The Centers for Medicare & Medicaid Services made updates to the functional-level points thresholds in the CY 2022 final rule. CY 2020 claims data were used to update the functional points and functional impairment levels by the clinical group. The update includes decreasing points on… Read More »Heads Up: New Changes in the Functional Level Scoring
The CY 2022 home health final payment rule implements important changes in PDGM calculations. Among these changes is the expansion of the comorbidity groups. Nine (9) new subgroups were added to the Low Comorbidity category, while three (3) existing ones were removed, for a total… Read More »Be Updated: New CY 2022 Comorbidity Subgroups
*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
How Staffing Remains to Be a Challenge Results from a recent online survey on home health staffing that was conducted between July 21 and August 6, 2021 have been released. When the year started, staffing was identified as the top challenge for home health according… Read More »Key Takeaways: Home Health Staffing Survey 2021
The Importance of Documentation Needless to say, clinical documentation is vital for a number of reasons. It is used to communicate a patient’s medical background to staff, provides evidence of positive outcomes, quality care, and improvement, and determines agencies’ reimbursement claims. Documentation also protects both… Read More »Do You Understand the Documentation Needs of Your Clinicians?
