#Home Health Qapi Program

[elijahwilliampost]

ICD-10 coding and clinical documentation review

Amity Healthcare Group is offering a variety of options for home health organizations to outsource ICD-10 coding and clinical documentation review. Whether you are looking for ICD-10 coding support, OASIS review, or an episodic documentation review, our clinical professionals will be able to support your needs.

Outsourcing ICD-10 coding and clinical documentation review enables an organization to allocate more energy and attention to patient care. The guidelines governing ICD-10 coding, sequencing, and OASIS responses are complex and demand high levels of accuracy. Trained experts can identify errors, ensuring ongoing accuracy and compliance. Accurate coding and compliant clinical documentation that clearly reflect patients' medical necessity are crucial for maintaining regulatory compliance and the financial health of the organization. Entrusting coding and clinical documentation review to clinical professionals is one of the most effective strategies to strengthen documentation from regulatory, payment, and legal perspectives.

Visit to website - Home Health Coding Companies

Phone – 303-690-2749

ig@amityhealthcaregroup.com

[hislop3]

Wednesday Feature: Navigating the Evolving Landscape - Enhancing Ethics and Compliance Programs for Risk Mitigation

Happy Hump Day! Long title for what is going to be, a rather brief post.  As followers and regular readers know, my firm (I am the co-founder and part owner) H2 Healthcare, LLC has a practice area uniquely concentrated on clinical compliance and complex litigation support.  The practice area is headed by Diane Hislop, RN (yes, we are related – married). Within our organization, we have over 100…

[trilogyqualityassurance]

Interim Clinical Management Services Home Health and Hospice

Staffing transitions, regulatory updates, and rapid growth can leave home health and hospice agencies vulnerable—especially when it comes to clinical oversight. That’s why Trilogy Quality Assurance offers specialized Interim Clinical Management Services Home Health and Hospice providers can depend on. Our team steps in seamlessly to provide experienced leadership, ensure continuity of care, and support compliance, documentation, and operational goals.

The Need for Interim Clinical Management in Today’s Landscape

Whether you're facing sudden leadership vacancies, expanding operations, or preparing for surveys, having qualified interim clinical management can be the difference between stability and chaos. At Trilogy Quality Assurance, we provide seasoned professionals ready to support your agency without disruption.

Our Interim Clinical Management Services Home Health and Hospice offerings are tailored to your organization’s unique needs. From acting directors of nursing (DONs) and clinical supervisors to QAPI leaders, we ensure your clinical operations stay compliant and efficient during transitional periods.

What Our Interim Services Include:

Leadership & Oversight: We provide temporary clinical leaders who guide teams, ensure protocol adherence, and manage documentation quality.

Compliance & Survey Readiness: Our experts prepare your agency for Medicare, state, and accreditation surveys with thorough reviews and compliance strategies.

QAPI Program Support: We help evaluate and improve Quality Assurance and Performance Improvement programs to meet evolving standards.

Documentation Review: Interim managers oversee clinical documentation, helping staff align care notes with coding and Home Health and Hospice billing best practices.

Connecting Clinical Oversight with Billing Accuracy

Strong clinical management doesn’t just impact care—it also plays a crucial role in financial performance. Inaccurate or incomplete documentation can disrupt Home Health and Hospice billing, delay reimbursements, and trigger denials. Our interim managers work hand-in-hand with your billing and coding teams to ensure clinical records support proper coding and compliance.

By reinforcing strong documentation practices, we protect your revenue and streamline the billing process—something many agencies struggle with during times of leadership transition.

Why Trilogy Quality Assurance?

We’re not a staffing agency—we’re a team of healthcare operations professionals with decades of combined experience in post-acute care. Our Interim Clinical Management Services Home Health and Hospice solutions are provided by licensed RNs, compliance specialists, and former agency leaders who know the demands of real-world agency operations.

Trilogy’s interim managers integrate smoothly into your team, maintaining your agency’s standards while implementing improvements in workflows, training, and regulatory alignment. We focus not just on managing, but on optimizing and stabilizing your clinical operations for long-term success.

Secure Clinical Stability with Proven Experts

Whether it’s a short-term vacancy or long-term transition, Trilogy Quality Assurance is here to ensure your agency stays compliant, efficient, and profitable. Trust our Interim Clinical Management Services Home Health and Hospice professionals to provide the leadership and support you need—when you need it most.

👉 Discover more at https://trilogyqualityassurance.com

[conferencepanel]

One of the key components of QAPI programs is data collection and analysis. Agencies must collect data on a variety of quality measures, such as patient outcomes, staff competency, and infection rates. This data is then analyzed to identify areas for improvement and track progress over time. By continually monitoring and analyzing data, agencies can identify problems and implement solutions to improve patient care.

Update yourself from QAPI Programs for Home Health webinar at Conferencepanel.com

[symposiumgo]

Why CMS Updates Are Important? Learn The Latest Changes Made In CoP Standards?

The Centers for Medicare and Medicaid updates for the new CoP standards which will come into effect in January of 2019.  

Recently, there were numerous updates made by CMS in the healthcare industry. The Medicare program has updated and eliminated various reforms for a better patient care atmosphere in a hospital. Consequently, Conditions of Participation (CoP) has also been updated by CMS.  The published finalized plan for the CY 2019-20 was in the limelight as Centers for Medicare and Medicaid reformed several CoP standards and regulations.

Why the CoP updates are important in healthcare?

In order to receive financial backing from the Medicare and Medicaid programs, the healthcare organizations must follow and include themselves in the CoP standards. The hospital and other associations are requisite to be in compliance with CMS and for that it mandatory for them to meet the CoP requirements.  

Cop Background

CoP was first established from the consideration that various hospitals and healthcare organizations were out of reach of the Joint Commission accredited program. Therefore the Medicare legislation created a program under the federal law where hospitals and other healthcare providers can volunteer consequently. This was done to include those facilities which were still deprived of the benefits of the Medicare program.

The OCR initiates to publish the updated CoP in the federal register and then CMS publishes it in the interpretive guidelines. These changes are made in respect to the Hospital Improvement Rule, plans of care and staff policy changes by the CMS.

Conditions of Participation (CoP) standards are chiefly the rules within which an entity is governed for participating in the activities of the Medicare and Medicaid program. CoP standards are first published in the federal register, and then CMS publishes the interpretive guidelines. CMS updates CoP a few times a year regarding various alterations in surveys and certification memos. The updates are mandatory to be followed by all the nurse practitioners and other medical staff of every organization.

Over the revision, CoP has updated various steps and margins within which a registered nurse can act. The new standards also determine the detailed contributions of the nursing staff in patient care. CMS has changed the way nurses interact with the patients and it has also impacted the patient-nurse relationship profoundly.

Recent updates by CMS

The new changes in the CoP are currently affecting more than 13,000 home health agencies (HHA) under the Medicare program. If the healthcare agencies want to get reimbursed for treating Medicaid and Medicare patients, then they must consider and comprehend the new changes stated below:-

1- Updates in the facilities accredited by the Joint Commission, Health Care Facility Accreditation Program, CIHQ, and DNV Healthcare.

2- CMS has also issued the revised memos related to privacy and confidentiality, humidity, insulin pen, and practice memo.

3- Various changes have also been made to IV medications, safe injection practices, restraint reporting, soft wrist restraints as well as standing reports.

4- The proposed changes also include discharge planning, infection control worksheet, and the final worksheet on QAPI.

5- The modernized lists illustrate that Quality Assessment and Performance Improvement (QAPI) must create and follow system to plan, assess, scrutinize and regularly report the outcome data.

6- The biggest change made was in regards with the significance of updating the care plan assessment system. Earlier, the nurse practitioners would only consult the physicians and then modify the documents. But after the 2019 updates by CMS, it is a mandatory step for hospitals to update the patients’ records and the documents, whether good or bad, regularly and systematically.

The Outdated and Updated changes in Condition of Participations

1. Bulging out exhausted systems

The last time CMS updated the guidelines of CoP was more than 30 years ago. It was a much-awaited change in the healthcare industry; the reason being an exalting increase in the percentage of patients' receiving home healthcare. Therefore, the changes in the policies and regulations were implemented to serve patients with the latest medical care plan requirements and to eliminate the used-up policies from the hospital environment.

2. Incompetent use of paper-based HHA system

CMS has made it impractical today to use the paper-based system in the hospitals which were being incessantly used from the last 30 years. The efficient use of electronic health record (EHR) in the organization will be beneficial for the Nurse Practitioners together with the members of the interdisciplinary care team.

The updated alterations by CoP will help the practitioners to document, allocate, and capture the assessment information of the patients as well as the relevant drugs.

3. Need for refinement in the Patient Driven Groupings Model (PDGM)

PGDM is not new in the industry but a reformed model of Home Health Groupings Model (HHGS) which was proposed and then dropped by CMS in 2017. The latest proposed model is subjected to cut down and halves the 60-day unit program to a 30-day program which is a remarkable change made by CMS.

The object behind it was to curb the cost of care and amplify the value of care.  The Medicare program has reformed interpretive guidelines for CoP by making significant changes in the model.

4. Required removal of two Outcomes and Assessment Information Set (OASIS) based measures

The program has decided to remove “influenza Immunization Received for Current Flu Season” measure and the “Pneumococcal Polysaccharide Vaccine Ever Received” measure from the Home Health Value-Based Purchasing Model.

5. Inadequate nurse staff

The main agenda behind updating cop standards besides serving patients was to ease up the burden of nurse practitioners and other medical practitioners through organized and efficient regulatory rules. A new study revealed that the shortage in nurse staffing has directly increased the patient mortality rate by 7%.  Therefore, it has been estimated that by 2020, there will be increased by 80% to balance the nurse-patient ratio.

To summarize it all, the latest updates are vital for the medical practitioners as well as the related hospitals to meticulously follow and inculcate the latest CoP standards to be in compliance with the Medicare program and HIPAA.

At SymposiumGo, we cover various other topics on healthcare and also provide webinars on the subject matter. Our webinars are conducted by eminent Healthcare Speakers of the industry with decades of experience in their respective fields.

[toddpatterson9]

QAPI: How to Set the Standards for Success

Since Nov. 28, 2016, nursing homes have been required to have their quality assessment and assurance (QAA) committee’s role as the quality assurance and performance improvement (QAPI) committee established and documented, points out Carmen Woodward, RN, a QAPI specialist with Columbia, MO-based Primaris. Note: For more information, see the new interpretive guidance for F868 (QAA Committee) in the advance copy of the revised Appendix PP, “Guidance to Surveyors of Long-term Care Facilities,” in the State Operations Manual.

  “Currently, as of Nov. 28, 2017, providers are also required to have a written QAPI plan, with full implementation, including a performance improvement project (PIP), by Nov. 28, 2019,” says Woodward. However, industry sources have suggested the possibility that these dates could be postponed. Nursing homes should watch for information on these deadlines and the final ruling from the Centers for Medicare and Medicaid Services (CMS).

  Whether or not providers are granted an implementation delay, QAPI is coming—and it’s an overall positive for nursing homes, says Woodward. “QAPI benefits providers that have sufficient resources for implementation because it couples quality assurance (the existing process for meeting minimal standards) with process or performance improvement, which is a continuous cycle of looking at your areas of low performance and constantly cycling work to try to improve those.”

  Here are critical steps directors of nursing services (DNSs) should take to ensure their facility’s QAPI program can withstand scrutiny no matter when it comes:

from Health Care News https://www.aanac.org/Information/Care-Connection-Blog/Blog-Detail/post/qapi-how-to-set-the-standards-for-success/2017-11-14

[compliagent]

Home Heath Gets New Conditions of Participation

The Centers for Medicare and Medicaid Services (CMS) released a final rule on January 13, 2017, that modernizes home health agency Conditions of Participation (CoPs).

Many home health CoPs have not been comprehensively updated since the 1990s, when most of the requirements were first created. The CoPs govern how home health agencies can qualify to participate in the federal and state healthcare system.

Katie Goodrich, CMS chief medical officer and director of the Center for Clinical Standards and Quality for CMS, stated that, “Our priority is to ensure that Medicare and Medicaid beneficiaries who receive health services at home get the highest level of patient-centered care from home health agencies. Today’s announcement is the first update in many years to Medicare and Medicaid home health agency rules and reflects current best practices for in-home care, based on recommendations from stakeholder and medical evidence.”

Currently, there are more than 5 million Medicare and Medicaid beneficiaries receiving home health services and, according to a 2016 report issued by the Office of Inspector General (OIG), Medicare reimbursed approximately $18.4 billion for home health care in 2015.  

Many of the themes incorporated into the final rule relate to patient-centered care, outcome oriented processes, and data driven results. Changes addressed in the final rule include:

·         An expanded patients’ rights section that explicitly sets forth the rights of home health agency patients and requires agencies to provide patients and their representatives with a notice of those rights;

·         New infection prevention and control section that focuses on standard precautions as set out by national and industry best practice standards;

·         An expanded patient care coordination requirement;

·         A new requirement for home health agencies to implement a data-driven, agency-wide quality assessment and performance improvement (QAPI) program that will require continuous evaluation; and

·         New personnel qualifications for home health agency administrators and clinical managers.

Among the above changes, the final rule incorporates additional provisions, which include: an expanded comprehensive patient assessment requirement, additional documentation requirements, and expanded supervision requirements. CMS estimates the new CoPs will cost roughly $293.3 million in the first year. With an effective date of July 13, 2017, home health agencies must be proactive in implementing the required changes to remain in compliance.  

To read the full final rule please visit: https://www.federalregister.gov/documents/2017/01/13/2017-00283/medicare-and-medicaid-program-conditions-of-participation-for-home-health-agencies.

[elijahwilliampost]

ACHC and CHAP Certified Products and Services

Amity Healthcare Group developed a variety of products for home health and home care organizations to support their daily operations, policies and procedures, processes, and documentation. 

These products underwent a thorough review by ACHC and/or CHAP to verify that Amity Healthcare Group provides resources that allow home health and home care organizations to meet the intent of applicable regulations and standards.

Phone - 303-690-2749

For more information visit to website - Home Health Care Consultants

Business mail - ig@amityhealthcaregroup.com