Description

This is a State-Share Educational Program. OCHCH has partnered with Home Care Association of Florida to offer this education to OCHCH members.

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Background

This progressive webinar series walks you through all the contemporary Home Health changes in the 2026 Final Rule, discusses rationale for the changes, outlines Operational changes to make for PDGM/VBP success, and presents Case Study demos of HH providers who are on the path to ongoing HH success with improved financial margins.

Home Health reforms continue with major programming and reimbursement changes outlined in the Calendar Year (CY) 2026 Home Health Prospective Payment System (PPS) Final Rule. Providers seeking success will face new challenges related to the Home Health Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey and the Home Health Value-Based Purchasing (HHVBP) Model, with significant reimbursement cuts occurring simultaneously. The result is a Home Health landscape considerably different from what most of us operated under during the PPS and early Patient-Driven Groupings Model (PDGM) era.

3-Part Webinar Schedule. 

• February 18: Expanded Home Health Value-Based Purchasing (HHVBP) Model
• March 18: Payment Changes: What to Expect for Medicare Home Health Payments in 2026
• April 15: What Does This Mean for Revenue Cycle Management (RCM) and Agencies?

Contact Hours for Attendees

• This online program offers 1 Contact Hour for Nurses

Session Summary

What Does This Mean for RCM and Agencies?

Bottom Line for RCM Leadership: The CY 2026 proposed home health rule signals a convergence of financial pressure, operational complexity, and quality realignment. RCM teams must quickly model impacts, optimize coding and documentation systems, recalibrate quality and value-based strategies, and advocate wisely as CMS finalizes the rule later this year.

• Tighten coding/OASIS accuracy to optimize case-mix appropriateness.
• Leverage tech to streamline documentation and support efficiencies.

Steps to Manage HH Margins through Clinical Quality:

• Audit PDGM Coding and Visit Plans - Ensure diagnosis coding and comorbidity capture are detailed and accurate to protect revenue. Review visit plans carefully to avoid unintentional LUPA penalties due to new thresholds.
• Update Face-to-Face and Order Workflows - Adjust documentation templates for the expanded list of practitioners now allowed for F2F visits. Track any F2F issues as a key metric for avoiding denials.
• Protect Quality Reporting Data - Treat QRP submission deadlines like payroll, don’t miss them. Prepare early for digital reporting transitions (dQM and FHIR) by testing your data systems.
• Train Staff on New HHVBP Measures - Educate clinicians on new cost-based indicators, and OASIS functional items related to bathing and dressing. Improve processes to manage spending efficiency to improve Medicare Spending Per Beneficiary – Post-Acute Care (MSPB-PAC)
• Strengthen Denial and Audit Defenses - Be ready for more reviews from Medicare auditors focusing on behavioral payment adjustments. Keep documentation strong and organized to support every claim.
• Manage Labor and Visit Scheduling Closely - Align visit schedules with the new case-mix recalibration and LUPA thresholds. Use alerts to avoid plans drifting into under-visit situations
• Additional operational adjustments

Our Speakers

Arnie Cisneros is the President of Home Health Strategic Management (HHSM). He has over 30 years of experience as a physical therapist across the care continuum, and he serves as a Post-Acute Consultant for multiple Pioneer Accountable Care Organizations (ACOs). He is renowned for his adaptation of traditional health care operations to address ongoing Centers for Medicare & Medicaid Services (CMS) reforms.

Kimberly McCormick is a highly accomplished nurse consultant in home health. She is the Executive Clinical Director for Home Health Strategic Management. With 24 years of experience in home health, including nearly a decade as the administrator of a home health agency, Kimberly has the experience and knowledge to provide unrivaled insight into the home health arena. Kimberly previously served as an Associate Consultant with HHSM, where she has established herself as an expert in the utilization management of home health services.

Disclosure to Learners

Accreditation Statement: Ohio Council for Home Care & Hospice is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Relevant Financial Relationships: There are no relevant financial relationships with ineligible companies for those involved with the ability to control the content of this activity, or any relevant financial relationships disclosed by participants have been mitigated.

Criteria for Awarding Contact Hours & Continuing Education Certificates: Attendance for the duration of the educational activity. Contact hours are not awarded for watching a recording of the session.