care was documented. Once the timeline, changes, and interventions were clearly outlined, the need for continued services became much easier to support.

  • Documentation supported continued services
  • Interdisciplinary care clearly reflected
  • Plan of Care aligned with current condition
  • Risk of denial reduced
Don’t Let Weak Recert Documentation Cost You

Ensure your documentation tells the full story of care and supports continued skilled need with RN-led review.

Complimentary Chart Review
CASE STUDY 4 - DISCHARGE
Discharge (DC)

Ensuring OASIS & Outcome Accuracy

Reviewing Discharge Documentation for Consistency Across the Episode

What Was Identified
  • M2401 marked as N/A despite goals addressed at SOC
  • Medication status listed as “no issues” despite prior discrepancies
  • M2020 showed decline not clearly reflected
  • Functional mobility required adjustment (uneven surfaces)
  • Discharge did not fully reflect episode changes
RN-Led Review Approach
  • Updated OASIS items to reflect care provided
  • Reconciled medication status with DRR findings
  • Reviewed and adjusted functional scoring
  • Ensured consistency across episode documentation
CASE STUDY 1 - Start of Care (SOC) CASE STUDY 1 - Start of Care (SOC)
How We Helped
Reviewer Insight & Outcome

This review highlighted how easy it is for discharge documentation to miss important details from earlier in the episode. Small inconsistencies can change how the entire episode is interpreted if not corrected.

  • Discharge accurately reflected care provided
  • Medication issues properly documented
  • Changes from SOC to discharge clearly shown
  • Documentation consistent across the full episode
Kupono Solutions - Medical Billing Experts
What We Consistently Find

These are the patterns we see most often when reviewing charts across agencies. Left unaddressed, they can directly impact reimbursement, compliance, and audit risk.

  • ✓ Incomplete or unsupported diagnoses
  • ✓ OASIS responses not fully aligned with clinical documentation
  • ✓ Medication discrepancies and reconciliation gaps
  • ✓ Functional scoring inconsistencies
  • ✓ Plan of Care not fully supporting skilled need
  • ✓ Missing or unclear clinical justification
Discharge Documentation Telling the Wrong Story?

Align OASIS, medications, and functional outcomes with RN-led review to accurately represent patient progress.

Complimentary Chart Review