Managing Home Health Margins Through Clinical Quality (Webinar Series)
Wednesday, April 15, 2026 (1:00 PM - 2:30 PM) (EDT)
Description
3-Part Live Webinar Schedule (recordings available too): Wednesdays from 1:00-2:30pm (ET)
- 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?
Background: Reflecting the CY 2026 Final CMS Home Health PPS Rule (click arrow to see more)
Home Health reforms continue with significant programming and reimbursement changes finalized in the Calendar Year (CY) 2026 Home Health Prospective Payment System (PPS) Final Rule. Providers preparing for success will face heightened challenges related to the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS®) survey and the expanded Home Health Value-Based Purchasing (HHVBP) Model—changes that coincide with substantial reimbursement reductions. The result is a Home Health landscape markedly different from the systems many agencies operated under during traditional PPS and the early Patient-Driven Groupings Model (PDGM) era.
Nationally, Home Health agencies have been focused on navigating finalized fiscal cuts and their downstream operational and margin impacts. As established models strain under PDGM, VBP, and HHCAHPS requirements, providers relying on legacy processes frequently find themselves facing eroded episodic margins. This instability threatens long-term sustainability, and nearly half of HH agencies continue to report negative margins.
In addition to the finalized payment cuts, the new HHCAHPS survey structure—effective beginning with the April 2026 sample month—directly impacts VBP scoring. CMS finalized the modernization of the HHCAHPS survey, reducing the total number of questions from 35 to 30 (adding three, removing eight). Because these changes materially impact baseline calculations, CMS removed the three existing HHCAHPS composite measures (Care of Patients, Communications Between Providers and Patients, and Specific Care Issues) from the HHVBP Model beginning in CY 2026.
In their place, CMS finalized the addition of four new measures to the HHVBP measure set beginning in Performance Year (PY) 2026:
- Medicare Spending Per Beneficiary – Post-Acute Care (MSPB-PAC)
- Improvement in Bathing (OASIS M1830)
- Improvement in Upper Body Dressing (OASIS M1810)
- Improvement in Lower Body Dressing (OASIS M1820)
The CY 2026 Final Rule establishes an overall payment decrease of 1.3% (–$220 million) compared to CY 2025. Finalized updates include adjustments to:
- LUPA thresholds
- PDGM case-mix weights
- Functional impairment levels
Part 3: 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
There is still time to catch up on the first and second sessions of this series! Register for the full series today and receive access to the Part 1 and Part 2 recordings.
Meet the 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.
Continuing Education
Attendees receive 1.5 continuing education units per webinar for Florida-licensed skilled nursing, occupational therapy, and speech-language pathology and audiology.
Call for Sponsors
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Register online or call (850) 222-8967 to register by phone. HCAF members receive a discounted registration rate! To obtain the member discount, please log in to your profile before registering.
Single Webinar
HCAF Members: $49
Prospective Members: $98
Full 3-Part Series
HCAF Members: $119
Prospective Members: $238
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