Kenyon HomeCare ConsultingLeadership Archives - Kenyon HomeCare Consulting (206) 721-5091

Kenyon Connects


Can running my agency be easier?

Interim Manager helps frustrated nusiness ownerChanging government regulations and industry transitions make administration more challenging than ever. As a result, the past 5 years have put business owners on administrative overload! Sometimes, all you need is interim management to put a fresh perspective on the issues you face.

Streamlining Administration with Interim Management

Fortunately for owners and managers, there’s a solution to administration conundrum. Whether you’re understaffed or overwhelmed, interim management is an effective option for to simplify the areas listed below.


Running a home care agency is a different ballgame than many other businesses. With home care, you must consider the well-being of your clients— they’re health is at least partially in your hands. An interim manager helps ensure caregivers and the organization are in compliance with regulations, etc. This is great news since keeping up with these ever-evolving requirements is especially difficult for the average owner.

Billing and Financial

Improper billing procedures leads to errors which potentially leaves money on the table. Unfortunately, finding these errors takes time and attention to detail. The good news? Interim management professionals can help streamline billing methods and what mistakes keep you from maximizing revenue.


Your agency’s success depends on how smoothly operations run. From client care to paperwork—and everything in-between—the way team members handle responsibilities can make or break your agency. With help from interim management, operations run more efficiently that what you thought. Why? These experts have been in the industry for years seeing agencies thrive or fail based on operations. So, they know what leads to success.


If your home care agency seems to be doing well, there’s always room for growth. Whether growth comes from diversification of services or branch expansion, interim management is a must. The right interim manager allows a smooth transition that leads to growth while maintaining daily operations. This way, you can operate with minimum interruptions.

Kenyon HomeCare and Interim Management

At Kenyon HomeCare Consulting, we know exactly what it takes to make running your home care agency easier. It doesn’t have to be a struggle every day, so reach out to us now to learn more.

How do I communicate agency needs to my Interim Manager?

Interim ManagementYou’ve hired an interim manager.  that’s great-a first step toward success.But what now? How do you communicate your agency’s true strengths and weaknesses? If you’re like many home health owners, you question where problems lie or where to begin. Don’t fret. Here are practical tips for communicating your agency’s needs to your consultant.

Communicating with Your Interim Management Consultant

First things first: be honest. Don’t try to hide your trouble areas or gloss over anything that potentially interferes with seeking outside help. Once you open up and lay it on the line, follow the six tips listed below.

1. Start with obvious concerns.

Maybe you don’t have a clue why certain things are going the way they are. That’s okay. You probably have at least one or two big concerns you want addressed.Start with those major issues, and with help of your interim manager, you can uncover the root causes for them.

2. Don’t be afraid to admit you don’t know something.

During the course time with you, your interim manager will ask lot of questions. It helps paint a picture where your agency is in growth and operations. In the midst of these questions, speak honestly if you don’t the answers. Conjecture can hinder consultant progress.

3. Reveal the goals for your agency.

This one’s obvious but neglected. Often, agencies become so focused on correcting weaknesses, that the goals are lost. Take time with your interim manager and discuss every goal, both short- and long-term. Doing so gives the consultant a clear direction.

4. Give an account of past attempts.

Discuss what what has been tried unsuccessfully in the past? Make a list for your interim management consultant of the marketing, operational systems, etc. you’ve put into place before. Then, you interim manager can evaluate why these strategies didn’t work and what to do differently.

5. Willingly accept constructive criticism.

Nobody enjoys being told they’re doing something wrong, but sometimes it’s necessary for improvement. Keep in mind interim management is there to help. Anything said is out of desire for agency success.

6. Be open to change.

Along those same lines, be open to change. If you follow the status quo, then nothing will change for the better.

Kenyon HomeCare Consulting and Your Interim Management Consultant

Follow the tips above and you’ll be well on your way to establishing a beneficial relationship with an interim manager. Reach out to our experts to learn more about our interim management program

5 Reasons Staffing Can Be Attached To Leadership

LeadershipIn today’s world, good leadership makes a huge difference. This means poor management can cause turnover, poor morale, and decreased productivity.

Working With Interim Management Companies

Management methods makes a huge difference for staff. Here are five reasons to assess management of your organization.

1. Home Health/Hospice Responsibilities

Home health care and hospice are very different from other healthcare organizations. Nurses in homecare also function as amateur physical therapists, nutritionists, occupational therapists, and often clergy. That’s a lot of pressure for nurses. Therefore, effective management is important to help handle it.

2. Financial Success

Even though a passion for the mission is so important, clinical staff also need to make a solid living. Strong leadership gives employees a sense of security. Strong leadership equals agency success, which equals employee success.

3. Critical Thinking Skills

Nurses must provide care solutions that are unique to each patient in their own surroundings. This differs from the controlled environment of a hospital or SNF.  Management needs to promote critical and comprehensive thinking skills.  Then, nurses can properly assess and make the best decisions.

4. A Feeling Of Support

In the day-to-day requirements of home and hospice care, nurses can quickly become overwhelmed. If leadership functions in an environment of fear, employees will struggle. On the other hand, employees who feel supported are likely to thrive—and stick around.

5. Education And Preparedness

Many times, an employee’s performance comes down to training. Leaders offering education beyond the basics have better prepared employees. Hence, less turnover and top-notch client care results.

Making It Happen: Finding Interim Management Companies

Sometimes, this level of leadership can seem impossible. This is where interim management is key. Consultants can fill a void or help you find what’s missing in agency leadership.

At Kenyon HomeCare Consulting, we understand the value of effective leadership. Our interim management program has the tools you need to improve management skill.  Reach out to us today to learn more.

Abandonment Or Termination Of Homecare Services For Violence?

Today’s article, written by Elizabeth Hogue, a well-known health care attorney provides guidance about how to terminate services to patients in the face of violence or threatened violence against field staff members. Homecare field staff who provide services on behalf of private duty agencies, hospices, Medicare-certified home health agencies and home medical equipment (HME) companies are extremely vulnerable. Contributing to their vulnerability is the fact that they work alone on territory that may be unfamiliar and over which they have little control. Staff members certainly need as much protection as possible.

In Part 1 of this series, exposure to workplace violence was reviewed from the point of view of requirements of the Occupational Safety and Health Administration (OSHA). Also, the previous article addressed the potential liability of all types of home care providers for negligence when employees are injured as a result of violence. This article provides guidance about how to terminate services to patients in the face of violence or threatened violence. Providers are at risk for legal liability of abandonment when they terminate services to patients. Violence or threatened violence, however, likely warrants immediate termination of services. Providers show concern understandably about the possibility of legal liability associated with the termination of beneficial services.Abandonment

Liability for Abandonment

Specifically, providers remain concerned about the possibility of liability for abandonment of patients. Practitioners often speak of abandonment as though it is equivalent to termination of services. On the contrary, patients who want to hold case managers liable for abandonment must show that:

  1. Providers unilaterally terminate the provider/patient relationship
  2. Without reasonable notice
  3. When further action was needed

Patients who fail to prove any one of these requirements are likely to lose their lawsuits against providers.

As indicated above, abandonment requires unilateral termination of the relationship between the patient and the provider by the provider. In instances of violence or threatened violence, this requirement of proof of abandonment may be met when providers decide unilaterally to discontinue services.

Requirements of Abandonment

The second requirement of abandonment means that providers who give patients reasonable notice prior to termination of services will not be liable for abandonment. The key question is: what is “reasonable” notice? Providers should view what is reasonable on a continuum. That is, on one extreme end of the spectrum are patients who are violent or threaten violence. Practitioners are likely justified in terminating services immediately to patients who fall into this category. Providers are also likely justified in ending services to patients whose family members threaten violence or are actually violent.

Statutes and/or regulations in some states govern how much notice must be given to patients prior to termination of services. Some of these statutes address the issues of violence or threatened violence and permit providers to terminate services to patients immediately under these circumstances. Providers must carefully review requirements for the state in which the patient resides before terminating services.

After staff members agree that immediate termination of services due to violence or threatened violence is reasonable, patients and attending physicians should receive notice verbally and in writing. Written notices should be hand-delivered to patients’ homes. Although it is desirable, it is unnecessary to obtain a signature verifying receipt. Written notices to physicians may be faxed or hand-delivered.

After giving notice, providers must terminate care as planned. Practitioners are sometimes tempted to continue services in the face of pleas from patients, physicians, and/or family members. Providers must bear in mind, however, that one of their most important responsibilities is to protect staff members from harm.

How Providers Defeat Claims of Abandonment

Finally, providers can defeat claims of abandonment if patients for whom services are discontinued need no further attention. How do providers know whether further attention is needed? Is this requirement as subjective as it appears? On the contrary, judges are likely to make retrospective determinations about whether further attention was needed. The basis for such determinations will probably be whether patients were injured as a result of termination. In other words, the law is likely to conclude that no further attention was needed, so long as patients are not injured as a result of termination of services.

What kind of injury must patients prove? Can patients who attempt to prove emotional damage only as a result of termination of services win lawsuits? The “good news” for providers is that courts generally require proof of physical injury or damage before they will find providers liable for abandonment. Providers must, therefore, take appropriate steps to make certain that patients are not physically injured as a result of termination of services.

In rare instances, appropriate action may include sending an ambulance to take a patient to the nearest hospital. Even if patients refuse transport by ambulance, providers may avoid liability because patients likely assumed the risk or were contributorily negligent when they refused transport via ambulance.

In Conclusion

It does not appear that the world is becoming a kinder, gentler place for anyone. Field staff members must face their vulnerability every day. Those who are behind the firing line must provide support by shielding them from threatened or actual violence whenever possible.

If you need to develop or implement a comprehensive program to prevent violence in the workplace, Kenyon HomeCare Consulting is here to help! Schedule an appointment to speak with one of our experts or give us a call at 206-721-5091.

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

©2017 Elizabeth E. Hogue, Esq. All rights reserved.


Cybersecurity Issues: 4 Ways To Safeguard Your Home Care Agency

Issues of security breaches, resulting in the theft of credit card information or loss of access to systems are frequently in the headlines. The healthcare industry and home care are not immune.  We are all responsible for the protection of our patients’ and clients’ personal health information. These protections are mandated for home care organizations by HIPAA (Health Insurance Portability and Accountability Act), HITECH (Health Information Technology for Economic and Clinical Health) and other regulations. Today’s guest post is by Marcus Jensen who is a writer from Australia and the Editor-in- Chief of Technivorz blog. Besides working on Technivorz, his work has been featured on several prominent tech and business editorials. Although the examples cited by Marcus are not specific to home care, his cybersecurity recommendations are applicable to all of us.

Increase in Cybersecurity Issues for HealthcareCyber Security

The last couple of years have not been great cybersecurity-wise for anyone, healthcare organizations included. For instance, in 2015 alone, the Office of Civil Rights reported 253 healthcare data breaches which resulted in a combined loss of 112 million records. The vast majority of the biggest cyber security issues involved outside hacking in 2015.

In 2016, the situation is somewhat different, at least in the healthcare industry. Namely, a relatively large number of cybersecurity incidents included old-fashioned theft of devices such as laptops and simple human errors. In March, for example, Premier Healthcare had a laptop stolen from their billing department and since it was not sufficiently encrypted, data pertaining to more than 200,000 patients was stolen.

Moving away from healthcare for a while, 2016 has seen its share of hacking and other cybersecurity attacks from outside. Wendy’s, Oracle, Weebly and Snapchat are just some of the major players whose cybersecurity was compromised in one way or another in 2016.

According to security experts such as Securelink, 2016 saw an explosion in ransom-ware attacks, many of which aimed at healthcare, educational and even law-enforcement organizations.

If such big players are struggling to keep their data secure, what hope do small home care agencies stand?

Quite a bit of hope, actually. Namely, with a few smart practices and a comprehensive approach to cybersecurity, home care agencies can do a lot to keep their data and their patients safe.

Improve Cybersecurity With Education, Education, Education

It may seem like somewhat of a cliché, but when cybersecurity in any kind of an organization is in question, education truly is the cornerstone on which you build everything.

First of all, you as the home care agency owner need to learn as much as you can about cybersecurity, the different kinds of threats and the most common current trends. There are quite a few websites and blogs out there on this subject and it might be a good idea to acquaint yourself with them. This is a great list of cyber security blogs you might want to check out if you have the time.

The next step is ensuring that everyone who works for your agency has had at least the basic cybersecurity training. This will include talks on the importance of strong passwords, not sharing one’s credentials with anyone, not misplacing company devices and more. This training should also include something on social engineering, a practice where an attacker tricks an employee into thinking they are communicating with an official of some kind from some outside agency.

Use Proper Software to Expand Your Cyber security

There are plenty of cybersecurity software solutions out there, from firewalls to anti-malware software and more. Your agency is probably already using some sort of protection, but it never hurts to remind that using such software is a must.

It also has to be pointed out that cybersecurity software has to be allowed to update on a daily basis, sometimes even a few times every day. This provides the anti-malware software installed on your system with the ability to recognize the latest versions of malware.

In case you are employing third-party solutions such as any cloud-based software for other aspects of running your company, make sure that you are using the latest versions of the software and that it is secure. Every point of access to your system needs to be secured and monitored.

Cybersecurity Must Have-Back Up Everything Regularly

We should avoid junk food. We should try and keep our stress levels low. We should exercise every day. We should backup our systems. Most of the time, we follow such instructions. Every now and then, however, we forget about them or choose to ignore them.

When it comes to backing up your home care agency computer system, forgetting it may result in devastating complications.

For example, let’s say that you become a victim of a ransom-ware attack where someone encrypts your data and asks for money in return. Until you pay up (hoping they will actually let you decrypt your data) and decrypt everything, you have no access to your system, your data, anything really. By the time you are certain your system is once again “clean”, you will not have been 100% operational for days, perhaps weeks or even months.

Can you really afford this?

When you back up regularly (meaning every day or every second day at the least), such a situation is effectively prevented. You simply revert back to the most recent backup and the attacker cannot do a thing about it. Of course, this is not the only reason why you should back up your data regularly.

Ensure Physical Safety of Your Devices

In December last year, the Radiology Regional Center in Florida notified patients that some of their data was compromised due to their paper records literally getting lost in the street. Around that same time, a laptop belonging to Valley Hope Association was stolen from an employee’s car. We already mentioned a laptop being stolen from Premier Health’s billing department.

As you can see, patient and agency data can be easily compromised through basic physical access to the devices that store such data or that have access to such data.

Because of this, it is absolutely essential that you have strict policies in place, prescribing the physical safety and security of devices. All of the devices that can provide access to any sensitive patient information need to be accounted for at all times. Secure areas need to be limited to authorized individuals while equipment in less secure and high-traffic areas need to be additionally protected and monitored.

In short, know where your devices are and who has access to them.

Closing Word

In the end, it all comes down to a bit of education and using common sense. Keeping things simple and staying informed and vigilant will do the job in the majority of cases. If you are not 100% certain about what to do and how to behave, talk to professionals and heed their recommendations.

There is only one thing you must never do and that is to underestimate the importance of cyber security in the modern world.

For more food for thought, Ankota has a new e-book available for download called, Winning with the Home Health Value-Based Purchasing Program, that offers further insight on the discussion.  Just click the link here to download.

This article first appeared as “4 Ways Your Home Care Agency Can Safeguard Against Cyber Attacks” on the Ankota blog on December 5, 2016. Ankota provides software to improve the delivery of care, focusing on efficiency and care coordination.  Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care.


What Providers Need To Know: Violence Against Homecare Staff

Much thanks to Elizabeth Hogue, our esteemed colleague and well-known health care attorney for this article. Homecare staff who provide services on behalf of private duty providers, hospices, Medicare-certified home health agencies and home medical equipment (HME) companies are extremely vulnerable. Contributing to their vulnerability is the fact that they work alone on territory that may be unfamiliar and over which they have little control. Staff certainly need as much protection as possible.

First, we will review exposure to workplace violence from the Occupational Safety and Health Administration’s (OSHA) point of view. And then explore the liability of home care providers of all types for negligence when employees are injured as a result of violence.

Agency providers may be liable when field staff members are injured as a result of violence. The Occupational Safety and Health Administration (OSHA) may, for example, take action against homecare providers when patients are injured as a result of violence. Likewise, agencies may be liable for negligence. Recent enforcement action taken by OSHA against a private duty agency illustrates the likelihood of liability for such violations by homecare providers of all types.

Agency Providers Learn From Recent OSHA’s RulingProviders

On July 5, 2016, OSHA issued a $98,000 fine for an alleged willful violation of applicable requirements related to exposure to workplace violence, including physical and sexual assault. The citation was based on an investigation that began on February 1, 2016, after a staff member was assaulted by a homecare client. In this case, a staff member who previously took care of the client had warned the Agency about sexual assaults by the client. OSHA concluded that the Agency failed to protect its staff members from life-threatening hazards of workplace violence. According to OSHA, the Agency also failed to provide an effective workplace violence prevention program.

Specifically, OSHA took issue with two types of conduct by the Agency:
• Staff members were exposed to physical assault.
• There was no system in place for staff members to use to report threats and instances of violence to the Agency.

If OSHA’s citation is upheld, OSHA will require the Agency to abate these findings by:
• Developing and implementing a written, comprehensive program to prevent violence in the workplace
• Implementing a hazard assessment of violence in the workplace
• Developing and implementing measures to control violence in the workplace. Example: an option to refuse to provide services to clients in hazardous situations
• Develop and implement a training program on violence in the workplace
• Developing procedures to follow in instances of violence, including making reports and conducting investigations of such instances
• Putting in place a system that allows staff members to report all instances of violence, regardless of severity

Homecare Providers Responsibility to Protect Staff

Homecare staff members provide increasingly important services under circumstances that can be difficult, to say the least. Perhaps the highest obligation of all homecare providers is to protect their staff members. Proposed action by OSHA described above provides a “road map” for providers to follow as they continue to work to address the issue of violence against homecare staff members.

Providers owe their employees a duty of reasonable care. That is, they are responsible to take reasonable precautions to protect their employees from harm. This obligation may be far easier to talk about than to fulfill due to increasingly threatening environments for home care personnel. A key question regarding this obligation is: what is reasonable?

Homecare Providers and Reasonable Precautions

Reasonableness is determined by what other providers are doing across the country. In other words, whether providers are taking reasonable precautions to protect workers will be judged by comparison to what others throughout the country would have done under the same or similar circumstances. This definition of reasonableness poses particular difficulty for home care providers. There is a lack of data or even anecdotal information about how other companies are dealing with a number of key issues in home care, including protecting workers from harm.

Failure of agencies to fulfill their obligation of reasonable care can be in the form of: (1) acts or errors, and (2) omissions. In other words, providers must show that nothing happened to harm workers because of something that the providers did or should have done. Providers will be found to have caused injury to employees if the damage to employees would not have occurred “but for” an act or omission by employers. Courts generally require proof that employees were injured physically, as opposed to only emotionally, in order to compensate them for their injuries.

What Providers can do to Protect Employees From Harm

From a practical point of view, it is important to ask what providers can do to protect their employees from harm. The most important answer to this question is that managers must listen and take action when staff members complain about safety hazards.

One of the strengths of the home care industry has always been that staff members are willing to go beyond the extra mile to care for patients. The perception of many who know the industry well is that workers tend to put up with safety hazards that others would not hesitate to avoid. It becomes essential, therefore, for supervisors to listen carefully to staff members who complain about safety hazards. Assessments by most staff members that they regard situations as unsafe are usually valid since their natural inclination is to continue to provide services to patients in unsafe situations.

It is also extremely important for managers to take action in response to complaints by personnel. There is an old legal adage that “every dog is entitled to one bite.” This means that, as soon as the dog has bitten one person, those responsible for the animal are on notice that the dog is dangerous. They must then take reasonable precautions to prevent further injury or damage. Consequently, once employees register even a single complaint regarding dangers associated with the care of particular patients, employers are likely on notice that further care may involve harm to workers. In view of this “first bite,” so to speak, providers must take appropriate action or face possible liability for injuries to their personnel. What kinds of actions are appropriate?

Defining Appropriate Actions for Providers

The use of so-called “escorts;” including armed, off-duty police officers; may be appropriate. Some home care personnel, however, object to use of escorts. The basis for their concern may be that the presence of escorts interferes with their relationships with patients. They point out that there is an essential inconsistency between the caring and nurturing relationships they wish to foster with patients and their families and the use of escorts. Some workers also express concern about their reputations in the community when escorts are used, especially if they live in the community in which they make home care visits.

Providers may, therefore, decide to implement a policy that staff may not reject escorts when management deems their use is appropriate. Refusal of escorts should be defined as insubordination in such policies and procedures, and appropriate disciplinary action, including termination of employment, should be taken in response to this type of insubordination.

Termination of services to patients is also an appropriate response to concerns regarding the safety of home care staff members.

Home care personnel knock on the doors of thousands of patients each day, unaware of what may be inside their homes. They regularly encounter unfamiliar terrain and unknown risks. These risks are likely to become even greater as the use of home care services continues to expand. Managers and field staff must be prepared to deal with the constant potential for compromised safety.

If you need to develop or implement a comprehensive program to prevent violence in the workplace, Kenyon HomeCare Consulting is here to help! Schedule an appointment to speak with one of our experts or give us a call at 206-721-5091.

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

©2016 Elizabeth E. Hogue, Esq. All rights reserved.


3 Approaches Home Care Uses To Help Clients Avoid Financial Scams

As the American population grows older and more of its wealth becomes controlled by senior citizens, home care agencies must be able to help their clients both recognize and avoid instances of financial scams and fraud.

Unfortunately, financial scams targeting older adults remain one of the most common forms of fraudulent criminal activity. Elderly individuals are frequent targets, due to the effects of age on memory, cognition and social participation. And that situation can be exacerbated by a revolving door of strangers entering an elderly person’s home. But, it’s also an opportunity for care agencies to provide safety measures to ensure clients aren’t taken advantage of.

“As it is with any employed position, caregivers will come and go,” said Joy Loverde, author of The Complete Eldercare Planner and the upcoming Who Will Take Care Of Me When I’m Old? “Caregiver burnout is a significant industry problem with high rates of annual staff turnover — between 40 and 60% in home care agencies, according to research conducted by the Paraprofessional Healthcare Institute.”

The only steady relationship most clients have with the home care agency is with the owner and their care manager. That’s why an extra layer of “scam security” is necessary to safeguard both your staff and clients.

Loverde suggested the following best practices for home care agencies to help their elderly clients avoid financial scams like those noted by the Federal Bureau of Investigation:

Avoid Financial Scams: Safeguard Finances, Correspondence & Valuables

Financial Scams

During the initial home visit, ask clients specific questions about their financial-management and mail-management systems.

“Ask clients: Who manages your finances and your incoming mail? Who is directly responsible for paying your bills? Importantly, the goal is to find out if clients have an existing system in place for averting financial abuse,” Loverde said.

Ascertaining such details as who is responsible for paying credit cards and other bills or who balances the checkbook can help determine not only if the client has already been a victim of fraud (like debt collection scams) and if they are still at risk.

“Experts say most people don’t realize they’ve been scammed right away. It’s only later they feel something ‘wasn’t right,’  Loverde said. Intelligent, well-read and accomplished people succumb to slick sales pitches, fearing exposure of the incident might bring their competence into question.” “Some victims choose to forget about the loss and keep it a secret.”

Also during the initial home visit, “put the topic of valuables on the table,” Loverde said. “It is not uncommon for home care workers to be unjustly accused of stealing. Discuss with clients and family members the importance of putting away private papers, cash, and valuables in a safe place.”

Avoid Financial Scams: Provide Documentation of Caregiver Vetting Process

“Among other questions, clients deserve to know: Why are you recommending this particular person for this job?” Loverde said. “What kind of background check did you conduct on this person?”

You can obtain forms online that will help identify and organize the documents providing proof of a potential caregiver’s skill set. A personal care agreement, or contract between the individual who agrees to provide caregiver services and the person receiving care, can serve to protect your loved one should they need a legal advocate.

Avoid Financial Scams: Provide Training for Designated Managers and Caregivers

Loverde suggests providing certain staff members with sensitivity training around financial scams. Also providing clients with written documentation of part of this training.

“Care managers and caregivers should be aware of how the client manages their incoming mail, unexpected visitors who pose as healthcare or home repair representatives, use of internet, and incoming telemarketing phone calls, among other scam tactics,” she said.

Determining if elder clients have already been victimized can be difficult.  But, Loverde recommends observing their behavior when the subject is brought up. Do they clam up? Become standoffish?  She suggests watching for other clues such as:

  • Overdue bill notices and bounced checks
  • Unusual activity in bank accounts and cash withdrawal machines
  • Withdrawals of large amounts of cash
  • Unrecognizable signatures on financial documents
  • Conflicting accounts of incidents
  • Forgetfulness regarding the whereabouts of checkbooks, bank and credit card statements
  • Frequent trips to gambling casinos
  • Recent changes in wills or the creation of a new will
  • Increased frequency of incoming telephone calls
  • Large volume of mail that promotes prizes or free trips
  • Valuables such as artwork, silverware, and jewelry going missing

By putting these measures in place, you can help ensure that clients, family members, staff and your agency are all scam-aware and, hopefully, scam-free.


If you’re looking for additional ways to expand your knowledge-base or business, download Ankota’s free white paper, Why Care Transitions Is The Next Big Thing for the Home Care Industry.  Just click the link to download.

Writer of this post, Constance Brinkley-Badgett is an editor and writer at In the past she was as an editor for, senior digital producer for CNBC, and digital producer for NBC Nightly News. Constance is a graduate of the International Culinary Center in New York. She has worked for chefs such as April Bloomfield and Jean Georges Vongerichten, and is the founder of Crave Personal Chef Services in Austin, Texas.

This article first appeared as “3 Ways Home Care Agencies Can Help Clients Avoid Financial Scams” on the Ankota blog on December 14, 2016. Ankota provides software to improve the delivery of care, focusing on efficiency and care coordination.  Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care.

Need Help? Second Round Of Probe And Educate Review Is Here!

Late last year, Centers for Medicare & Medicaid Services (CMS) announced the roll out of the Home Health (HH) Probe and Educate Review Program. Each Medicare Administrative Contractor (MAC) conducts these reviews. This round required all Medicare HH agencies (HHAs) to submit five Additional Documentation Requests (ADRs) for prepayment review. According to first round data, 92% of the HHAs received payment denials on at least one but up to five of these ADRs. CMS considers the results of this review a colossal agency failure. As a result, in January 2016, CMS released additional information about the failed ADRs. And based on the outcomes of the initial five ADRs, CMS requested additional records for review.

Fast forward to 2017. Currently, the second round of  HH Probe and Educate Reviews are underway with agencies in Florida the first to experience these reviews. According to the MAC Palmetto GBA, as in the first round, MACs will do a pre-payment review of a five claim sample. However, agencies with claim reviews in the first round with only one or zero claim errors will not receive reviews in round two. Therefore, all other home health agencies should expect to receive a probe-and-educate review request.

Probe and Educate Review

What is a Probe and Educate Review?

Throughout this document, the term “HH Probe and Educate Review” will refer to home health reviews conducted by each MAC. These reviews will determine if the requirements for HH certification/recertification, patient eligibility, coding and medical necessity (CMS-1611-F requirements) meet compliance.

Purpose of the Home Health Probe and Educate Review

The primary HH Probe and Educate review process purpose is to ensure understanding of the patient certification CMS-1161-F requirements. CMS will direct MACs to apply CMS-1611-F and any additional CMS guidance, when conducting HH Probe and Educate reviews. Eligible claims will be for HHA episodes that start on or after August 1, 2015.

During the second round of reviews, MACs will take different follow-up actions, depending on the number of errors found in each review.  See the December 16, 2016 CMS Medicare Learning Network memorandum to examine these actions.

When conducting a HH Probe and Educate review, CMS will instruct MACs to review the 5 sample claims for compliance with:

  • Certification/recertification documentation of patient eligibility for Medicare home health services
  • Face-to-face encounter requirements
  • Coding
  • Medical necessity
  • Medicare coverage and payment criteria

Areas Subject To Additional Documentation Requests

While the program’s intent is to educate home health providers, those with significant deficiencies may be subject to further reviews and additional documentation requests. During round one the most common denials involved face-to-face issues.

Particular review and scrutiny areas for the latest reviews will focus on:

  • Excessive lengths of stay (120 to over 300 days average LOS)
  • Questionable patient eligibility and medical necessity
  • Failure to obtain required face to face documentation for all cases
  • Coding that does not have supporting documentation as to severity

More Probe and Educate Review Information

CMS modified the additional documentation request (ADR) limits for the Recovery Auditor program for home health providers effective January 1, 2016. Therefore, HHAs may expect an increase in ADRs.  Consider the following CMS instructions and information.

Additional Documentation Limits for Medicare providers (except suppliers and physicians)

CMS is basing each provider’s annual ADR limit on the number of Medicare claims paid in the previous year associated with their 6-digit CMS Certification Number (CNN) and the provider’s National Provider Identifier (NPI) number.

  1. The annual ADR Limit will be one-half of one percent (0.5%) of the provider’s total number of paid Medicare claims from the previous year.
  1. CMS is sending ADR letters on a 45-day cycle. The annual ADR Limit will be divided by eight to establish the ADR cycle limit, which is the maximum number of claims that can be included in a single 45-day period. Although the Recovery Auditors may go more than 45 days between record requests, in no case shall they make requests more frequently than every 45 days.

For example:

  • Provider A billed and was paid for 22,530 Medicare claims in 2014. The provider’s ADR limit would be 22,530 x 0.005, which is 112.65. The ADR cycle limit would be 112.65/ 8 = 14.08 and would be rounded to 14 additional documentation requests per 45 days.
  • Provider B billed and was paid for 255,000 Medicare claims in 2014. The provider’s ADR limit would be 255,000 x 0.005, which is 1,276. The ADR cycle limit would be 1,276/ 8, which is 159.375 and would be rounded to 159 additional documentation requests per 45 days.
  1. ADR limits will be diversified across all claim types, based on the Types of Bill (TOB) that the provider was paid for in the previous year.
  1. CMS will adjust a provider’s ADR limit based on the provider’s compliance with Medicare rules. Providers with low denial rates will have ADR limits decrease. And conversely, providers with high denial rates will see their ADR limits increase.
  1. CMS reserves the right to establish a different record limit when directing the Recovery Auditors to conduct reviews of specific topics or providers.
  2. Additionally, direct questions concerning this update to

Hence, Kenyon HomeCare Consulting believes that agencies must prepare for the continual increase in prepayment ADRs. Also, you must have the ability to contest as many denials as possible. Failure to either successfully contest denials or to not have the standing to contest, may well put you out of business.

If you are struggling with ADRs or round two of Probe and Educate Reviews, we are here to help! Call 206-721-5091 or contact us to schedule an appointment to get assistance today.

5 Sales Hacking Fundamentals To Improve Home Care Sales

Ankota’s marketing director, Jed Hammel doesn’t come from the home care world but instead is an expert is social media marketing, film making, event planning and more.  Jed wrote today’s article about how “Sales Hacking,” a term coined by the startup world, can be incorporated into your home care agency’s sales strategy.

What is Startup Growth Hacking?Sales Hacking

A few weeks back, I wrote an article about “Growth Hacking,” entitled, “Growth Hacking Tips for Home Care via Startup Marketing.” The piece went over the basics and some different definitions of a new kind of marketing/sales approach used in many startups and a growing number of other industries.

I suggest you click the above link and read the full article, but as a way to sum up:

Uber growth hacker Andrew Chen offers this as a definition for growth hacking:

“Growth hackers are a hybrid of marketer and coder, one who looks at the traditional question of “How do I get customers for my product?” and answers with A/B tests, landing pages, viral factor, email deliverability, and Open Graph. On top of this, they layer the discipline of direct marketing, with its emphasis on quantitative measurement, scenario modeling via spreadsheets, and a lot of database queries. If a startup is pre-product/market fit, growth hackers can make sure virility is embedded at the core of a product.”

What is Sales Hacking?

Good Question, glad you asked!  In this article by Vinod Mehra“What is Sales Hacking?” the author defines Sales Hacking as:

“Sales Hacking is shortening the sales cycle by authentic means.  For examples if sales process says you move from A to B followed by C to receive the Order D.  How can you short circuit step B & C to receive an order D is SALES HACKING.  In simple words what tactics can be used to short circuit B & C to reach D.”

I suggest that you read the entire article here since it outlines 7 tips for hacking sales that I feel you will find useful.

 5 Useful Sales Hacking Tips

One of the leading inbound marketing/sales companies, Hubspot, posted an article, “5 Small Sales Hacks That Will Increase Your Results in a Big Way” written by Brian Moseley that offers some easy ways for you to get started with sales hacking as well.  You should read the entire article here to get an in-depth perspective, but as a start, here’s what the author suggests:

1) Shorten Your meetings

2) Split Up Your Inbox

3) Label Your Emails

4) Pin Tabs

5) Use the Right Tools

What are some of your sales hacking tips?  What tools do you use to prospect, nurture, and close sales?  Share your tips in the comments below!

Also, one of Ankota’s recent whitepapers, entitled “Selling Care Transition Services to Hospitals” is available for download and we think you’ll find it useful.

This article was posted by Jed Hammel and first appeared as “5 Sales Hacking Tips for Home Care via a Startup Leader” on the Ankota blog on Nov 28, 2016. Jed Hammel is the marketing at Ankota LLC whose mission is to improve the efficiency and coordination of care outside of the hospital.  Ankota provides software to improve the delivery of care, focusing on efficiency and care coordination.  Ankota’s primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care.


HHABNs Are Gone! Introducing The Supposed More Simplistic HHCCN!

As Elizabeth Hogue, our esteemed colleague and well-known health care attorney explains in this article, The Centers for Medicare and Medicaid Services (CMS) has announced that the Home Health Change of Care Notice (HHCCN) has replaced two notice formats of the Home Health Advance Beneficiary Notice of Noncoverage (HHABN). And the HHABN will be discontinued. Providers using HHABNs understand they have three different notice formats, called “Option Boxes,” given to patients under certain circumstances. The HHCCN will replace Option Box 2 and Option Box 3 formats of the HHABN. The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 will replace the HHABN Option Box 1 format.HHABN

Home health agencies should begin using the HHCCN as soon as possible. There will, however, be a transition period during which agencies can use either the HHCCN or the HHABN. The date for mandatory, exclusive use of the HHCCN will be posted on the CMS website at some unspecified time in the future.

When Is a HHCCN Required?

Reductions or termination of care are triggering events for requirements to provide HHCCNs.

HHCCN’s should be issued to beneficiaries or their representatives for notification of changes in plans of care (POCs). Specifically, agencies must provide HHCCN’s whenever they reduce or terminate beneficiaries’ home health services due to orders from physicians and other providers or limitations of the agency to provide specific services for both covered and non-covered services listed in POCs.

An example of triggering events due to orders from physicians/providers includes: “The POC includes wound care every day. The physician writes a new order to decrease wound care to every other day.”

An example of triggering events due to agencies’ inability to provide specific services includes: “Physical therapy (PT) services are ordered four times per week in the POC. The Agency has an unexpected staffing shortage and can only provide PT services two times per week.”

If termination of services involves the end of all Medicare-covered care and no further care is being delivered, the only notice agencies must issue is the Notice of Medicare Non-coverage (NOMNC), Form CMS-10123.

What Instructions Are Available for HHCCN Completion?

CMS has also provided general instructions for the completion of HHCCNs. Among the instructions are the following:

  • Electronic issuance of HHCCNs is permitted. If agencies elect to issue HHCCNs viewed on electronic screens before signing, beneficiaries must be given the option to receive paper copies. Whether the notice is presented to beneficiaries electronically or on paper, beneficiaries must be given copies of signed HHCCN’s for their records.
  • Agencies may reproduce HHCCNs using a variety of methods, but the HHCCN cannot exceed one page in length.
  • Agencies can customize HHCCNs, including pre-printing agency-specific information to promote efficiency and to help ensure clarity for beneficiaries. Guidelines for customization are included in the instructions for use of the form.
  • When there are changes in care that require HHCCNs, agencies must list changes in the area under “Items/services” on the form and must indicate whether the item/service is being reduced or terminated in language understandable to beneficiaries. Examples are: “On December 17, 2016, we will stop all of your occupational therapy services.” or “On December 17, 2016, the frequency of your wound care will decrease to three days per week.”
  • In the blank area under “Reason for change” on the form, agencies must insert the specific reasons changes in care occur. An example related to changes in physicians’ orders is: “Your doctor has changed your order for this care.” An example related to agency related changes is: “Your dog has repeatedly threatened our staff, so we are unable to safely enter your home.”
  • HHCCNs must be signed by patients or their representatives. When patients’ representatives sign instead of patients this fact must be noted on the form next to representatives’ signatures. If beneficiaries refuse to sign, agencies must note this on HHCCNs and provide copies of annotated HHCCNs to beneficiaries.
  • When delivering HHCCNs, agencies are required to explain the entire notice and its contents and to answer all of beneficiaries’ questions. Delivery of the form in-person is not required.


Detailed information about this change can be found in the Medicare Claims Processing Manual, Chapter 30, Section 60.

Here we go again! Something new that is supposed to make providing care easier, but, at least initially, seems to be just the opposite!

For more information about this or other legal issues in homecare, contact Elizabeth as outlined below.

Elizabeth E. Hogue, Esq.

Office: (877) 871-4062

Twitter: @HogueHomecare

©2016 Elizabeth E. Hogue, Esq. All rights reserved.