October 2025 Home Health QRP Preview Reports and Star Ratings Now Available in iQIES The updated Home Health Agency (HHA) Provider Preview Reports are now accessible in iQIES in preparation for the October 2025 refresh of the Home Health Quality Reporting Program (HH QRP) data. These reports display provider-level quality measure performance data that will…
It is code update time again!
The FY2026 ICD-10 code update was released on June 9th and these additions/revisions will be effective on October 1st, 2026. There are 487 new codes being added to the code set with this update and includes changes to each Tabular Chapter with the exception of Chapter 8: Disease of the ear and mastoid process and…
Watch out for phishing scams!
Centers for Medicare & Medicaid Services (CMS) has identified a new fraud scheme targeting Medicare providers. Scammers are impersonating CMS and sending phishing fax requests for medical records and other documentation, falsely claiming to be part of a Medicare audit. Remember, CMS does NOT perform medical record audits directly and will not initiate audits by…
HHS Wants to Hear from Healthcare Providers
The Request for Information (RFI) titled “Ensuring Lawful Regulation and Unleashing Innovation to Make American Healthy Again” was published on May 14, 2025, by the Department of Health and Human Services (HHS). This RFI seeks public input on strategies to enhance healthcare affordability, accessibility, and innovation while ensuring lawful regulation. The comment period is open…
Hospice Leaders: Brace for Impact from Medicare Advantage Reform and Expanded Audits
A new piece of federal legislation is generating significant concern across the hospice industry. The Medicare Advantage Reform Act (H.R. 3467), introduced by Rep. David Schweikert (R-Ariz.), proposes major changes to the Medicare Advantage (MA) program including a requirement that MA plans cover hospice care directly. Currently, when a Medicare Advantage enrollee elects the hospice…
Who Can Perform a Face-to-Face Encounter?
Who can perform the Face-to-Face (F2F) encounter for home health? This seems like a question that would be easy to answer but has proven to be otherwise. The optimal situation would be when the provider that certifies the patient for home health care would also be the provider that performs the F2F encounter, but we…
Measuring What Matters: MedPAC’s 2025 Hospice Report Calls for Stronger Quality Metrics
In its March 2025 report to Congress, the Medicare Payment Advisory Commission (MedPAC) provided a detailed look at the state of hospice care, highlighting both the stability and ongoing challenges in the sector. Regarding hospice quality care, the report underscored that while quality of care remains difficult to measure comprehensively, existing indicators such as the…
CMS Unveils FY 2026 Hospice Proposed Rule: What Providers Need to Know
On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule for the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Update (CMS-1835-P), detailing planned changes to Medicare hospice payment rates, regulatory guidance, and updates to the Hospice Quality Reporting Program (HQRP). These proposed changes are part of…
These Errors Keep Showing Up in Audits—Let’s Break the Cycle
Our audit reviews continue to reveal the same key issues: eligibility, certification, and documentation. Medicare home health coverage isn’t just about providing care—it’s about clearly demonstrating the medical necessity through accurate and timely records. Home Health Eligibility: All Criteria Must Be MetTo qualify for Medicare home health services, the patient must: Plan of Care (POC)…
Ensuring Compliance with General Inpatient (GIP) Care
Hospice providers continue to be under high scrutiny for their use of General Inpatient (GIP) care. As audits increase, strict compliance is essential to avoid financial penalties and ensure quality patient care. The Heightened Regulatory Landscape A 2016 Office of Inspector General (OIG) study found that 31% of GIP claims were billed inappropriately, leading to…
