AHCC Talk

What truly defines a skilled service in home health—and why does it matter so much for compliance, reimbursement, and patient outcomes?

In this episode, host Jan Milliman, HCS-D, is joined by J'non Griffin, RN, MHA, HCS-D, HCS-H, HCS-C, COS-C and Apryl Swafford, RN, BSN, COS-C, HCS-D, HCS-H, HCS-O, both from SimiTree Healthcare Consulting, to break down how Medicare defines skilled service and what agencies need to document to defend it. From medical necessity to top denial drivers, this conversation covers the fundamentals every home health professional must master.

Whether you're a new clinician or a seasoned leader, this practical discussion will help you avoid pitfalls, strengthen documentation, and ensure services meet key requirements.

Links Mentioned in the Episode

🔗Medicare Benefit Policy Manual, Ch. 7 - Home Health Services: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c07.pdf

🔗Learn More About AHCC credentials: decisionhealth.com/credentials

🔗 If you're an AHCC Member, please take the Member Survey!: https://www.surveymonkey.com/r/7SKBX2J

⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/ahcc-talk-episode-84-defining-skilled-need/

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

Join host Jan Milliman, HCS-D (Director, AHCC) with AHCC Advisory Board members Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C and Sherri Parson, RN, HCS-D, HCS-O, HCS-H, COS-C as we break down what’s new for FY2026—what changed, what matters, and how to apply it correctly in home health and beyond.

In this episode:

• Code transition implications for billing and documentation

• Specialty impacts (including hospice)

• Tabular/Index updates and notable new concepts (e.g., E11.A T2DM in remission)

• Obesity guidance (April 2025) + Coding Clinic Q1 2025 notes

• High-impact condition areas: hypercholesterolemia, multiple sclerosis, muscular dystrophy

• Hypertensive heart disease changes + new guideline and examples

• Wound and skin updates (L98.4 and related ulcer coding)

• COPD + other chronic bronchitis clarifications

• Anatomy/site updates (e.g., flank), pelvis reclassification to M80.0B

• Medication and risk concepts (fluoroquinolones, genetic susceptibility)

• Real-world scenario spotlights and an AHCC product/member update

CHAPTERS

1:29 Code Transition
2:15 What This Means for Billing
3:15 What About Hospice?
3:46 Inflammatory Breast Carcinoma
4:36 Tabular and Index Updates
5:29 E11.A – T2DM without complications in remission
7:10 E11.A Guideline
7:29 Diabetes Mellitus with Venous Insufficiency
8:40 Obesity – new guideline (Apr 2025), Coding Clinic Q1 2025
9:32 Hypercholesterolemia
10:08 Multiple Sclerosis
12:12 Muscular Dystrophy
13:24 Big Changes to Hypertensive Heart Disease
14:39 New Guideline – Hypertension with Heart Disease
16:16 HTN Examples
17:21 L98.4 – Non-pressure chronic ulcer of skin, NEC
18:22 Related to Ulcer Codes
20:10 COPD with Other Chronic Bronchitis
21:16 Flank added as a new anatomic site
22:13 Pelvic parts moved to M80.0B Pelvis
23:06 Fluoroquinolones
24:05 Genetic Susceptibility
25:47 Scenario Spotlight
26:06 August Scenario
27:52 August Scenario Answer
28:40 September Scenario
29:30 Product Spotlight: Home Health Pro
30:00 What’s New with AHCC: Advisory Board Update; Member Survey

RESOURCES & LINKS

• CMS ICD-10-CM code files: https://www.cms.gov/medicare/coding-billing/icd-10-codes

• Learn more about Home Health Pro: decisionhealth.com/homehealthpro

• AHCC Member Survey: https://www.surveymonkey.com/r/7SKBX2J

• Download the slides from this episode: https://ahcc.decisionhealth.com/ahcc-talk-episode-83-fy2026-coding-update/

Questions, topic requests, or guest suggestions? Email Jan Milliman: [email protected]

🎧 If you found this episode helpful, follow AHCC Talk and share it with your team!

Get clarity on the latest CMS OASIS updates—straight from the experts.

In this episode of AHCC Talk, Jan Milliman and Lisa McClemmy break down the July 2025 CMS OASIS Quarterly Q&As, offering practical guidance on comprehensive assessment, OASIS data set items, and documentation for skilled services. You’ll also hear scenario discussions, a product spotlight, and the latest updates from AHCC.

Resources Mentioned:
📄 July 2025 CMS Quarterly Q&As
🎓 Start your 14-day free trial of Home Health Coding Center
👥 Learn more about AHCC membership
⬇️ Download slides from this episode

Big changes are coming to hospice quality reporting. In this episode of AHCC Talk, host Jan Milliman is joined by expert panelist Nanette Minton to break down CMS’ new HOPE tool, which will fully replace HIS starting October 1, 2025. You’ll learn what’s required for each HOPE visit, how it impacts compliance and QAPI, and how to navigate new quality measures like pain reassessment. The episode also includes real-world coding and OASIS scoring scenarios to help you prepare.

Our panel includes:

✅ Jan Milliman, HCS-D, Director, AHCC

✅ Nanette Minton, RN, HCS-D, HCS-H, HCS-O, Senior Clinical Coding Manager, MAC Legacy

Links Mentioned in the Episode

🔗 Learn more about the Payment & Compliance Virtual Summit: decisionhealth.com/pcvirtual

🔗New ways to earn CEUs: https://ahcc.decisionhealth.com/ahcc-blog/more-ways-to-earn-ahcc-ceus

🔗 Learn more about AHCC and how to become a member:store.decisionhealth.com/join-ahcc

Compliant queries in home health don’t have to be complicated. In this episode, our expert panel covers best practices, guidelines, and real-world scenarios to help you query smarter and stay compliant. Hear from Jan Milliman, Sherri Parson, and Christine Mickel as they share insights and answer practical questions.

🔗 Resources Mentioned

• Guidelines for achieving a compliant query practice (ACDIS): https://acdis.org/resources/guidelines-achieving-compliant-query-practice%E2%80%942022-update

• Payment & Compliance Virtual Summit: decisionhealth.com/PCVirtual

• Learn more about AHCC membership: store.decisionhealth.com/join-ahcc

• 📄 Download episode slides: https://hcpro-catalog.s3.dualstack.us-east-1.amazonaws.com/DecisionHealth/AHCC/AHCC_Talk_Slides/2025/ahcc-talk-episode-80-handouts.pdf

📧 Questions or suggestions?Email Jan Milliman: [email protected]

Links Mentioned in the Episode🔗Guidelines for achieving a compliant query practice: https://acdis.org/resources/guidelines-achieving-compliant-query-practice%E2%80%942022-update

🔗Payment & Compliance Virtual Summit registration: decisionhealth.com/PCVirtual🔗 Learn more about AHCC and how to become a member: store.decisionhealth.com/join-ahcc

⬇️ Downloadable slides from this discussion: https://hcpro-catalog.s3.dualstack.us-east-1.amazonaws.com/DecisionHealth/AHCC/AHCC_Talk_Slides/2025/ahcc-talk-episode-80-handouts.pdf

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

On this episode, the panel discusses functional statis versus self-care by comparing and contrasting M1800 function items versus GG0130 self-care items.

 This month's panel includes:

Jan Milliman, HCS-D, Director, AHCC

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

Nanette Minton, RN, HCS-D, HCS-H, HCS-O, Senior Clinical Coding Manager, MAC Legacy

Links Mentioned in the Episode

Printout of slides (including April and May scenarios)

 Chapters

1:31 Functional status vs. self-care: comparing and contrasting M1800 functional items versus GG0130 self-care items

1:40 Basics of guidance

4:32 Conventions for M1800 items

5:31 Conventions for GG self-care and mobility items

7:53 Grooming (M1800 grooming, GG0130B oral hygiene)

9:24 Scenario

11:28 Upper body dressing (M1810 upper body dressing, GG0130F upper body dressing)

12:40 Scenario

14:45 Lower body dressing (M1820 lower body dressing, GG0130G lower body dressing)

16:17 Lower body dressing (M1820 lower body dressing, GG0130H footwear)

17:01 Scenario

19:33 Bathing (M1830 bathing, GG0130E bathing)

20:54 Scenario

22:58 Toileting hygiene (M1845 toileting hygiene, GG0130C toileting hygiene)

24:51 Scenario

27:17 Eating (M1870 eating, GG0130A eating)

28:51 Scenario

30:33 Scenario Spotlight: April coding practice scenario answer

34:26 May practice scenario

35:10 Product spotlight: Home Health Payment and Compliance Virtual Summit (Sept. 9-10, 2025)

35:51 What's new with AHCC?

On this episode, the panel gives a coding update, including hospice invalid principal diagnosis codes list update, a CMS update to Medicare claims, and the answer to the March coding scenario.

This month's panel includes:

• Jan Milliman, HCS-D, Director, AHCC
• Nanette Minton, RN, HCS-D, HCS-H, HCS-O, Senior Clinical Coding Manager, MAC Legacy

Links Mentioned in the EpisodePrincipal Diagnosis Code Reporting Update for Hospice and Manual Updates to Sections 30.3, 40.2, and 50 of Chapter 11 of the Claims Processing Manual: Processing Hospice Claims

Chapters

1:15 Hospice invalid principal diagnosis codes list updated

6:32 CMS pointed out hospice agencies must also follow ICD-10-CM coding conventions in the ICD-10-CM, Tabular List, Alphabetic Index, and official coding guidelines

9:19 CMS updated Medicare Claims, Processing Manual, Chapter 11

11:22 Processing hospice claims - principal diagnosis code reporting update: Medicare claims processing manual, chapter 11, sections 30.3, 40.2 and 50

11:48 Coordination and maintenance committee

14:58 Proposed new codes for 2026

18:50 March OASIS practice scenario answer

20:59 March OASIS practice scenario rationale

22:37 April coding practice scenario

24:00 What’s new with AHCC: AHCC Member's Webinar on May 15, 2025

On this episode, the panel discusses social determinants of health (SDoH), including its history, when to use different codes, and some sample coding scenarios.

This month's panel includes:

• Jan Milliman, HCS-D, Director, AHCC
• Sherri Parson, RN, HCS-D, HCS-O, HCS-H, COS-C, CEO, Infusion Health
• Kelly Kavanaugh, RN, HCS-D, HCS-H, HCS-O, BCHH-C, Home health and hospice consultant, owner of The OTB Group, Inc.

You can download the show notes for this episode here: https://ahcc.decisionhealth.com/media/1735/ahcc-talk-episode-77-handouts.pdf

Links Mentioned in Episode

Outcome and Assessment Information Set OASIS-E Manual: https://www.cms.gov/files/document/oasis-e-guidance-manual51622.pdf?gclid=1000

Healthy People 2030: https://odphp.health.gov/healthypeople

AHCC Credential Holders Survey: https://www.surveymonkey.com/r/S6R8QYK

Chapters:

(1:30) Intro on social determinants of health

(1:55) Coding and SDoH - what do you need to know to assign SDoH codes?

(2:28) Z55-Z65 socioeconomic and psychosocial circumstances

(4:50) Scenario from February AHCC Talk

(5:35) Answer to scenario

(7:05) When to use Z60.2?

(8:04) What is a social determinant of health (SDoH)?

(8:53) The history of social determinants of care

(10:45) Assistant Secretary reports to Congress

(12:09) Watch out for personal bias!

(14:36) OASIS-E SDoH items

(15:37) Standardization of guidance

(16:27) A1005 Ethnicity

(17:59) Race

(18:37) A1100 Language

(19:32) Coding literacy SDoH codes

(21:13) Health literacy

(22:27) Impact of health literacy

(24:08) Transportation

(26:17) Assigning Z59.82 Transportation Insecurity

(27:45) Social Isolation D0700

(28:59) Coding Social Isolation

(29:57) Next Steps

(32:34) Scenario Spotlight: OASIS Practice Scenario (tune in next month for the answer!)

(34:45) Resources

(35:26) AHCC Member Discount: Save 20% on the ICD-10-CM Coding Companion

(36:08) What's new with AHCC: AHCC Credential Holders Survey

On this special guest episode, DecisionHealth interviews two Home Health Coding Center super users to learn their thoughts about this online coding tool.

This episode's panel includes:

• Steven Brust, Product Manager, eSolutions
• Tina Bursey, RN, HCS-O, HCS-D, Manager of Clinical Operations, HealthRev Partners
• Stephanie Donato, RN, HCS-O, HCS-D Manager of Clinical Operations, HealthRev Partners

Experience the Home Health Coding Center firsthand. Register for a Free Trial here: https://web.hcpro.com/hhcc-ft?utm_source=Web&utm_medium=Podcast&utm_campaign=DHHHCC&utm_content=FreeTrial

Learn more about the benefits of Home Health Coding Center here: https://store.decisionhealth.com/application-tools?utm_source=Web&utm_medium=Podcast&utm_campaign=DHHHCC&utm

On this episode, the panel discusses face-to-face encounters, including three scenarios and F2F basics, as well as a review of the January 2025 OASIS Q&As and a scenario involving COPD.

This month's panel includes:

• Jan Milliman, HCS-D, Director, AHCC
• Nanette Minton, RN, HCS-D, HCS-H, HCS-O, Senior Clinical Coding Manager, MAC Legacy
• Lisa McClammy, BSN, RN, COS-C, HCS-D, HCS-O, Senior Clinical Education Consultant, MAC Legacy

You can download the show notes for this episode here: https://ahcc.decisionhealth.com/ahcc-talk-episode-76-face-to-face-questions/