Medicare University – Webinar / Training Opportunities

Ordering & Certifying Medicare Home Health Services

Provider Outreach and Education will be hosting a webinar on the clinical documentation requirements of the referring and community physicians, as well as home health agency clinicians. This informational session will highlight the importance of collaboration of the documentation of the referring/ordering physician, the home health agency and the community physician monitoring the plan of care. Certification and re-certification of the five home health eligibility criteria will be outlined in detail, CMS resources delivered and a question and answer period will be available at the end of the session.

Login & register…

CMS Changes in Regulations and Reimbursements

Discharge Planning
CMS has proposed to revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals and home health agencies, must meet in order to participate in the Medicare and Medicaid programs. It would also implement the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).

As called for in the IMPACT Act, these facilities and providers would be required to develop a discharge plan based on the goals, preferences and needs of each applicable patient.


2016 Home Health Payment Changes
In a final ruling issued Thursday, CMS announced changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2016. CMS projects that Medicare payments to home health agencies in CY 2016 will be reduced by 1.4 percent, or $260 million.


Home Health Value-based Purchasing (HHVBP) Model
Also included in Thursday’s final rule was an update on the HHVBP model proposed in July. Beginning January 1, 2016, CMS will implement the HHVBP model among all home health agencies in nine states. All Medicare-certified home health agencies that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee will compete on value in the HHVBP model, where payment is tied to quality performance.


New Rules for Change Request 9189

Effective 8-11-15 CMS (Center for Medicare and Medicaid) recently released new rules for a 60 day comment period (Change Request 9189) that requires more narrative with a defined timeline for home health services when a physician certifies and/or re-certifies for home health services.   See the link to transmittal 602……….. click here.


Why Medicare ACOs have yet to generate savings


by Heather Caspi                                                                                                                                                                       September 16, 2015

Dive Brief:

  • Medicare’s ACO experiment, in which it incents providers and hospitals to work together to improve efficiency and patient outcomes, has yet to save the government money. In fact, the ACO program cost Medicare money last year.
  • During 2014, 196 ACOs generated savings while 157 ACOs cost more than predicted. After paying bonuses to 97 ACOs and receiving payment for losses from just three, the ACO program saw a net loss of almost $3 million to the Medicare trust fund.
  • Medicare projections in 2011 expected the program to save $10 million to $320 million during 2014.

Dive Insight:

CMS is optimistic savings will be realized in time as ACOs gain experience to improve performance.

“In the long run we’re shooting to achieve those goals,” CMS Deputy Administrator Sean Cavanaugh told Kaiser Health News.

Much of the difficulty is tied to risk aversion, with just 7% of ACOs opting in 2014 to take on deals involving financial risk for the opportunity higher rewards. As a result, the government is allowing ACOs to participate without risk for up to six years rather than phasing out the option.

The strong risk aversion leaves Medicare in a bind, Kaiser Health News reports, because if risk is mandatory, too few ACOs may participate. However, without risk, ACOs have little incentive to improve.

Recommended Reading

Kaiser Health News: Medicare yet to save money through heralded medical payment model

Medicare Training Available

Medicare University is offering many new courses…

Join now to learn about Ordering Home Health Services for a Medicare Beneficiary / Patient.

This webinar is designed specifically to meet the needs of every entity that may order or monitor home health services, (hospitals, SNFs, rehabilitation centers, Part B physicians) in Jurisdictions 6 and K. Staff members that should attend this educational session include those who order home health services, monitor home health care, develop or assist in development of the home health plan of care, develop, review or document home health face-to-face encounter documentation, evaluate or audit home health documentation for accuracy and physicians or any other staff that is involved with documentation in the Medicare patient medical record.

Register online by clicking the desired date / link…   Sessions are 12:30 – 2 pm EST.

Check out their course list at

NLRB rules that companies are responsible for violations by contractors…

Per HealthcareDive


Newsflash for Certified Home Health Agencies

Beginning on April 1, 2015, Medicare systems will compare the Health Insurance Prospective Payment System (HIPPS) code on a Medicare home health claim to the HIPPS code generated by the corresponding Outcomes and Assessment Information Set (OASIS) assessment before the claim is paid. If the HIPPS code from the OASIS assessment differs, Medicare will use the OASIS-calculated HIPPS code for payment. At this time, if no corresponding OASIS assessment is found the claim will process normally.

Click here – 2015 0209 SE1504 – for more information.

Accurately Assessing Pressure Ulcers

A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear (

Pressure ulcers are costly, painful and are often perceived as the result of poor quality care.  The Center for Medicare and Medicaid Services has included pressure ulcer risk assessment and implementation of prevention protocols in the OASIS-C. Home health agencies that fail to identify patients at risk are missing an important step to preventing pressure ulcers that occur under the care of the agency.

Tools for Outcome Measurements

Pressure ulcer prevention begins with risk assessment.  In the  OASIS-C item M1302, The Center for Medicare and Medicaid (CMS)  asks that patients be identified with or without a formal pressure ulcer screening tool. Agencies should choose a validated pressure ulcer screening tool. The Braden Scale (Bergquis & Frantz, 2001) has been validated with home care populations, but it is not the only validated tool available. The Norton and the Waterlow Scale are also good alternatives. What is more important is accuracy and consistency in use. This can only be accomplished through staff education.

Once the risk assessment is completed, implementation of  pressure ulcer prevention measures should be based on the information obtained. The Braden Scale has a set of measures correlated to the risk identified ( Many clinicians use the overall Braden score as a starting point for deciding risk. However, when sub-scale scores such as mobility, incontinence or shearing are triggered, it is just as important to address these with appropriate prevention measures.

Several factors impact pressure ulcer prevention in the home. Taking these factors into prevention planning will improve an agency’s ability to avoid pressure ulcers in their patients.

Accurately Assessing Pressure Ulcers

What is Team Building?

What could your team achieve if it were moving in complete coordination rather than as many individual, moving parts? Staff retention would increase, management could be freed up to focus on company growth, and communication would become seamless. Sound impossible? It isn’t with a well-coordinated team behind you.

We provide this future for healthcare companies across the U.S. with experiential team building strategies that are proving to be immensely successful. As teams become more productive and efficient, patient outcomes improve, revenue grows, and your reputation as a great healthcare provider spreads throughout your community.

NEWSFLASH for Certified Home Health Agencies

The fact that CMS has announced the 2014 homecare rates which represents a cost reduction has the home care industry buzzing. This and the newly expected ICD-10 codes are enough to send any executive into a panic, however home care executives now have another worry. CMS is now expecting that all surveyors investigate agencies with new rules of interpretation using the current Federal Condition of Participation.

If you own or operate a certified home health agency you are now at risk of more strict surveys that investigate patterns within certain conditions of participation can lead to condition level deficiencies. With a condition level deficiency a provider is at risk of losing the Medicare provider number.  Once a condition level deficiency is cited you have 45-90 days to clear it. For instance; if you have had issues with having the physicians sign the plan of care within the required time frame of your state, issues with missed visits, and any other issues regarding the plan of care including the therapists participating; all of these citations fall within the plan of care section of 484.18 and you are now at risk of receiving a condition level deficiency. The new interpretation looks for a specific pattern in section 484.18. There are other specific patterns for Patient Rights (484.10), compliance with Federal, State, and local laws (484.12) etc.

If you are an accredited organization you usually pay several thousand dollars (depending upon the agency’s census) for the site visit, as well as travel with some accreditation companies.  You will also have to pay for the return site visit within 45-90 days plus you now risk losing your business.

Wouldn’t it be worth it to have an expert at your side? No loss of business, no worries. Call for a free 30 minute consultation 800-530-3789 extension 1. Ask for Michelle.