OASIS documentation isn’t just paperwork—it directly impacts reimbursement, compliance, and patient care. When it is delayed or inefficient, it creates a ripple effect across key processes: care plans are held up, coding and QA are pushed back, and billing cannot move forward. In contrast, a timely and efficient OASIS workflow keeps both clinical and operational processes aligned and running smoothly, while easing pressure on the entire team.

When OASIS is submitted on time, coding and QA can begin immediately, leading to the timely development of the Plan of Care—which is required before claims can be submitted. Delays at this stage don’t just affect operations; they can also slow down care delivery and disrupt the agency’s revenue cycle.

Here are some practical tips on how you can  speed up your OASIS documentation:

At the Clinician Level

1. Document During the Visit

Whenever possible, answer OASIS items in real time while assessing the patient. Waiting until later increases documentation time because you’ll need to recall details and re-analyze the visit. Focus on completing functional items (GGs, M-items tied to observation) while the patient is still in front of you.

2. Use a Consistent Assessment Flow

Jumping back and forth between sections slows you down and increases errors. Follow the same mental sequence every time (e.g., safety → function → wounds → meds). It builds a pattern over time, reducing decision fatigue and improving speed.

3. Pre-Review Referral Documents Before the Visit

Spend 5–10 minutes reviewing hospital notes, diagnoses, and medication lists before stepping into the home. You avoid stopping mid-assessment to clarify basics and can focus on validating information rather than discovering it.

4. Standardize Your Narrative Language

Instead of rewriting similar notes from scratch, build a set of commonly used phrases for frequent scenarios (e.g., mobility limitations, caregiver availability, homebound status). Keep wording compliant but structured—this reduces documentation time without sacrificing quality.

At the Agency Level

1. Standardize Documentation Templates and Language

Provide clinicians with approved structured templates and phrase libraries for narratives (e.g., homebound status, caregiver support, functional limitations). This reduces time spent thinking about wording and ensures consistency across clinicians and QA.

2. Use Pre-Set Responses for Common Diagnoses in OASIS

Develop a library of standardized, diagnosis-based reference responses for common conditions (e.g., CHF, COPD, diabetes, post-stroke) aligned with OASIS requirements.

Clinicians can quickly use these as a baseline for expected findings and then adjust based on the patient’s actual presentation. This improves speed, consistency, and accuracy while still allowing individualized documentation.

3. Provide a Standardized Compact Assessment Tool for Visits

Create a concise, structured assessment form clinicians can use during visits to quickly capture key OASIS-related data (e.g., functional status, wounds, meds, homebound status, safety risks). Keep it aligned with OASIS flow but simplified—not a duplicate of the full assessment.

Instead of relying on memory or navigating the EMR during the visit, clinicians have a clear reference of findings. This makes it significantly faster to complete OASIS documentation after the visit.

4. Use Dedicated Support Roles

Consider adding documentation assistants or scribes. QA staff can also help identify and resolve documentation gaps based on the patient’s condition and assessment findings before final submission.

This reduces QA returns and minimizes back-and-forth corrections with clinicians. This allows clinicians to focus more on assessment and clinical decision-making, and less on administrative rework.

Other more advanced tip:

Implement Pre-Visit Prep Support

Have intake or office staff preload key information (demographics, medications, referral diagnoses) before the visit. This way, clinicians can focus on validation and assessment instead of gathering baseline data during the visit.

Speeding up OASIS documentation isn’t about rushing—it’s about working smarter, standardizing processes, and removing unnecessary friction. When clinicians and agencies build efficient systems and prioritize timely completion, OASIS becomes less of a burden and more of a streamlined part of delivering quality patient care.

The post Practical Tips for Faster OASIS Documentation first appeared on Qavalo.

The new guidelines for documenting falls are among the most significant updates in OASIS‑E2, effective April 1, 2026. The updates are designed to make fall reporting more complete, accurate, and consistent, helping clinicians keep patients safe and improving quality reporting.

CMS recognized that the Falls with Major Injury (FMI) quality measure was underreporting events when relying solely on OASIS data. To address this, CMS finalized the OASIS‑E2 fall documentation updates, clarifying definitions of falls, injury severity, and counting rules. This ensures that the information recorded in J1800 and J1900 is accurate and consistent, creating a reliable foundation for CMS as it implements future updates to the FMI measure in the Home Health Quality Reporting Program (QRP).

Here is an overview of the key changes in OASIS‑E2 for falls:

1. Broader Definition of a Fall

Under OASIS‑E2, any event where a patient loses balance and hits the ground counts as a fall — even if it occurred outside the home or was caused by an external force, such as tripping over an object or being bumped by someone. All falls since the last Start of Care (SOC) or Resumption of Care (ROC) must be recorded.

2. Clearer Injury Categories

Falls are now classified by severity:

• Major injuries: Includes, but is not limited to, traumatic bone fractures, joint dislocations/subluxations, internal organ injuries, amputations, spinal cord injuries, head injuries, and crush injuries.
  
• Non-major injuries: Includes, but is not limited to, skin tears, abrasions, lacerations, superficial bruises, hematomas, and sprains; or any fall-related injury that causes the patient to complain of pain.

3. How to Document Falls in OASIS‑E2

• J1800: indicate if any falls occurred.
• J1900: record the total number of falls since SOC/ROC and the highest level of injury for each.
• If the patient has multiple injuries in a single fall, record the fall at the highest level of injury.
• Use a dash (“–”) only if no information is available after asking the patient or caregiver.
• Fractures confirmed to be pathological (rather than traumatic) should NOT be considered a major injury resulting from a fall.

Remember that every fall should be documented, including the injury level, and recorded accurately. The updated rules make it easier to identify patterns, prevent future falls, and keep patients safe.

Ensuring Accuracy in Fall Documentation

As clinicians adjust to the new OASIS‑E2, leverage your QA team to review assessments and confirm that all falls are documented, totals in J1900 match clinical events, and injury severity is coded correctly. Beyond falls, QA should also ensure that all OASIS‑E2 updates are properly applied, helping clinicians as they adapt to the new requirements while maintaining agency compliance throughout the transition.

Why This Matters

By updating fall documentation in OASIS‑E2, CMS ensures that home health agencies capture all relevant falls accurately and classify injuries consistently. This not only enhances patient safety tracking but also provides reliable data for the FMI quality measure and other quality reporting programs. Aligning documentation with the FMI measure helps agencies remain CMS-compliant, supports meaningful performance comparisons, and ensures that quality reporting reflects the true care patients receive.

Resources:
Home Health J1800 and J1900 Errata for the OASIS Guidance Manual
October 2025 CMS Quarterly OASIS Q&As with 3 Q&As specific to J1800 and J1900 coding guidance

Read more about preparing for the new OASIS-E2:
CMS Released Final OASIS-E2 Resources >
Getting Ready for OASIS-E2 Rollout on April 1 >

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Lately, there has been a noticeable increase in denials due to invalid Face-to-Face documentation, affecting several home health agencies and raising concerns across the industry. Many of these denials seem to involve cases that came through Community Referrals.

Let’s review the F2F requirements and applicable guidelines to clarify documentation expectations and ensure compliance moving forward.

Who Can Perform the Face-to-Face Encounter?

Here are some guidance and clarifications referencing Palmetto GBA

1. F2F Must Come from the Discharging Facility

Palmetto GBA has recently issued an important clarification stating:

“A Certifying Physician or a physician with privileges caring for a patient in an acute or post-acute care facility, from which the patient is directly admitted to home health, may conduct and sign the Face-to-Face Encounter.”

This means the F2F Encounter must be completed and signed by a provider from the facility that directly discharges the patient to home health. For instance, if a patient is admitted to a hospital, then transferred to a skilled nursing facility (SNF), and the SNF is the one discharging them to home health, the F2F must come from a provider at the SNF—not the hospital.

2. Non-Physician Practitioners May Perform F2F

Since the public health emergency around 2020 to present, certain non-physician providers have been allowed to conduct F2F Encounters and certify patients for home health. These include:
– Nurse Practitioners (NPs)
– Clinical Nurse Specialists (CNSs)
– Physician Assistants (PAs)

3. F2F by a Non-Certifying Community Provider Is Allowed—with Collaboration

Palmetto further clarified that:

“A community provider may perform the Face-to-Face Encounter, even if they are not the certifying provider. However, documentation must include evidence of collaboration, showing that the certifying provider collaborated with the individual who performed the F2F Encounter prior to certification.” Learn more >

In short, it is acceptable for a non-certifying provider to perform the F2F—as long as collaboration is clearly documented.

4. No Collaboration Needed Within the Same Practice

There is one key exception to the collaboration requirement:
“No evidence of collaboration is required if the certifying provider and the F2F provider belong to the same physician practice.”

So, if a nurse practitioner or another physician within the same practice as the certifying physician conducts the F2F Encounter, no additional documentation of collaboration is needed.

Key Requirements to Remember

• The Face-to-Face Encounter must occur within 90 days before or within 30 days after the Start of Care date.
  
• The encounter must relate to the primary diagnosis and Plan of Care that initiated home health services.
  
• Telehealth remains an option for conducting F2F Encounters through September 30, 2025. For telehealth to be valid:
  • The visit must include both audio and video components.
  • It must be conducted on a HIPAA-compliant platform.
  • The provider must clearly document the use of telehealth in the clinical record.

F2F documentation compliance with CMS requirements is critical for proper code assignment and claims affirmation. To support this, intake teams and coders must be well-versed in current F2F guidelines. A solid understanding of these requirements goes a long way in preventing denials and keeping the billing process smooth and efficient.

The post New Insights on Face-to-Face Requirements in Home Health first appeared on Qavalo.

In the April 2025 OASIS Q&As, CMS provided several clarifications to help agencies determine which patients require OASIS data collection. Let’s break them down in this article.

What Does “Regardless of Payer” Mean?

Many HHAs serve a wide range of patients—some covered by private insurance, others by community programs or self-pay, and some with no payer at all. The updated guidance clarifies that OASIS data collection and submission is required for all patients receiving skilled services, even if the care is not paid for by Medicare or Medicaid.

This includes patients whose care is:

• Paid by commercial insurance
• Funded by a charity or community waiver program
• Self-paid
• Provided without a payer

When Is OASIS Data Collection Required?

Based on the most recent CMS guidance, OASIS is required when:

• A Medicare-certified home health agency or a Medicaid provider (in states that follow Medicare’s Conditions of Participation) delivers more than one visit within a quality episode.
• The patient is receiving skilled services, as defined by Chapter 7 of the Medicare Benefit Policy Manual. (This manual is available on the CMS website).

When Is OASIS Data Collection Not Required?

OASIS is not required in the following situations:

• The patient is under the age of 18
• The patient is only receiving chore, housekeeping, or personal care services
• The patient is only receiving maternity services
• The HHA staff are contracted under a loaned employee agreement (e.g., with a pharmacy company) to provide services outside the scope of home health agency responsibilities

These exceptions were confirmed in the April 2025 CMS OASIS Quarterly Q&As and the November 2024 All-Payer Q&A document.

Preparing for July 1, 2025

As July 1 approaches, it is essential for HHAs to have a clear understanding of the updated OASIS requirements and accurately identify which patients require data collection. The all-payer mandate further emphasizes the need for OASIS compliance and reinforces the importance of maintaining high-quality, consistent care documentation across all payer types.

The post Which Patients are Subject to All-Payer OASIS Data Collection first appeared on Qavalo.

2024 Interim Performance Reports (IPRs) Now Available

The October 2024 Interim Performance Reports (IPRs) for the expanded Home Health Value-Based Purchasing (HHVBP) Model are now available on the iQIES system. This quarterly report offers crucial information for home health agencies, including:

• Cohort assignments
• Performance data for the past 12 months
• Interim Total Performance Score (TPS)

IPRs help agencies monitor and compare their performance against peers in the same cohort throughout the performance year.

Preparing for 2025 Updates

With about one month remaining in the year, HHAs still have time to enhance their 2024 scores while preparing for upcoming changes in 2025. Here’s what to keep in mind:

• Starts of Care (SOC) and Resumptions of Care (ROC): Assessments completed now will be influenced by the timing of patient discharges. If a patient is discharged in 2025, their outcome measures from the discharge OASIS will count toward 2025 performance hence, accurate and thorough assessments now are crucial.
  
• 2025 HHVBP Changes: The 2025 updates will incorporate GG items into the Discharge Function Score. If your agency has already started GG item training, you’re on track. If not, it is crucial to start immediately.
  
• Payment Adjustments: In 2025, claims for services rendered on a single date will be paid based on the updated Value-Based Purchasing rates. Payments will be adjusted according to your agency’s performance in 2023, with a positive or negative percentage applied to either increase or decrease the payment amount for those 2025 claims.

Upcoming Final 2024 Annual Performance Report (APR)

The Centers for Medicare & Medicaid Services (CMS) will soon release the Final Calendar Year (CY) 2024 Annual Performance Report (APR) which is crucial for planning and improving future HHVBP performance. This report will include:

• The Total Performance Score (TPS) for CY 2023
• The Adjusted Payment Percentage (APP), applied to all Medicare Fee-for-Service claims with dates through CY 2025

Utilize the reports provided by CMS to identify areas for improvement in your HHVBP performance score and take advantage of the payment incentives. It might take a while to reap that incentive but it is a worthy investment that goes beyond reimbursement but also positively impacts patient care and your overall business. Start educating your staff now, if you haven’t yet, especially on new assessment and documentation guidelines impacting HHVBP scores.

The post October 2024 IPRs Out Now; HHVBP Preparations for 2025 first appeared on Qavalo.

The home health Discharge OASIS plays a crucial role in agencies’ performance scores under Value-Based Purchasing and quality reporting (star ratings) programs, as well as in assessing the impact of patient care services on overall patient recovery.

Here are practical tips to ensure accuracy in your Discharge OASIS documentation:

1. Use OASIS “Follow-Up” to Clarify Changes
During the care episode, if a patient experiences significant changes in their condition—such as hospitalization or severe illness—be sure to accurately complete the OASIS Follow-Up to document these changes. This will create a clear narrative that highlights the impact of these significant changes on the patient’s outcomes and discharge status.

2. Document the Final Visit Thoroughly
On the final visit, assess the patient holistically. Be mindful of capturing every improvement or decline in functional abilities. Thorough documentation not only justifies the patient’s discharge status but can improve outcome measures like the improvement in ambulation or medication management, which are key for HHVBP adjustments.

3. Cross-Check Assessments With the latest OASIS Data
To ensure accuracy and consistency, review the patient’s latest OASIS data (SOC/ REC/ROC/Follow-up) and compare them with their discharge status. Any significant improvement or decline should be clinically supported. Inconsistencies between the patient status between the last OASIS assessment and discharge data can lead to audits and affect your HHVBP score negatively.

4. Ensure Accurate Reporting on Wounds and Infections
Pay close attention to the status of wounds and infections. Since wound care is a common trigger for rehospitalizations, the correct documentation of healing rates and infection status impacts both star ratings and HHVBP measures. Reassess all wounds to avoid discrepancies between the wound status at the start of the care episode and at discharge.

5. Encourage Real-Time OASIS Entry
Whenever possible, encourage clinicians to complete OASIS documentation in real-time rather than after the visit. This reduces the likelihood of errors or omissions. Real-time entry also provides a more accurate reflection of the patient’s status, impacting clinical outcomes measures and, subsequently, your agency’s HHVBP adjustments.

6. Ensure Accurate Functional Assessment
Beginning in 2025, the HHVBP will include a new Discharge Function Score, an OASIS-based outcome measure calculated from GG functional assessment items. This new HHVBP measure focuses on functional improvement at discharge. Scoring GG items accurately helps showcase progress in patient function. Be sure to record any improvements in self-care and mobility, but also document if the patient has maintained a higher functional status during the episode.

The GG items are graded on a scale that requires attention to small details. Ensure the staff understands the nuances between “helper needed” versus “independent” scoring levels. For example, a patient who requires assistance with setting up a task (GG0130A – Eating) is not the same as someone who requires active feeding assistance. Training staff to correctly identify these levels can prevent inaccuracies and boost overall performance on the Discharge Function measure.

Importance of Knowledge and Training

It is vital that clinicians and the QA teams are well-versed in the proper guidelines and standards for OASIS Discharge documentation. Accurate assessment is key to demonstrating patient improvement at discharge (if applicable) and maximizing performance scores on HHVBP and star ratings. Refresher training on discharge documentation can greatly help. A key topic to cover is proper GG item scoring, especially in preparation for the upcoming introduction of the new Discharge Function Score.

The post 6 Tips for Completing a Discharge OASIS first appeared on Qavalo.

M1700: Cognitive Functioning

M1700 assesses the patient’s cognitive functioning on the day of evaluation. This includes alertness, orientation, comprehension, concentration, and immediate memory for simple commands. When answering this item, clinicians should consider the following:

• Cognitive dysfunction observed during the visit.
• Cognitive behavior from the previous 24 hours.
• The level of supervision and care required due to cognitive deficits.

Patients assessed with Response 4 (Totally dependent due to disturbances like constant disorientation, coma, persistent vegetative state, or delirium) will trigger an exclusion from OASIS-based outcome quality measures. This reflects the severity of the cognitive deficits.

M1710: When Confused and M1720: When Anxious

M1710 assesses the specific times or situations when the patient experiences confusion, while M1720 focuses on the frequency of the patient’s anxiety over the last 14 days.

For both M1710 and M1720

• Clinicians should consider what they observe and what is reported by the patient or caregiver over the past 14 days, not just on the day of assessment.
• If a patient is non-responsive (i.e., unable to answer or provide a response that allows a clinical judgment), clinicians should still attempt to gather information from caregivers or medical records to make an informed assessment.
  
  Non-Responsive Patients:
  If a patient is non-responsive and no relevant information can be obtained from caregivers or medical records, the clinician should respond “NA.” Coding NA in M1710 or M1720 excludes the episode from OASIS-based outcome quality measures.

Understanding Non-Responsiveness

Non-responsive patients are those who cannot provide answers that allow clinicians to make an informed judgment about their orientation or anxiety levels. This does not include patients who are merely uncooperative or refuse to answer questions.
When a patient meets the criteria for non-responsiveness, agencies must code the items accordingly to avoid erroneous inclusion in quality measures. For instance, a patient in a persistent vegetative state or unresponsive in a way that inhibits clinical judgment would not be expected to improve and should be excluded from the outcome measures.

Avoiding Errors and Missed Opportunities

Agencies should be cautious not to exclude patients from quality measure calculations based on misunderstandings of the guidance or incorrect coding. Inaccurate OASIS assessment can lead to missed opportunities for quality improvement.

Properly assessing cognitive items ensures accurate data collection and optimal agency performance reporting. Since these cognitive items are often overlooked, re-education to ensure a clear understanding of their impact can offer significant benefits in quality measure outcomes.

Accurate assessment and coding of cognitive items—particularly M1700, M1710, and M1720—are essential for quality data collection and reporting. By educating clinicians on OASIS-E guidance, home health agencies can improve their reporting accuracy, better measure performance, and avoid missing opportunities for quality improvements.

The post OASIS Cognitive Items: Reviewing Guidelines and Their Impact first appeared on Qavalo.

The demand for home and community-based care will grow due to aging baby boomers, elderly preference to age at home, and healthcare cost reduction pressures. Despite growth opportunities, home healthcare providers will face headwinds in 2024, including a persistent labor shortage, heightened competition, reimbursement cuts, and regulatory requirements. Diversifying services and payers will help agencies gain more business, mitigate costs, and enhance patient satisfaction.

We have outlined the trends that are shaping the home health industry and revolutionizing patient care delivery and agency operations.

Demand for Home-Based Care

Driven by retiring baby boomers who prefer at-home care, the demand for home-based services is set to continue growing. By 2050, the elderly population is projected to surpass 80 million, with adults over 65 outnumbering those under 18. U.S. Home Health Care is expected to increase from $94.17 billion in 2022 to $153.19 billion by 2029.

Diversification of Services and Payers

The growing aging population’s preference for home-based care offers significant growth opportunities for home health agencies. Large Managed Care Organizations and Medicare Advantage (MA) plans, aligning with the shift to value-based care, drive agencies to diversify services. Physicians now feel more comfortable prescribing advanced services like mental health, respiratory care, wound care, cardiological conditions, and orthopedics for patients in their homes.

Emerging care delivery models like SNF at Home and Hospital at Home are gaining traction, prompting partnerships with acute care and skilled nursing facilities. This diversification of services will also help agencies maintain continuity of patient care and improve patient satisfaction.

Exploring the diversification of payers also helps agencies navigate regulatory and reimbursement challenges. As Medicare Advantage enrollment continues to rise, home health operators must prepare to capture more managed care business opportunities in 2024. In 2023, around 30.8 million people, or about 51% of eligible Medicare beneficiaries, were enrolled in an MA plan, reflecting a nearly 1 million increase from the previous year (Kaiser Family Foundation).

Other payment incentive models home health providers need to know in 2024:

• States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD)
• Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH)
• Guiding an Improved Dementia Experience (GUIDE)

Staffing Shortage

The ongoing healthcare staffing shortage will be an enduring challenge, exacerbated by the sharp increase in the elderly population from 35 million in 2000 to over 80 million in 2050. If current work and retirement patterns persist, there could be a significant drop in caregivers per elderly.

In addition to bolstering recruitment efforts, home health agencies should prioritize staff retention. One effective approach is to invest in technology and support solutions that can improve clinicians’ efficiency and overall work experience. For instance, implementing tech automation and documentation solutions can ease documentation burdens, fostering improved productivity, satisfaction, and care quality. At the same time, agencies must implement training programs for staff, focusing on technological proficiency and adapting to process changes. 

Consolidation and M&A Activity

Consolidation in the home health industry is an ongoing trend expected to persist in 2024, resulting in a reduction in the number of agencies. This trend intensifies competition within the sector. The primary drivers of this consolidation include the continual compliance and cost pressures on operators, increased private equity investment, and payers expanding their healthcare services by adding home health capabilities.

A notable example of payer interest in home health care is UnitedHealth Group (NYSE: UNH), which acquired one of the largest home health providers, LHC Group, for $5.4 billion in February 2023. The company is now pursuing another transaction to acquire Amedisys Inc.

Regulatory and Reimbursement Challenges

Home Health Care agencies will confront rising regulatory demands and reimbursement challenges. Decreased Medicare, Medicaid, and Managed Care reimbursements will compel agencies to navigate regulatory changes with limited labor resources. State and Federal labor and wage regulations will further strain costs and the agency’s bottom line. The implementation of Electronic Visit Verification (EVV) requirements for skilled home care services in 2024 will also introduce additional operational challenges for home health agencies.

Higher-acuity Patients

In 2024, the trend of caring for increasingly sicker, frailer, and medically complex patients is set to continue as more care moves to the home. Home-based higher-acuity care models, proven safe and effective during the pandemic, contribute to this shift.

According to the latest Home Health Chartbook from the Research Institute for Home Care, over 76% of home health users have three or more chronic conditions, nearly a quarter require assistance with two or more activities of daily living (ADLs), and over 37% have a serious mental illness (SMI).

Despite challenges, home healthcare agencies have numerous opportunities and will persist in growing as a crucial players in delivering care at home. To stay ahead, providers, regardless of size, must grasp effective approaches to navigate industry dynamics. Strategizing to maximize efficiency while upholding high-quality care is essential, especially amidst the transition to value-based care.

The post Industry Trends Shaping Home Health in 2024 first appeared on Qavalo.

The CY 2024 Home Health Final Payment Rule introduces a wave of changes, including updates on the comorbidity adjustments.

The final rule reads: “only those subgroups of diagnoses that represent more than 0.1 percent of periods of care and that have at least as high as the median resource use will receive a low comorbidity adjustment. This is based on the knowledge that the average number of comorbidities in the aggregate becomes the standard within that population for the purpose of payment. However, because we still expect HHAs to report all secondary diagnoses that affect care planning, there will be comorbidity subgroups included in the home health-specific list that do not meet the criteria to receive an adjustment.”

Low Comorbidity Adjustment Subgroups

In 2024, there will still be 22 Low Comorbidity Adjustment Subgroups, but significant changes are underway. Specifically, the following diagnoses will be removed from the low comorbidity adjustment subgroup. This implies that if any of these diagnoses are now listed as comorbidities in slots 2-25, you will no longer be eligible for a low comorbidity adjustment.

• Gastrointestinal 1 – Crohn’s, Ulcerative Colitis, and other Functional Intestinal Disorders
• Musculoskeletal 2 – Rheumatoid Arthritis
• Neoplasm 6 – Malignant neoplasms of the trachea, bronchus, lung, and mediastinum

Conversely, the following will be added to the low comorbidity adjustment subgroups:

• Neoplasms 17 – Secondary neoplasms of respiratory and GI systems
• Neurological 4 – Alzheimer’s disease and related dementias (including G30.9 Alzheimer’s disease, unspecified)
• Respiratory 10 – 2019 Novel Coronavirus (U07.1 COVID-19)

High Comorbidity Adjustment Interactions

For High Comorbidity Adjustment, 11 additional comorbidity group interactions will be added increasing the number from 91 (in 2023) to 102. Below are some examples of the newly added comorbidity group interactions.

A combination of these codes in positions 2-25 on the claim will result in a positive adjustment to the reimbursement value.

Comorbidity adjustments have a significant impact on your reimbursements, so make sure your coders are well aware of these changes and properly apply them accordingly as they assign codes.

The post Comorbidity Adjustment Changes in 2024 first appeared on Qavalo.

The 2024 Home Health Final Payment Rule, released on November 1, 2023, brings significant changes directly impacting the Value-Based Purchasing (VBP) model in 2025. We have summarized these changes and added some notes about their implications.

While VBP generally stays the same in 2024, maintaining the 2022 baseline, the changes will be brought about by the five outcome measures being replaced by three new ones. This shift will adjust the weight of individual items, affecting the Total Performance Scores (TPS). Importantly, the method for calculating HHCAHPS measures and their 6% contribution to the Total Performance Score remains unchanged.

1. The new Discharge Function Score (DFS) will replace the existing Total Normalized Composite Change in Self-Care and Total Normalized Composite Change in Mobility measures, which depend on the 1800 items on the OASIS.
   
   This new Discharge Function Score measure will be solely based on GG0130 and GG0170 items. Specifically, only Eating, Oral Hygiene, and Toileting Hygiene from GG0130 will be used in calculating this score.
   
   The Discharge Function Score based on GG items, uses patient info from the Start of Care or Resumption of Care OASIS in a new CMS algorithm. This algorithm predicts the expected discharge status based on the documented patient status during SOC or ROC.  If the agency’s reported discharge status matches or exceeds the algorithm’s calculation after submitting the Discharge OASIS, it leads to a positive measure outcome.
   
   
2. A new Discharge to Community-Post Acute Care (DTC-PAC) measure, which will then utilize claims data, will replace the current OASIS-based Discharge to Community (DTC) measure.
   
   This change impacts Value-Based Purchasing calculations, with the new measure using a 2-year data span instead of 12 months.
   
3. A new single Potentially Preventable Hospitalization (PPH) measure will consolidate the existing Acute Care Hospitalization (ACH) and Emergency Department (ED) measures. The PPH, combined with the Discharge to Community-Post Acute Care Measure, will constitute the claims data for the VBP model.
   
   Keep in mind that the PPH measure incorporates Observation stays. Consequently, if a patient under Home Health care undergoes an Acute Care Hospitalization or Observation stay, it will adversely affect the measure outcome.
   
4. Both the Improvement in Dyspnea and Improvement in Management of Oral Medications measures will continue to be included in the model, but there will be a slight adjustment to their weight impact on the overall TPS.

Preparing for the Changes

The changes to the Value-Based Purchasing model pose a challenge and require staff education by 2025, particularly focusing on GG items. This is crucial for sustaining success in the VBP mode considering the newly introduced measures. Nationwide data indicates a lack of sufficient education for GG items in the OASIS compared to ADLs in the M1800 section.

Home health agencies should ensure that their staff receives sufficient education as early as possible. In addition, utilize QA audits to help ensure accurate responses to GG items and support continuous learning for clinicians.

The post [CY 2024 Final Rule] Upcoming Changes to HHVBP first appeared on Qavalo.