[4035] Under the Microscope | Illuminating Documentation for Medical Review
This program illuminates exactly what reviewers look for — and exactly where agencies most often fall short.
Presentation Info:
- TAHC&H Event | 57th Annual Meeting | Rich-Media Presentation Capture | Online On-Demand Access
- Presentation Date: September 2nd , 2026
Program Description:
Home health documentation has never been under more scrutiny. Six states now operate under the Review Choice Demonstration, ADR volumes from Palmetto GBA TPE rounds remain elevated, Noridian SMRC project reviews continue to expand, and UPIC investigations carry broader authority than ever. Across every one of these programs, reviewers ask the same question: does the record support what was billed?
This session illuminates exactly what reviewers look for — and exactly where agencies most often fall short. We will spend dedicated time on the Review Choice Demonstration, including Palmetto GBA's four-question framework for establishing medical necessity, the documentation bundle required for Pre-Claim Review affirmation, and the most common non-affirmation reasons paired with specific documentation fixes. We will then walk through the anatomy of a typical denial, the four most common documentation disconnects between OASIS, the 485, visit notes, and the face-to-face encounter, high-risk OASIS items, the Golden Thread that ties assessment to justification, and the building blocks of a defensible record — including pre-bill QA, education that actually changes clinician behavior, and AI-assisted audit tools. Through case studies, real denial reason codes, and side-by-side documentation comparisons, you will leave with concrete, applicable techniques you can implement at your agency on Monday morning.
HCSSA Topic(s) Addressed:
- §558.259[c][2]information on the state and federal laws applicable to an agency
- §558.259[d][4] agency responsibilities
- §558.260[a][3] basic principles of management in a licensed health-related setting
- §558.260[a][6]risk assessment and management
- §558.260[a][7]financial management
Education-Training Credits:
- TX HCSSA Administrator/Alternate Continuing Education
- Continuing Education for Nurses
- 1.0 Contact Hr(s)
- This program awards CNE until 09.02.2028
- Continuing Education for Social Workers
- 1.0 Contact Hr(s)
- This program awards SW CE until 09.02.2028
Texas HCSSA CE Approval Statement
This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
Nurse CE Approval Statement
Texas Association for Home Care & Hospice is an approved provider of continuing nursing education by Louisiana State Nurses Association,
an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. LSNA Provider No. 4002151
Requirements for Successful Completion:
To receive continuing education credits for this online presentation, the participant must view the entire online presentation, complete an evaluation, and post-test attestation.
Reporting of Perceived Bias:
Bias, as defined by the American Nurses Credentialing Center's Commission on Accreditation (ANCC COA/LSNA) is the tendency or inclination to cause partiality, favoritism, or influence.
Commercial bias may occur when a CNE activity promotes one or more product(s) (drugs, devices, services, software, hardware, etc.). This definition is not all inclusive and participants
may use their own interpretation in deciding if a presentation is biased. The ANCC COA is interested in the opinions and perceptions of participants at approved CNE activities,
especially in the presence of actual or perceived bias in continuing education. Therefore, ANCC invites participants to access their ANCC Accreditation Feedback Line to report any noted
bias or conflict of interest in the education activity.
The toll-free number is 1(866) 262-9730.
TAHC&H Faculty/Presenter(s):
J'non Griffin, RN, MHA, HCS-D, HCS-O, COS-C, HCS-H, HCS-C, SVP Coding and OASIS/Compliance, SimiTree
About the Presenter(s): J'non Griffin
J’non Griffin is a 36 year veteran of home care as an RN. She received her Master’s Degree in Health Care Administration in 2005.
She has experience as a field nurse, director and executive with home health and hospice agencies, both large and small.
J’non is certified as a Homecare Coding Specialist-Diagnosis (HCS-D), Certified in OASIS competency, COS-C and HCS-O, Certified in
Homecare Coding Specialist-Hospice (HCS-H), Home Care Specialist-Compliance (HCS-C) and is an AHIMA approved ICD-10-CM trainer/ambassador.
J’non is an accredited ACHC and CHAP consultant. J’non currently continues her role at SimiTree as the Sr. Vice President of Coding/OASIS department.
J’non is also on the board of Home Care Association of Florida. She has also been a frequent contributor to the Decision Health Publication,
The Diagnosis Coding Pro, and the Home Health Line. She has published several manuals, and assisted with composition of several online modules for
coding and OASIS instruction. She has presented several webinars, and has been a nationally recognized speaker on a variety of subjects.
[4035] Under the Microscope | Illuminating Documentation for Medical Review
