Are You A Medicare Certified Home Health Agency Who Doesn't Really See Medicare Patients? Could You Be Targeted For Deactivation?

June 9, 2023

If you are members of the National Association for Home Care and Hospice or your respective state associations, then you may have already heard of the "Organization Deactivation Project 2022". If not, then your agency may be at risk if you haven't been servicing Medicare patients in the last year.

Many states without licensure require agencies to be Medicare certified in order to meet state requirements for providing services to Medicaid and other non-Medicare payers. So, Medicare certification was a necessity and servicing Medicare patients was not necessarily your target for market share. It appears some agencies have already received letters from their Medicare Administrative Contractor (MAC) if they have not submitted Medicare claims in the past 12-13 months. Ultimately, those organizations in business to serve only Medicaid will want to consider marketing for some Medicare patients. Now, an agency that never plans to bill Medicare may not see an issue with deactivation of Medicare billing privileges. It becomes an issue if CMS wants to potentially revoke enrollment in the Medicare system which would negatively impact those states that have no choice but to be Medicare certified. An agency would then potentially need to submit a new 855 and start the enrollment process for Medicare all over again to bill for services. This would be costly for providers who would be going through additional survey and providing care for free during the interim. Ultimately, this may a be hard push from CMS for states without licensure to put it in place. From the federal level, you can see how this would make sense. It makes the states wholly responsible for those Medicare certified agencies billing for only for Medicaid and non-Medicare payers within the state.

If CMS is looking into this, then agencies servicing only Medicaid and Medicaid waivers need to look closely at their patients. Are your dually-eligible patient qualifying for the Medicare home health benefit at different times but not being discharged from a Medicaid plan of care? Now, we have no confirmation that this is something CMS is looking at, but it could potentially show the states that Medicaid dollars are going to patients who qualify for Medicare services. At Kenyon Homecare Consulting, we encourage all agencies to belong to their respective state associations as well as NAHC. There is a wealth of education, advocacy, and resources for agencies. If you need individual consulting or education, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online to see if we can help you achieve your clinical, operational, and financial goals.

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From Crisis to Control: Home Care Staff Training That Reduces Readmissions and Elevates Outcomes

By Ginny Kenyon • April 25, 2026

In the rapidly evolving landscape of healthcare, the burden of care is increasingly shifting from clinical facilities to the home. As the population ages, the prevalence of chronic conditions—such as heart disease, diabetes, and respiratory disorders—has reached unprecedented levels. For home care agencies, the quality of service is no longer just about assistance with daily living; it is more and more defined by the clinical competencies and disease-specific knowledge of your field staff. Chronic disease education for home care staff is not a luxury, is a strategic necessity that directly impacts patient outcomes, caregiver confidence, and the business’s bottom line. 1. Enhancing Clinical Outcomes and Safety Home care staff are the "eyes and ears" of the healthcare system. When aides and clinicians are highly educated on chronic disease processes, they can identify subtle shifts in a patient's condition before they escalate into emergencies. · Early Intervention: An educated caregiver can recognize the early signs of fluid retention in a Congestive Heart Failure (CHF) patient or skin changes in a diabetic patient, allowing for proactive adjustments rather than reactive ER visits. · Medication Adherence: Understanding why a medication is prescribed for a specific chronic condition helps staff reinforce the importance of adherence to the patient, reducing the risk of complications. 2. Reducing Hospital Readmissions Hospital readmission rates are a primary metric for home health success. Chronic diseases are the leading cause of "revolving door" hospitalizations. By providing specialized education, agencies empower their staff to implement Evidence-Based Practices at the bedside. When staff can effectively manage symptoms and educate patients on self-care, the likelihood of a patient staying stable at home increases dramatically. This not only benefits the patient but also strengthens the agency’s reputation with referral sources like hospitals and physician groups. 3. Boosting Staff Confidence and Retention The home care industry faces significant challenges with staff turnover. Often, burnout is fueled by the stress of feeling unprepared for complex patient needs. Knowledge is Empowerment: When staff members receive robust training, they feel more confident in their roles. This professional growth fosters a sense of value and belonging within the organization, leading to higher job satisfaction and lower turnover rates. 4. Improving Documentation Accuracy In an era of increased regulatory scrutiny, clinical documentation must be precise. Education on chronic diseases ensures that staff members use the correct terminology and focus on the most relevant clinical indicators during their assessments. · OASIS Accuracy: For Medicare-certified agencies, a deep understanding of chronic conditions leads to more accurate OASIS scoring, which directly influences reimbursement and quality ratings. · Audit Readiness: Well-educated staff produce notes that clearly reflect the necessity of care, making the agency much more resilient during regulatory surveys or audits. 5. Bridging the Communication Gap Effective chronic disease management requires a multidisciplinary approach. A caregiver who understands the nuances of a disease can communicate more effectively with: · Physicians: Providing clear, clinical updates that help doctors make informed decisions. · Family Members: Offering clear explanations and peace of mind to stressed family caregivers. · The Internal Team: Ensuring a seamless transition of care and consistent messaging across all disciplines. Conclusion Investing in chronic disease education is an investment in the agency’s future. By elevating the knowledge of the frontline workforce, home care providers can transform from basic service agencies into high-value clinical partners. In the end, the goal is simple: providing the highest quality of life for patients in the comfort of their own homes, a goal that can only be met through a highly trained and knowledgeable staff. If you do not know where to get comprehensive education for Chronic diseases, contact Kenyon Homecare Consulting at gkenyon@kenyonhcc.com or call 206-721-5091. We are here to help