AHCC Talk

Association of Home Care Coding and Compliance
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Join advisory board members from the Association of Home Care Coding & Compliance for a monthly update on diagnosis coding, OASIS and HOPE assessment data collection, and the documentation issues that matter most in home health and hospice. https://ahcc.decisionhealth.com/

  1. JAN 27

    Falls & the New FMI Outcome: What Changed and Why It Matters

    Falls are receiving greater scrutiny than ever before—and with the introduction of the new Falls with Major Injury (FMI) Outcome, accurate assessment, scoring, and documentation matter more than ever.  In this episode, our expert panel breaks down what’s changed, why it matters, and how clinicians and agencies should respond. From OIG findings and CMS definition updates to practical scoring tips for OASIS items J1800 and J1900, this discussion connects regulatory guidance to real-world clinical scenarios. You’ll also learn how the FMI outcome is calculated, how risk adjustment works, and why the new methodology tells a different story about falls data—plus how agencies can focus on prevention without over- or under-reporting. ✅ Jan Milliman, HCS-D, Director, AHCC ✅ Lisa Selman-Holman, JD, BSN, RN, HCS-D ✅ Kelly Kavanaugh, RN, HCS-D, HCS-O, HCS-H Links Mentioned inthe Episode  🔗 OASIS E1 Manual: https://www.cms.gov/files/document/draft-oasis-e1-manual-04-28-2024.pdf 🔗OASIS Quarterly Q&As October 2025:https://qtso.cms.gov/reference-and-manuals/oasis-quarterly-q 🔗OASIS Static Q&As: https://qtso.cms.gov/providers/home-health-agency-hha-providers/reference-manuals 🔗All OASIS materials can be found at: https://qtso.cms.gov/providers/home-health-agency-hha-providers/reference-manuals 🔗Home Health - Falls with Major InjuryRespecification: Technical Specification Report https://www.cms.gov/files/document/fmi-technical-specification-report-hh.pdf-0List of codes found in Appendix B and Appendix C 🔗Home Health J1800/J1900 Errata: https://www.cms.gov/files/document/oasis-e1-guidance-manual-errata-fmi-items.pdf 🔗Join us for the next live airing of AHCC Talk on February 23 at 1pm EST: https://register.gotowebinar.com/#register/2224811617290518541?source=podcast 🔗 Learn more about AHCC and how to become a member:store.decisionhealth.com/join-ahcc   ⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/ahcc-talk-episode-87-updates-for-classifying-falls-in-home-health/   📧Have a question, episode request, or suggestionsfor a future panel guest? Email Jan at jan.milliman@decisionhealth.com

    45 min

  2. 12/16/2025

    Medical Necessity at Recertification: Documentation Tips, Common Gaps, and Real-World Scenarios

    In this episode of AHCC Talk, we break down what Medicare expects when it comes to medical necessity at recertification — and where agencies most often fall short. Host Jan Milliman, HCS-D is joined by Lisa McClammy, BSN, RN, COS-C, HCS-D, HCS-O, Senior Clinical Education Consultant at MAC Legacy, to discuss: What documentation must show to justify continued skilled careKey elements that support recertification and homebound statusCommon documentation gaps that put agencies at riskPractical examples of when skilled services are — and are not — reasonable and necessaryHow progress to goals, functional status, and risk factors support complianceThis episode also features a Scenario Spotlight focused on OASIS M1033.1 - History of Falls, helping listeners apply guidance to real-world documentation decisions. Links Mentioned in the Episode 🔗 AHCC certification study guides: decisionhealth.com/studyguides 🔗 If you're an AHCC member, register for the AHCC Member's Call on January 28 at 1pm EST: https://register.gotowebinar.com/register/8915984221266150240 🔗 Learn more about AHCC and how to become a member:store.decisionhealth.com/join-ahcc ⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/ahcc-talk-episode-86-medical-necessity-at-recert/   📧Have a question, episode request, or suggestionsfor a future panel guest? Email Jan at jan.milliman@decisionhealth.com

    25 min

  3. 11/18/2025

    Aligning Diagnosis Coding and Hospice HOPE Tool Responses

    On this episode of AHCC Talk, our panel dives into diagnosis coding for hospice and how to accurately complete the Hospice Outcomes & Patient Evaluation (HOPE) tool, with a focus on Section I: Active Diagnoses. You’ll hear discussion of real-world charts, CMS guidance, and HOPE scenarios so you can feel more confident about aligning your claims, assessments, and documentation. Our Panel ✅ Jan Milliman, HCS-D, Director, AHCC ✅ Kelly Kavanaugh, RN, HCS-D, HCS-H,HCS-O, BCHH-C, Independent Home Health and Hospice Consultant owner of The OTBGroup ✅ Lisa Selman-Holman, JD, BSN, RN, VP Education andQuality, McBee Links Mentioned in the Episode 🔗 HOPE Assessment Tool: All About Active Diagnoses(CHAP): https://chapinc.org/blog-news/hope-assessment-tool-active-diagnoses/ 🔗 Register now for the Home Care Leadership Summit happening in Orlando, FL from May 19-21, 2026decisionhealth.com/hcls2026 🔗 Free Webinar: HOPE Tool Training for Easy, Compliant Rollout https://web.hcpro.com/hope-training-tool 🔗 Learn more about AHCC and how to become a member:store.decisionhealth.com/join-ahcc   ⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/ahcc-talk-episode-85-diagnosis-coding-and-the-hospice-hope-tool/   📧Have a question, episode request, or suggestions for a future panel guest? Email Jan at jan.milliman@decisionhealth.com

    38 min

  4. 10/23/2025

    Defining "skilled service" in homecare

    What truly defines a skilled service in home health—and why does it matter so much for compliance, reimbursement, and patient outcomes? In this episode, host Jan Milliman, HCS-D, is joined by J'non Griffin, RN, MHA, HCS-D, HCS-H, HCS-C, COS-C and Apryl Swafford, RN, BSN, COS-C, HCS-D, HCS-H, HCS-O, both from SimiTree Healthcare Consulting, to break down how Medicare defines skilled service and what agencies need to document to defend it. From medical necessity to top denial drivers, this conversation covers the fundamentals every home health professional must master. Whether you're a new clinician or a seasoned leader, this practical discussion will help you avoid pitfalls, strengthen documentation, and ensure services meet key requirements. Links Mentioned in the Episode 🔗Medicare Benefit Policy Manual, Ch. 7 - Home Health Services: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c07.pdf 🔗Learn More About AHCC credentials: decisionhealth.com/credentials 🔗 If you're an AHCC Member, please take the Member Survey!: https://www.surveymonkey.com/r/7SKBX2J ⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/ahcc-talk-episode-84-defining-skilled-need/   📧Have a question, episode request, or suggestionsfor a future panel guest? Email Jan at jan.milliman@decisionhealth.com

    36 min

  5. 09/30/2025

    FY2026 Code Updates: What changed? What matters? What to do next?

    Join host Jan Milliman, HCS-D (Director, AHCC) with AHCC Advisory Board members Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C and Sherri Parson, RN, HCS-D, HCS-O, HCS-H, COS-C as we break down what’s new for FY2026—what changed, what matters, and how to apply it correctly in home health and beyond. In this episode: Code transition implications for billing and documentation Specialty impacts (including hospice) Tabular/Index updates and notable new concepts (e.g., E11.A T2DM in remission) Obesity guidance (April 2025) + Coding Clinic Q1 2025 notes High-impact condition areas: hypercholesterolemia, multiple sclerosis, muscular dystrophy Hypertensive heart disease changes + new guideline and examples Wound and skin updates (L98.4 and related ulcer coding) COPD + other chronic bronchitis clarifications Anatomy/site updates (e.g., flank), pelvis reclassification to M80.0B Medication and risk concepts (fluoroquinolones, genetic susceptibility) Real-world scenario spotlights and an AHCC product/member update CHAPTERS 1:29 Code Transition2:15 What This Means for Billing3:15 What About Hospice?3:46 Inflammatory Breast Carcinoma4:36 Tabular and Index Updates5:29 E11.A – T2DM without complications in remission7:10 E11.A Guideline7:29 Diabetes Mellitus with Venous Insufficiency8:40 Obesity – new guideline (Apr 2025), Coding Clinic Q1 20259:32 Hypercholesterolemia10:08 Multiple Sclerosis12:12 Muscular Dystrophy13:24 Big Changes to Hypertensive Heart Disease14:39 New Guideline – Hypertension with Heart Disease16:16 HTN Examples17:21 L98.4 – Non-pressure chronic ulcer of skin, NEC18:22 Related to Ulcer Codes20:10 COPD with Other Chronic Bronchitis21:16 Flank added as a new anatomic site22:13 Pelvic parts moved to M80.0B Pelvis23:06 Fluoroquinolones24:05 Genetic Susceptibility25:47 Scenario Spotlight26:06 August Scenario27:52 August Scenario Answer28:40 September Scenario29:30 Product Spotlight: Home Health Pro30:00 What’s New with AHCC: Advisory Board Update; Member Survey RESOURCES & LINKS CMS ICD-10-CM code files: https://www.cms.gov/medicare/coding-billing/icd-10-codes Learn more about Home Health Pro: decisionhealth.com/homehealthpro AHCC Member Survey: https://www.surveymonkey.com/r/7SKBX2J Download the slides from this episode: https://ahcc.decisionhealth.com/ahcc-talk-episode-83-fy2026-coding-update/ Questions, topic requests, or guest suggestions? Email Jan Milliman: jan.milliman@decisionhealth.com 🎧 If you found this episode helpful, follow AHCC Talk and share it with your team!

    31 min

  6. 08/21/2025

    July 2025 CMS OASIS Q&As Explained

    Get clarity on the latest CMS OASIS updates—straight from the experts. In this episode of AHCC Talk, Jan Milliman and Lisa McClemmy break down the July 2025 CMS OASIS Quarterly Q&As, offering practical guidance on comprehensive assessment, OASIS data set items, and documentation for skilled services. You’ll also hear scenario discussions, a product spotlight, and the latest updates from AHCC. Resources Mentioned:📄 July 2025 CMS Quarterly Q&As🎓 Start your 14-day free trial of Home Health Coding Center👥 Learn more about AHCC membership⬇️ Download slides from this episode

    35 min

  7. 07/30/2025

    Understanding the HOPE Tool: What Hospice Providers Need to Know Before October 1

    Big changes are coming to hospice quality reporting. In this episode of AHCC Talk, host Jan Milliman is joined by expert panelist Nanette Minton to break down CMS’ new HOPE tool, which will fully replace HIS starting October 1, 2025. You’ll learn what’s required for each HOPE visit, how it impacts compliance and QAPI, and how to navigate new quality measures like pain reassessment. The episode also includes real-world coding and OASIS scoring scenarios to help you prepare. Our panel includes: ✅ Jan Milliman, HCS-D, Director, AHCC ✅ Nanette Minton, RN, HCS-D, HCS-H, HCS-O, Senior Clinical Coding Manager, MAC Legacy Links Mentioned in the Episode 🔗 Learn more about the Payment & Compliance Virtual Summit: decisionhealth.com/pcvirtual 🔗New ways to earn CEUs: https://ahcc.decisionhealth.com/ahcc-blog/more-ways-to-earn-ahcc-ceus 🔗 Learn more about AHCC and how to become a member:store.decisionhealth.com/join-ahcc

    31 min

  8. 06/27/2025

    Compliant Queries in Home Health: Best Practices & Real-World Scenarios

    Compliant queries in home health don’t have to be complicated. In this episode, our expert panel covers best practices, guidelines, and real-world scenarios to help you query smarter and stay compliant. Hear from Jan Milliman, Sherri Parson, and Christine Mickel as they share insights and answer practical questions. 🔗 Resources Mentioned Guidelines for achieving a compliant query practice (ACDIS): https://acdis.org/resources/guidelines-achieving-compliant-query-practice%E2%80%942022-update Payment & Compliance Virtual Summit: decisionhealth.com/PCVirtual Learn more about AHCC membership: store.decisionhealth.com/join-ahcc 📄 Download episode slides: https://hcpro-catalog.s3.dualstack.us-east-1.amazonaws.com/DecisionHealth/AHCC/AHCC_Talk_Slides/2025/ahcc-talk-episode-80-handouts.pdf 📧 Questions or suggestions?Email Jan Milliman: jan.milliman@decisionhealth.com Links Mentioned in the Episode🔗Guidelines for achieving a compliant query practice: https://acdis.org/resources/guidelines-achieving-compliant-query-practice%E2%80%942022-update 🔗Payment & Compliance Virtual Summit registration: decisionhealth.com/PCVirtual🔗 Learn more about AHCC and how to become a member: store.decisionhealth.com/join-ahcc ⬇️ Downloadable slides from this discussion: https://hcpro-catalog.s3.dualstack.us-east-1.amazonaws.com/DecisionHealth/AHCC/AHCC_Talk_Slides/2025/ahcc-talk-episode-80-handouts.pdf 📧Have a question, episode request, or suggestions for a future panel guest? Email Jan at jan.milliman@decisionhealth.com

    32 min
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About

Join advisory board members from the Association of Home Care Coding & Compliance for a monthly update on diagnosis coding, OASIS and HOPE assessment data collection, and the documentation issues that matter most in home health and hospice. https://ahcc.decisionhealth.com/

Information

  • Creator
    Association of Home Care Coding and Compliance
  • Years Active
    2023 - 2026
  • Episodes
    32
  • Rating
    Clean
  • Copyright
    © Association of Home Care Coding and Compliance
  • Show Website
    AHCC Talk