Home Care Expert Insights

In Conversation with Keith Grunig to Bring His Insights on Navigating Home Health Challenges

Addressing the complexities of home health care is essential to ensuring high-quality, compliant services in today’s dynamic healthcare environment. With the transition to value-based care models like the Patient-Driven Groupings Model (PDGM), agencies are under increasing pressure to enhance care outcomes while maintaining financial stability.

Accurate OASIS assessments and diagnosis coding form the cornerstone of success, as they dictate reimbursement, reflect care conditions, and guide care plans.

Data serves as a powerful tool in overcoming these challenges, enabling agencies to prevent claim denials, monitor compliance, and identify trends for improved operations. However, leveraging data effectively requires a thoughtful approach that respects patient individuality, avoiding the pitfalls of a cookie-cutter methodology.

Staying updated with federal and state regulations, such as the Conditions of Participation (CoPs), further ensures compliance and audit readiness. Agencies benefit from expert guidance, robust training, and advanced tools to stay ahead of the curve.

By meeting these challenges head-on, home health providers can achieve better outcomes, optimize revenue, and uphold their commitment to exceptional client care.

To shed some light on the same, we interviewed a home care industry expert to bring his perspective on navigating home health challenges.

Expert QA session with Keith Grunig

Who Did We Interview?

Keith is a seasoned C-Suite Executive with extensive experience overseeing sales, marketing, HR, and core business functions. He excels in data analytics, leveraging tools to deliver accurate revenue, headcount, and financial forecasts—consistently landing within 4% of targets.

Keith’s strategic approach includes market analysis, segmentation, and competitive positioning to drive growth. He has a proven track record of implementing strategies to recruit new customers, retain existing ones, and re-engage former clients, building a solid foundation for sustained success.

Let us now delve into what he has to say about navigating home health challenges:

Question 1: How do your services balance the dual goals of optimizing revenue and improving care outcomes, especially in an increasingly value-based care environment?

There really aren’t dual goals to balance. Accuracy is the goal. When there is accuracy, the revenue is optimized. Agencies are appropriately and accurately reimbursed for the care that is needed for the patient.

Accurate OASIS is essential for many reasons. First, OASIS accuracy provides correct and accurate data for reimbursement. The Patient-Driven Groupings Model (PDGM) is a cost-based system. The CMS uses cost inputs from cost reporting for many years to know what the estimated cost would be to care for a patient with certain conditions, functional impairment levels, and comorbidities.

That is reimbursed along with some estimated profit for the business to make some profit. OASIS accuracy also sets the bar for accurately representing the condition of the patient at the time of the assessment. The issue is if the OASIS isn’t accurate at the time of assessment, then there isn’t much room for patient improvement to reflect in the outcome.

Likely, patients are improving. Unfortunately, many clinicians do not understand what the CMS is asking in several OASIS questions, so the likelihood of a correct response is low. That impacts outcomes because a patient likely wasn’t at the level OASIS was scored prior to whatever event or events happened to necessitate home health. That results in home health agencies not getting credit for the wonderful work and care they’re providing- what a shame!

Home Care Answers provides accurate coding and OASIS to paint the most accurate picture of the patient, in code form, as possible to reflect the need for services and appropriate reimbursement based on the needed cost of care for that patient to help the patient improve.

Question 2: What educational resources or support does Home Care Answers provide to help agencies stay updated on best practices and changes in OASIS requirements?

Home Care Answers trains internal employees weekly to ensure we are up to date with the rules, regulations, and guidance from the CMS. This training is reflected in the work we do and the ongoing training we provide on our chart reports.

We provide clinicians with detailed guidance on every chart we review, explaining not only the suggested changes to OASIS questions but also the rationale behind them. At Home Care Answers, we are committed to ongoing education for agencies, regularly offering training to enhance their expertise.

Excitingly, we’re preparing to launch a revolutionary new education platform by the end of Q1 this year, set to transform training in the home care industry.

Question 3: Given Utah’s specific home health regulations, how do you ensure compliance with state and federal guidelines while helping agencies maximize revenue?

Home Care Answers follows Federal CMS guidance to ensure compliance with Medicare regulations, which are governed at the federal level. These rules are outlined in key resources such as the Final Rule, Conditions of Participation (CoPs), and the Medicare Beneficiary Guide.

While there are state-level practice act considerations that may influence what clinicians can or cannot do, these rarely impact Home Care Answers’ chart auditing and QA approach, allowing us to maintain a consistent and federally aligned methodology.

Question 4: In what ways can technology, including predictive analytics, help agencies better prepare for audits and reduce claim denials?

I firmly believe that “Data drives decisions, and great data drives great decisions.” At Home Care Answers, we provide agencies with actionable data to help identify trends and prevent denials, with the most common issue being valid Face-to-Face documentation. For every chart we review, we highlight the elements that are present or missing, enabling agencies to track and address these issues to maintain compliance effectively.

It’s important to remember that data is neutral—it simply reflects the facts. While it is a powerful tool for informing decisions, agencies must balance data insights with the individuality of each patient. A cookie-cutter approach to care can lead to compliance issues, especially when predictive analytics inaccurately assign diagnoses based on patient profiles. The key is to use data wisely, combining it with personalized care to achieve the best outcomes.

Question 5: Looking ahead, what are your top predictions for how OASIS review and coding will evolve in 2025, and what should home health agencies prioritize to stay competitive?

OASIS reviews remain critical to driving reimbursement as the CMS relies on data to shape policy. Historically, many agencies submitted inaccurate data to CMS, particularly before PDGM, when agencies would often use therapy utilization as a means to drive revenue rather than accurate coding, OASIS, and therapy utilization. This led to OASIS and coding being deprioritized, contributing to flawed data that the CMS used to develop policies. PDGM removed therapy utilization as a component of revenue calculation, thus putting accurate coding and OASIS as the only way revenue is generated and calculated. Agencies cannot afford to not have accurate and compliant coding and OASIS.

As technology advances, it offers opportunities to streamline processes, but a measured approach is essential as these tools mature and CMS clarifies regulations. At Home Care Answers, we embrace technology to enhance efficiency while ensuring the highest accuracy in OASIS reviews and coding, supported by our team of US-based reviewers.

In Conclusion

Keith Grunig’s insights emphasize the critical balance of leveraging accurate data and personalized care to navigate the complexities of home health. By prioritizing OASIS accuracy, maintaining compliance with federal and state regulations, and embracing innovative technology, home health agencies can optimize reimbursement and enhance care outcomes.

Keith’s leadership at Home Care Answers, combined with his forward-thinking strategies, provides a roadmap for agencies to thrive in the evolving healthcare landscape. As the industry looks to 2025, his expertise highlights the importance of continuous education, actionable data, and a tailored approach to achieving long-term success.

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