I had been approached by a previous employer in HH to change my documentation because an episode had been denied payment by CMS. It was an unplanned discharge (was supposed to be a routine supervisory visit) due to the patient no longer being homebound. (Franky, they probably never were to begin with but I didn't admit them so I can't say). I got "talked to" for discharging them and causing a LUPA, and was also asked to change, "Patient reports she has been driving and is able to leave home without difficulty." I refused. Which, to me, never having seen the patient before was covering my own butt as for why I was discharging them. I am glad I charted it because I would not have remembered accurately the situation if I hadn't, and if it came into question later (which it did) I would not have remembered why I discharged them. Know what I mean?
Anyway, I also worked for a different agency who insisted that I not lock my OASIS until billing had a chance to review it. I also refused to do this, and it became a sticking point so I quit that job too. Leaving my OASIS unlocked in the computer I saw as akin to completing and signing a paper OASIS in pencil, making it impossible to tell if changes were made and by whom. The stupid thing is there was a way for anyone, billers included, to unlock it and make whatever changes they needed to make and lock it again, and leave an electronic trail of this activity. Not so if I didn't lock it in the first place. Also, I did find my OASIS answers changed which proves my point. I tried to report this to CMS as possible fraud activity but the fools at CMS said, "Unless you have actual evidence of fraud, we're not able to investigate." Well, where is the evidence if there is no paper trail/electronic trail of changes made? Pretty fishy stuff.
For my most recent HH job which I quit. I was asked to fix my charting on 80% of my visits. Now, don't get me wrong, I am not perfect, but I know HH and had been doing it for several years and know exactly what I am doing and what CMS requires. But, they insisted I update and use key words in every single entry. Not fraudulent, because really it is a silly matter of interpretation and I obliged them. But still, it took 10 hours of unpaid time for me to do so.
As for which ICD-9 codes were appropriate to assign to the case, I don't give a rip what the billers/coders chose. Not my job, not my problem. My documentation shows the diagnoses and if CMS has issues with the codes chosen by billing they can take it up with the coders. In that department I totally understand that certain case mixes get reimbursed a higher rate and if they can swing it based on the assessment info I provide, go for it, it's how the ridiculous system works and you have to play the game to stay in the race. Just don't expect me to care which Dx gets more money!