AHCC Talk

How does a new ICD-10-CM diagnosis code make its way into the code set?

On this episode of AHCC Talk, AHCC Advisory Board member Sherri Parson, RN, HCS-D, HCS-O, HCS-H, COS-C, and Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director, Coding Policy and Compliance with AHIMA, join the discussion to explain the ICD-10-CM code proposal and approval process.

Learn what makes a strong proposal, what evidence submitters should provide, how proposals move through the ICD-10 Coordination and Maintenance Committee process, and why public comments can have a meaningful impact on the final outcome. The presentation emphasizes clinical validity, documentation, statistical and public health needs, and technical considerations when evaluating a proposed code or revision.

Then, AHCC Advisory Board member Lisa Selman-Holman, JD, BSN, RN, HCS-D, Vice President of Clinical Services with McBee, walks through the answer and rationale to the latest coding and OASIS scenario, including how code sequencing can change a patient's PDGM clinical grouping, functional category, and payment.

✅ Jan Milliman, HCS-D, Director, AHCC

✅ Sue Bowman, MJ, RHIA, CCS, FAHIMA, Senior Director, Coding Policy and Compliance AHIMA®

✅ Sherri Parson, RN, HCS-D, HCS-O,HCS-H, COS-C, Owner, Parson Coding/Consulting LLC, and Regulatory Advisor, LSHERA

✅ Lisa Selman-Holman, JD, BSN, RN, HCS-D, HCS-H, HCS-O, COS-C, Vice President of Clinical Services, McBee

Links Mentioned In The Episode

🔗 ICD-10-CM Coordination & Maintenance Committee

🔗 ICD-10-CM code files, addenda, and guidelines

🔗 CMS ICD-10 website

🔗 AHA Coding Clinic

🔗Federal Register

🔗⁠Send completed proposal template by the submission deadline to [email protected]

⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/media/1807/ahcc-talk-episode-95-handouts.pdf
📧Have a question, episode request, or suggestions for a future panel guest? Email Jan at [email protected]

On this episode of AHCC Talk, Christine Mickel joins Jan Milliman to examine the connection between physician documentation, clinical assessment, coding, OASIS responses, and reimbursement under PDGM. Learn how clinical grouping is established, when comorbidities may affect payment, why the same functional score can produce different results, and what to reassess at recertification.

Plus, work through the latest AHCC scenario spotlights involving hospice symptom follow-up requirements and proposed CY 2027 PDGM changes.

✅ Jan Milliman, HCS-D, Director, AHCC

✅ Christine Mickel, PTA, HCS-D, HCS-O, HCS-H, Manager, OASIS and Coding, McBee Associates

Links Mentioned in the Episode

2026 Home Health Payment & Compliance Virtual Summit: https://store.decisionhealth.com/hh-payment-compliance

Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update: https://www.federalregister.gov/documents/2026/07/06/2026-13602/calendar-year-2027-home-health-prospective-payment-system-hh-pps-rate-update-requirements-for-the-hh

Learn more about AHCC credentials: https://store.decisionhealth.com/ahcc-credentials

⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/media/1795/ahcc-talk-episode-93-handouts-final.pdf

📧Have a question, episode request, or suggestions for a future panel guest? Email Jan at [email protected]

On this episode of AHCC Talk, Jan Milliman, HCS-D, Director of AHCC, is joined by AHCC Advisory Board member Lisa Selman-Holman, JD, BSN, RN, HCS-D, HCS-H, HCS-O, COS-C, Vice President of Clinical Services with McBee, for a look back at the first eight months of using the Hospice Outcomes and Patient Evaluation — HOPE — tool.

Jan and Lisa discuss how the transition from HIS to HOPE has affected hospice workflows, documentation, visit timing, symptom follow-up visits, data integrity, and compliance risk. They also review common submission issues, rejection patterns, warning vs. error distinctions, and practical ways teams can improve acceptance rates and HOPE accuracy.✅ Jan Milliman, HCS-D, Director, AHCC✅ Lisa Selman-Holman, JD, BSN, RN, HCS-D, HCS-H, HCS-O, COS-C, Vice President of Clinical Services, McBee

Links Mentioned in the Episode

Medicare Program; FY2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements: https://www.federalregister.gov/documents/2026/04/06/2026-06604/medicare-program-fy-2027-hospice-wage-index-and-payment-rate-update-and-hospice-quality-reporting

Hospice Outcomes and Patient Evaluation (HOPE) Guidance Manual v1.01: https://www.cms.gov/files/document/hope-guidance-manual-v1-01.pdf

Hospice Quality Reporting Program: https://www.cms.gov/medicare/quality/hospice

Learn more about AHCC credentials: https://store.decisionhealth.com/ahcc-credentials

⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/ahcc-talk-episode-92-eight-months-of-the-hospice-hope-tool/

📧Have a question, episode request, or suggestionsfor a future panel guest? Email Jan at [email protected]

In this episode of AHCC Talk, host Jan Milliman, HCS-D, is joined by J’non Griffin, RN, MHA, HCS-D, HCS-H, HCS-C, COS-C, Director at SimiTree Healthcare Consulting, for a timely discussion on survey readiness for home health agencies.

Jan and J’non break down the most common deficiencies identified by CMS, CHAP, ACHC, and TJC, including recurring issues around individualized plans of care, patient communication, documentation reliability, medication regimen review, infection control, and aide supervision.

Listeners will learn why the same standards continue to appear year after year, how agencies can identify workflow gaps before surveyors arrive, and what a practical 90-day survey readiness plan can look like.

✅ Jan Milliman, HCS-D, Director, AHCC

✅ J'non Griffin, RN, MHA, HCS-D, HCS-H, HCS-C,COS-C, Director, SimiTree Healthcare Consulting

Links Mentioned in the Episode

• Reserve your spot at the Home Care Leadership Summit: decisionhealth.com/hcls2026
• ⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/media/1785/ahcc-talk-episode-91-handouts.pdf
• 📧Have a question, episode request, or suggestionsfor a future panel guest? Email Jan at [email protected]

In this episode of AHCC Talk, host Jan Milliman is joined by coding experts Celeste Miller and Apryl Swafford to walk through real-world coding challenges that home health professionals face every day.

From respiratory conditions and sepsis to trauma and complex post-surgical infections, this episode breaks down how to approach difficult scenarios with confidence—while staying aligned with official coding guidance.

What you’ll learn:

• How to code COPD with exacerbation and concurrent conditions
• Key considerations for sepsis with resolved acute conditions
• Documentation pitfalls in fracture coding
• How to approach post-procedural infections and osteomyelitis
• Clarifications on Face-to-Face requirements
• What to do when a recertification OASIS is completed outside the allowed window

Each scenario is designed to sharpen your coding accuracy and help you apply guidelines to complex patient cases.

✅ Jan Milliman, HCS-D, Director, AHCC

✅ Celeste Miller, RN, BS, HCS-D, HCS-O, Executive Director of Quality Assurance, Aegis Healthcare

✅ Apryl Swafford, RN, BSN, COS-C, HCS-D, HCS-H, HCS-O, QA Manager, SimiTree Healthcare Consulting

Linked Mentioned in the Episode

• Downloadable slides from this discussion: https://ahcc.decisionhealth.com/media/1783/ahcc-talk-episode-90-handouts.pdf

• Learn more about AHCC: https://ahcc.decisionhealth.com/?utm_source=spotify&utm_medium=podcast&utm_campaign=dhbmscahcc&utm_content=ahcc_talk_spotify
• Home Care Leadership Summit (May 19–21, Orlando): https://store.decisionhealth.com/home-care-leadership-summit?utm_source=spotify&utm_medium=podcast&utm_campaign=hcls_2026&utm_content=ahcc_talk_spotify

In this episode of AHCC Talk, we break down the face-to-face (F2F) requirement for home health—a critical condition of payment tied to compliance and reimbursement.

Learn what qualifies as a valid encounter, who can perform it, and how to avoid the most common documentation mistakes that lead to denials.

We also cover timing rules, telehealth updates through 2027, and practical strategies to ensure your agency stays compliant and audit-ready.

Perfect for coders, clinicians, and compliance professionals navigating home health regulations.This episode's panel includes:

✅ Jan Milliman, HCS-D, Director, AHCC

✅ Lisa Selman-Holman, JD, BSN, RN, HCS-D, HCS-H,HCS-O, COS-C, Vice President of Clinical Services, McBee

✅ Lisa McClammy, BSN, RN, COS-C, HCS-D,HCS-O, Senior Clinical Education Consultant, MAC Legacy

Links Mentioned in the Episode

🔗 § 424.22 Requirements for home health services. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-424/subpart-B/section-424.22

🔗 A Rule by the Centers for Medicare & Medicaid Services on 12/02/2025: https://www.federalregister.gov/documents/2025/12/02/2025-21767/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-hh-pps-rate

🔗 Palmetto GBO: Home Health Face to Face Checklist: https://dominoapps.palmettogba.com/palmetto/providers.nsf/files/Home_Health_Face_to_Face_Checklist.pdf/$FILE/Home_Health_Face_to_Face_Checklist.pdf

🔗 Join us May 19-21 at the Home Care Leadership Summit in Orlando, FL: decisionhealth.com/hcls2026

🔗 Join us for the next live airing of AHCC Talk: https://attendee.gotowebinar.com/register/2224811617290518541?source=yt

🔗 Learn more about AHCC and how to become a member:store.decisionhealth.com/join-ahcc🔗 NEW BOOK: Home Health Guide to Crafting a Compliant Plan of Care, 1st Edition: ⁠https://store.decisionhealth.com/2026-plan-of-care-guide⁠

⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/media/1774/ahcc-talk-episode-89-handouts.pdf

📧Have a question, episode request, or suggestions for a future panel guest? Email Jan at [email protected]

In this episode of AHCC Talk, our expert panel discusses how to create and implement a compliant and individualized plan of care (POC).Learn how to:

• Meet Conditions of Participation requirements
• Develop meaningful goals and interventions
• Avoid common plan of care audit risks
• Individualize care plans for better outcomes
• Apply real-world POC examples

The discussion includes practical scenarios and guidance to help clinicians and agencies strengthen documentation and compliance.

✅ Jan Milliman, HCS-D, Director, AHCC

✅ Sherri Parson, RN,. HCS-D, HCS-O, COS-C, CEO,Infusion Health

✅J'non Griffin, RN, MHA, HCS-D, HCS-H,COS-C, Direction, SimiTree Healthcare Consulting

Links Mentioned in the Episode

 🔗 NEW BOOK: Home Health Guide to Crafting a Compliant Plan of Care, 1stEdition: https://store.decisionhealth.com/2026-plan-of-care-guide

🔗Home Health J1800/J1900 Errata: https://www.cms.gov/files/document/oasis-e1-guidance-manual-errata-fmi-items.pdf

🔗October 2025 CMS Quarterly OASIS Q&As: https://qtso.cms.gov/system/files/qtso/CMS_OAI_Qtr_4_2025_QAs_October_2025_508c.pdf

🔗Join us May 19-21 at the Home Care Leadership Summit in Orlando, FL: decisionhealth.com/hcls2026

🔗Join us for the next live airing of AHCC Talk on March 16 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/media/1773/ahcc-talk-episode-88-handouts.pdf

📧Have a question, episode request, or suggestionsfor a future panel guest? Email Jan at [email protected]

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 [email protected]

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 care
• Key elements that support recertification and homebound status
• Common documentation gaps that put agencies at risk
• Practical examples of when skilled services are — and are not — reasonable and necessary
• How progress to goals, functional status, and risk factors support compliance

This 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 [email protected]

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 [email protected]