• Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) – Kepro is the BFCC-QIO for 29 states, including Florida. The BFCC-QIO helps the Medicare program make the quality of care and health outcomes better. Services include assisting beneficiaries, their families, and with filing quality of care complaints and hospital discharge and skilled service termination appeals. They also offer Immediate Advocacy, which can be useful in specific situations.
  • Information for Health Care Providers
• Florida Medicare Review Contractor Directory
• Nationwide Analysis of Common Characteristics in Office of the Inspector General Home Health Fraud Cases (June 2016)
• Recovery Audit Contractor (RAC) – Performant Recovery is the RAC for Medicare fee-for-service home health providers in all 50 states. RACs review fee-for-service Medicare claims on a post-payment basis.
  • CMS Recovery Audit Program Overview
  • CMS-Approved Audit Topics
  • CMS Proposed Audit Topics
  • Discussion Period Request Form
  • Frequently Asked Questions
  • Provider Portal
• Responding to Home Health Additional Documentation Request (ADR) Checklist (Palmetto GBA)
• Targeted Probe and Educate (TPA) Program Overview
• Unified Program Integrity Contractor (UPIC) – SafeGuard Services, LLC is the UPIC in the South-Eastern Jurisdiction, which includes Florida and seven other states. UPICs perform fraud, waste, and abuse detection, deterrence, and prevention activities for Medicare and Medicaid claims. In 2018, UPICs combined and integrated functions previously performed by the Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC), and Medicaid Integrity Contractor (MIC) contracts.
  • Services Brochure
• U.S. Department of Health and Human Services Office of the Inspector General Compliance Resource Portal

• 2022 Home Health Payment Rates By County (Courtesy of BKD, LLP)
• Healthcare Common Procedure Coding System (HCPCS)
  • 2020 Alpha-Numeric HCPCS File
• Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year 2022
• ICD-10 Coding
• Medicare Learning Network Article 11721: New Codes for Therapist Assistants Providing Maintenance Programs in the Home Health Setting (May 2020)
• Medicare Payment Advisory Commission (MedPAC)
  • Home Health Care Services Basic Payment System Primer (November 2021)
• Medicare Physician Fee Schedules
• Outlier Payment Percent Calculator
• Rural Add-On Payments Based on County of Residence:
• Medicare Learning Network Article 10782: Home Health Rural Add-on Payments Based on County of Residence (December 2018)
• • CMS Manual System Transmittal 4106: Medicare Claims Processing (August 2018)
  • Federal Information Processing Standards (FIPS) County Codes

• CMS CoPs Frequently Asked Questions (January 2019)
• Revised CoPs Crosswalk: Patient Care and Organizational Environment (January 2018)
• Revised CoPs Delay of Effective Date (July 2017)
• Revised CoPs Final Rule (January 2017)
• Revised CoPs Frequently Asked Questions (Courtesy of Accreditation Commission for Health Care)
• Revised CoPs Guide to Compliance (Courtesy of the Home Care Alliance of Massachusetts)
• Revised CoPs Interpretive Guidelines (August 2018)
• Revised CoPs Survey Protocols/G-Tags (January 2018)
• Revised CoPs Surveyor Training
• Revised Home Health Agency State Operations Manual: Appendix B (G-Tags), Enforcement Guidance, and Revisions to Chapter 2 Certification Process (May 2014)
• Sample Patient Rights and Responsibilities (Courtesy of SimiTree Healthcare Consulting)
• Short Assessment of Health Literacy (Spanish and English)

• CMS Home Health Prospective Payment System Booklet
• CMS Medicare Home Health Benefit Booklet
• CMS Provider Compliance Tips for Home Health Services Fact Sheet
  • Medicare Provider Compliance Tips Educational Tool
• Compare Florida Home Health Agencies (Agency for Health Care Administration)
• Florida Home Health Outcomes and Met Quality Measures (Research Institute for Home Care & National Association for Home Care & Hospice)
• Florida Home Health Patients & Workforce (Research Institute for Home Care & National Association for Home Care & Hospice)
• Home Health Care Reducing Readmissions Toolkit (Courtesy of Alliant Health Solutions)
• Program for Evaluating Payment Patterns Electronic Report (PEPPER)
• Quality Matters – Archived monthly resource on quality-related home health issues
• State Benchmarking Reports – Includes Medicare payment data and comparisons, Key Performance Indicators (KPIs) to assess performance under the Medicare Patient-Driven Groupings Model (PDGM), and more (Courtesy of BKD, LLP)

• CMS Certification of Eligibility for Medicare Home Health Services
  • Progress Note Electronic Guidance
  • Supporting Statement for Paperwork Reduction Act Submissions Medicare Program: Home Health Face-to-Face Encounter Progress Note Templates
• CMS Certifying Patients for the Medicare Home Health Benefit Presentation Slide Deck (December 2014)
• CMS Face-to-Face Documentation Examples (December 2014):
  • Example 1
  • Example 2
  • Example 3: Part 1 | Part 2
  • Example 4: Part 1 | Part 2
• CMS Face-to-Face Frequently Asked Questions (February 2013)
• Face-to-Face Encounters: Avoiding Liability for Abandonment (Courtesy of Elizabeth E. Hogue, Esq.; 2011)
• Medicare Home Health Face-to-Face Requirement Presentation Slide Deck
• Medicare Learning Network Article: A Physician’s Guide to Medicare’s Home Health Certification, Including the Face-to-Face Encounter

• Client Rights Under HIPAA
• Health Care Provider Guide to HIPAA Privacy Rule
• Health Care Provider Model HIPAA Notice of Privacy Booklet
• Health Care Provider Model HIPAA Notice of Privacy Flyer
• Health Care Provider Model HIPAA Notice of Privacy Infographic
• Health Care Provider Questions and Instructions
• HIPAA Frequently Asked Questions
• Privacy Policy for Private Health Information (PHI)
• Sample Notice of Privacy Practices (Courtesy of Alternatives, A Consulting & Education Service)
• Summary of HIPAA Privacy Rule
• Summary of HIPAA Security Rule
• Understanding HIPAA

• Advocate's Guide to the Florida Long-Term Care Medicaid Waiver (Courtesy of the Florida Health Justice Project & Legal Services of Greater Miami; January 2021)
• Agency for Health Care Administration (AHCA) Recent Medicaid Presentations and Reports
• Florida Medicaid Complaints
  • Provider Tip Sheet – Submitting Online Complaints
• Florida Medicaid Health Care Alerts – Last 90 Days
• Florida Medicaid Provider Bulletins
• Medicaid and CHIP Payment and Access Commission (MACPAC)
• Provider Reimbursement Schedules and Billing Codes
• Statewide Medicaid Managed Care Program
  • Health Plan Provider Relations Contacts

• Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 (Expires June 30, 2023)
• Care Compare
• CMS Home Health, Hospice, and Durable Medical Equipment Open Door Forum
• CMS Home Health Quality Reporting Program Help Desks
• CMS Online Manuals
  • Transmittals – New or changes to policies or procedures that will be incorporated into the CMS Online Manual System
• CMS Quality, Safety & Oversight – Health and safety standards memos to beneficiaries, providers/suppliers, researchers, and State surveyors
• Federal Register
• Home Health Care Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
  • Home Health Care CAHPS® Survey Protocols and Guidelines Manual (January 2020)
• Home Health Change of Care Notice (HHCCN) (Expires April 30, 2022)
• Medicare & Home Health Care Official Government Booklet (September 2020) (September 2020)
• Medicare Enrollment Revalidation
• Notice of Medicare Non-Coverage (NOMNC)
• Provider Enrollment, Chain, and Ownership System (PECOS)
• Remuneration
  • AHCA Declaratory Statement on Medical Director Issues

• Certification Exam – The Certificate for OASIS Specialist-Clinical (COS-C) exam is 2.5 hours long and consists of 100 multiple-choice questions. Content is based on the most current rules and guidance provided by CMS, and scores are based upon the number of questions answered correctly. For more information, the following resources have been made available courtesy of OASIS Answers, Inc.
• Fall Risk Assessment Tool (Courtesy of the Missouri Alliance for Home Care)
• Florida Internet Quality Improvement and Evaluation System (iQIES) Help Desk

Susan Harris, OASIS Coordinator
Jennifer Babcock, OASIS Automation Coordinator
Survey and Certification Support Branch
Telephone: (850) 412-4501
Florida Relay Service (TDD): (800) 955-8771
Fax: (850) 414-6946
Email: FLQIES_HELP@ahca.myflorida.com

• Frequently Asked Questions
• Guidance on OASIS-C2 Integumentary Items- Best Practice for Clinicians (Courtesy of the Wound, Ostomy and Continence Nurses Society™; 2018)
• OASIS Considerations for Medicare Patient-Driven Groupings Model (PDGM) Patients (November 2019)
• OASIS Follow-Up Assessment Scheduling Calendar
• OASIS User Manuals
• Quarterly Updates
• Software
• Venous, Arterial, and Neuropathic Lower-Extremity Wounds: Clinical Resource Guide (Courtesy of the Wound, Ostomy and Continence Nurses Society™; 2019)

• Palmetto GBA Jurisdiction M Home Health and Hospice Medicare Administrative Contractor Website
  • Education Events
  • Frequently Asked Questions
• 16-State Home Health Coalition Reports
• Home Health Agency Prospective Payment System Claims Calculator
• Home Health Review Tool
• Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), Coverage Articles
• Local Coverage Determination: Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus

• 7 Steps to Effective Point of Care Software Selection: Position Your Agency for Success (Courtesy of WellSky)
• Health Information Technology Primer (Courtesy of the Home Care Technology Association of America)