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Medicare Qualifying Criteria and Eligibility Requirements

presented by Georgia Hockenjos, BSN, RN

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Disclosure Statement:

Financial: Georgia Hockenjos receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Georgia Hockenjos has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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Video Runtime: 41 Minutes; Learning Assessment Time: 29 Minutes

It is key to understand and operationalize the Medicare home care qualifying criteria and the certification of eligibility requirements in order to provide appropriate patient care, ensure regulatory compliance, and achieve financial success. This course is designed to provide an overview of the Medicare Conditions of Participation (CoPs) related to Medicare qualifying criteria and certification of eligibility requirements. Examples will be given throughout the course to assist the participants in operationalizing the concepts. Interactive question/answers will be used to reinforce participants' understanding at the end of this course.

Meet Your Instructor

Georgia Hockenjos, BSN, RN

Georgia Hockenjos, BSN, RN, is vice president and COO of Aleckna and Associates, Manalapan, New Jersey. Ms. Hockenjos has more than 40 years' experience in the home care industry, with more than 15 years in a management or director-level position at a large multibranch nonprofit home care agency (VNA) and 20 years as vice president…

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Chapters & Learning Objectives

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1. Medicare Conditions of Participation (CoPs) Related to Eligibility

To ensure the participants have a baseline knowledge of Medicare requirements, this chapter provides information about the Medicare Manual and CoPs. The focus of the discussion is on the need to know and to understand the applicable CoPs, recognize their importance, and be able to operationalize these successfully within their agencies. A review of the top reasons for Medicare denials is presented to enable participants to determine trends in their agencies related to Medicare requirements.

2. Qualifying Criteria for Medicare Home Health

The key to ensuring care provision that is compliant with regulations is knowing and understanding the Medicare home care qualifying criteria. This chapter presents an overview of the Medicare qualifying criteria for home care. As each requirement is discussed, examples will be given and applicable core agency processes will be discussed to encourage participants in applying the knowledge.

3. Physician Certification of Eligibility Requirements

Medicare home care and hospice are physician-directed models of care. Untimely or inaccurate physician certification is a primary reason for Medicare denials in home care. This chapter reviews the requirements associated with physician certification of eligibility, including the F2F (face-to-face) encounter requirement as a result of the Affordable Care Act. These requirements will be discussed in detail with a chapter summary that will discuss best practice strategies for obtaining and verifying or validating the certification of eligibility. Examples of well-documented narratives will be presented.

4. Putting It All Together

This chapter is designed to summarize and reinforce the information presented in the course. The methodology will be an interactive discussion between a home care supervisor and a nurse who is new to home care. The interactive discussion will highlight some of the key points presented in the chapters.

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