Medicare Qualifying Criteria and Eligibility Requirements
Presented by Georgia Hockenjos
Non-Financial: Georgia Hockenjos has no competing non-financial interests or relationships with regard to the content presented in this course.
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
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…
Chapters & learning objectives
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.
More courses in this series
Discharge Planning & Transitions for Patients With Complex Care Needs
Georgia Hockenjos
Home Care and Hospice QAPI: Root Cause Analysis (RCA)
Georgia Hockenjos
Serious Incidents and Sentinel Events in Home Care and Hospice
Georgia Hockenjos
Medicare Qualifying Criteria and Eligibility Requirements
Georgia Hockenjos
Medicare Qualifying Criteria & Recertification Requirements: Part 1
Georgia Hockenjos
Medicare Qualifying Criteria & Recertification Requirements: Part 2
Georgia Hockenjos
Frequently asked questions
Everything you need to know about Medbridge courses.
Who creates Medbridge courses?
We work with industry-leaders, top researchers, and consultants to build content roadmaps that are then structured into courses, filmed, and edited by our production team before being launched to our site.
How often does Medbridge release new courses?
New courses are added monthly and are automatically included in your subscription as they launch.
How often does Medbridge update courses?
Medbridge reviews its courses annually for relevance and to assess if content is up to date. Based on these reviews it may be determined that a course is out of date resulting in the course being re-filmed or retired, if the content is no longer needed (e.g. a replacement course already exists, the concepts are no longer best practice, etc.).
How many courses does Medbridge offer?
We have over 3,000 accredited courses and we are continually updating our library with new courses. Check our course library for the most up-to-date count for your discipline.
Are there any additional fees for taking a Medbridge course?
There are no additional fees for taking a Medbridge course, obtaining a course certificate of completion, earning CEUs as a subscriber, or accessing any of the additional tools your subscription may include.
Is there a limit to the number of courses I can take?
There is no limit to the number of courses you can take as a subscriber! As a subscriber to Medbridge, you have unlimited access to over 3,000+ accredited CE courses.
If you are a Premium subscriber, you also have unlimited access to our Patient Engagement Tools such as the Home Exercise Program, Patient Education Library, Orthopedic Exam Tests, and Manual Therapy Techniques. We have over 7,000 exercises and over 650+ videos and handouts of patient education resources with more exercises and patient education added to the library based on subscriber feedback, volume of request and specialities.
What is your refund policy?
You are eligible for a refund provided your request is received within 30 days of your subscription purchase and your account has no activity.