*In the interest of client confidentiality, the agency name was changed for this case study. Using efficient coding and OASIS documentation solutions, Endeavor Home Care optimized its reimbursement levels and improved the performance of its clinicians with the help of Qavalo. Qavalo’s expert coders were… Read More »How Proactive Coding and a Comprehensive OASIS QA Program Can Help Optimize Reimbursements
Medical Necessity: A Top Reason for Denials During the first quarter of 2021, the top five reasons for denials identified by Medicare Administrative Contractors revolve around inadequate medical necessity documentation. This can also be linked to a related data from Q1 of 2020 identifying 32%… Read More »Medical Necessity Documentation 101
The Centers for Medicare & Medicaid Services (CMS) recently released the 2022 home health final payment rule. The highlight of which is how agencies nationwide will soon be subject to the Home Health Value-Based Purchasing (HHVBP) Model, which is recognized as one of the most… Read More »In Summary: 2022 Home Health Final Rule
QAPI: What is it and why is it important? As the pressure to transition towards value-based care increases, home health agencies must implement an effective Quality Assurance and Performance Improvement (QAPI) program to improve patient care and documentation, and maintain compliance with the Conditions of… Read More »How to Build an Effective QAPI Program
The Centers for Medicare & Medicaid Services (CMS) just released their Q3 OASIS Q&As, providing more insights and guidance on OASIS documentation. The new set of Q&As sheds light on answering OASIS items on confusing and complex scenarios. Questions included were received directly by CMS… Read More »Q3 2021 OASIS Q&As: More OASIS Documentation Guidance
The Centers for Medicare & Medicaid Services (CMS) announced that the Targeted Probe & Educate (TPE) program has resumed after being suspended in March 2020 due to the COVID-19 public health emergency. Although some medical reviews resumed in August 2020, the TPE program remained on… Read More »TPE Is Back: Here’s What You Need to Know
For a time, the Centers for Medicare & Medicaid Services (CMS) suspended certain surveys and routine inspections, and temporarily froze survey data in 2020 in response to the COVID-19 pandemic. Along with this pause was the prioritization of infection control and immediate jeopardy situations… Read More »[Part 1] Is Your Agency Survey-Ready? Reviewing Common Deficiencies on the CoPs
A Rising Demand for Medicare Programs By 2030, the entire baby-boom generation will have reached the age of eligibility for Medicare, hence the rapid acceleration in enrollment from 62 million (in 2020) to 78 million. This increased enrollment will also trigger an increase in… Read More »Business Growth Potential in Medicare and Home Health
The Centers for Medicare & Medicaid Services (CMS) just recently released their Q2 OASIS Q&As providing insights into the latest updates on OASIS documentation. The new set of Q&As provides important guidance specifically on updating the OASIS within (or after) the 5-day Request for… Read More »Q2 OASIS Q&As: New Guidance on GG Items
While there is currently an alarming shortage of nursing professionals in the US, another looming crisis, this time in the pool of direct care workers, stands to hurt the entire healthcare ecosystem, including home health care, if left unchecked. Direct care workers refers to… Read More »Shortage in Direct Care Workers: How Home Health Agencies Can Help
