Respiratory Capture is Being Audited: What Are the Denials Telling Us?

Seeing an uptick in respiratory denials is frustrating, but let's clear up a common misconception: auditors are not arguing against the use of respiratory modalities. In fact, Dynamic Respiratory Services encounters patients every day who meet the same clinical criteria yet experience different audit outcomes based solely on documentation.

Auditors are focused on ensuring proper assessments, documentation, and care planning to justify respiratory therapy, which ultimately aims to incentivize better patient outcomes.

So, where does your facility stand? First, define your respiratory capture outlook:

• Resistant: Those uninterested in respiratory capture, lacking the resources or interest to implement proper protocols.
• Struggling: Despite their best efforts, these centers face challenges due to inadequate training or systems.
• Compliant: These facilities consistently meet standards with thorough documentation and robust processes.
• Superficial: Facilities that meet the bare minimum, checking off tasks without ensuring quality or effectiveness. Think of those that have orders that just say "Deliver respiratory therapy for 15 minutes" and simply check it off after delivery (we now know these are not going to hold up).

Most centers fall between being resistant and struggling or struggling and compliant. If you're only superficially meeting requirements, consider this a wake-up call to add structure to your program. For those who already cross their T's and dot their I's, make minor adjustments to further reduce audit risks.

And if your facility is resistant or continues to struggle, now is the perfect time to step up. Audits are validating the importance of respiratory therapy, with more captures being approved than denied. Embrace this opportunity to improve both patient outcomes and your bottom line.

As more payers adopt the PDPM grouper, accurately capturing respiratory therapy is crucial to avoid losing out on reimbursement and reducing readmissions in a meaningful way. Remember, auditors are there to ensure that facilities maintain legitimate standards through proper assessments, documentation, and care planning.

While audits might bring short-term challenges like clawbacks or lost opportunities, they pave the way for long-term benefits by establishing compliance standards and effective practices.

Oh, and I almost forgot. Make sure you have your nurses do their competencies!

Need assistance? Discover how DynamicRT can provide a consistent, cost-effective framework for running a successful respiratory program and capturing RT. Get in touch today! Learn more at DynamicResp.com.

- Greg