Medicare Qualifying Criteria & Recertification Requirements: Part 1

presented by Georgia Hockenjos, BSN, RN

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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.

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Video Runtime: 33 Minutes; Learning Assessment Time: 33 Minutes

The key to an organization's ability to provide appropriate patient care, ensure regulatory compliance, and achieve financial success is understanding and operationalizing the Medicare home care qualifying criteria. This course is designed to provide a detailed review of the major Medicare qualifying criteria, using the Medicare Benefit Policy Manual as its reference. Examples and best practice processes will be provided to assist the participants in operationalizing their knowledge. Interactive review, including questions/answers, will be used as a summary to highlight areas of the course. This is Part 1 in a two-part series for Medicare Qualifying Criteria & Recertification Requirements.

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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Download the learning objectives for Medicare Qualifying Criteria & Recertification Requirements: Part 1.

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1. Homebound Status

The Medicare definition of homebound status can be confusing and at times difficult to teach, and it continues to be a primary reason for Medicare denials. This chapter utilizes the Medicare Benefit Policy Manual—Chapter 7, Section 30: Home Health Services—as its reference to teach the participants the two criteria used to support homebound status. Specific examples of when patients may leave their homes, as well as case studies of patients who may not be considered homebound, will be used.

2. Plan of Care Requirements and Physician Oversight

Inaccurate, incomplete, or untimely plan of care (POC) development and signature is costly and one of the primary reasons for Medicare denials in home health. This stems from difficulty understanding the qualifying requirements related to the POC. This chapter introduces the Medicare requirements of physician oversight and POC development, including some best practices to ensure compliance.

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