In the CY 2026 Home Health Prospective Payment Final Rule, CMS finalized updates to the Patient-Driven Groupings Model (PDGM) that recalibrate how comorbid conditions influence payment adjustments. These updates reflect CMS’s ongoing effort to better align Medicare payments with actual patient care needs using the… Read More »2026 Updated Comorbidity Subgroups and Interactions
As 2026 begins, home health agencies should keep an eye on several updates that could affect payments, documentation, and compliance. We have listed the updates we believe will matter most to agencies and have a direct impact on day-to-day operations. Staying informed will help agencies… Read More »Recap of Home Health Updates to Watch for 2026
The U.S. Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Home Health Final Payment Rule on November 28. We have summarized the key changes home health agencies should be ready for in 2026. Medicare Payment Update CMS projects that Medicare aggregate payments… Read More »Key Updates from the CY 2026 Home Health Final Rule
With the implementation of the FY 2026 ICD‑10‑CM updates effective October 1, 2025, a new diagnosis code has been introduced: Type 2 Diabetes Mellitus without complications, in remission (E11.A). This code was created to reflect an increasingly common clinical scenario: patients who previously had type 2 diabetes but no… Read More »Guidelines for Documenting and Coding Diabetes in Remission in Home Health
Quality Assurance (QA) review for the OASIS is essential to ensure accuracy, compliance, and optimal reimbursement in home health. However, without the right strategy in place, QA reviews can become time-consuming, inconsistent, and burdensome for clinicians. By implementing best practices, the review process can be… Read More »Best Practices for Efficient OASIS QA Review Program
In home health, accurate diagnosis coding is critical—not only for compliance but also for ensuring agencies receive appropriate reimbursement. Even experienced coders sometimes miss nuances that can impact revenue. Being mindful of these commonly overlooked areas can help capture the full clinical picture and optimize… Read More »Common Coding Mistakes That Can Affect Reimbursements
When a patient returns to Home Health services after an inpatient stay, the OASIS Resumption of Care (ROC) is crucial for ensuring accurate continuity of care and maintaining compliance. Beyond simply updating patient status, the ROC reflects your agency’s quality performance and directly impacts reimbursement. … Read More »8 Key Pointers for Completing an ROC OASIS
The Recertification OASIS is one of the most critical assessments in Home Health—yet it’s also one of the most error-prone. Many clinicians treat it as a simple continuation of care, which often leads to copying prior data, failing to update diagnoses, or overlooking subtle functional… Read More »7 Tips for Completing a Recert OASIS
The Transfer OASIS may be shorter than other timepoints, but it plays a critical role for compliance, continuity of care, and quality reporting. Errors in the Transfer OASIS can cause confusion when the patient returns to home health, distort outcome measures, and raise concerns during… Read More »9 Tips for Completing a Transfer OASIS
For home health coders, the real challenge is not understanding coding rules—it is applying them strategically to balance compliance and reimbursement under PDGM. While primary diagnoses capture the main reason for care, secondary diagnoses play a vital role in reflecting the full clinical picture of… Read More »Coding Secondary Diagnoses and Maximizing Comorbidity Adjustment in Home Health
