Gateway Home Health Coding & Consulting, LLC

09/11/2026

Today marks 25 years as we take a moment of silence to remember the people that lost their lives and praise those that rushed in to rescue the helpless.

09/04/2026

09/03/2026

The government itself is signaling increased hospice scrutiny!

On May 13, 2026, CMS announced a six-month nationwide moratorium on new Medicare enrollment for hospices and home health agencies, describing the action as part of an aggressive effort against fraud, waste and abuse.

CMS also recently published its FY 2027 hospice rule highlighting a Hospice Service and Spending Variation Index (SSVI) based on nine claims-based measures designed to identify providers that may need additional targeted education and oversight.

“CMS scrutiny of hospice utilization and billing patterns isn't going away. In 2026, CMS has continued expanding data-driven oversight of the hospice industry.”

A UPIC review is substantially more serious than a routine ADR

“A UPIC review is not just another Medicare audit. It can become a significant financial and regulatory event. We help hospice leadership respond strategically before a documentation problem becomes a much larger repayment or enforcement problem.”

Call us today to learn how we can help!

04/29/2026

https://bit.ly/4mYdQlJ

The presence of a CMS Quality Improvement Organization (QIO) representative at an Administrative Law Judge (ALJ) hearing are now the norm. These QIO Reps are armed with a formal Position Paper opposing claim coverage. THIS introduces a level of clinical, regulatory, and legal scrutiny that can mater...

03/12/2026

Join us at the DecisionHealth, 2026 Home Care Leadership Summit, and get vital information from our Lead Clinical Appeals Specialist.

https://bit.ly/4oOHuc8

02/11/2026

Mentor Plus is a dynamic program designed to keep you in full Compliance with all of CMS requirements. Mentor Plus guides you through areas in your program to allow you to not only grow but maintain compliance with every challenge you face in today’s risky home health environment!!

Unlimited practical and impactful coaching is provided for a minimal monthly fixed cost. It’s like having a full-time homecare and hospice expert at your side at all times!!

Backed by home health and Hospice experts that are simply a phone call away, and ready to answer the most difficult questions, provide you with the most up-to-date tools, solutions and education in the industry.

-PDGM Guidance
-OASIS and/or HOPE Assessment Guidance
-Medicare Conditions of Participation
-Administrative and/or Clinical Documentation
-QAPI / Quality Assurance Guidance
-Survey related Issues
-Customized Webinar Training

For more information contact us at... [email protected]

02/04/2026

The Centers for Medicare & Medicaid Services (CMS) continues to expand prior authorization and pre-claim review programs as central mechanisms to reduce improper Medicare payments while preserving beneficiary access to medically necessary services. The Review Choice Demonstration (RCD) for Home Health Services represents a mature application of this strategy, shifting enforcement earlier in the claim’s lifecycle. This paper analyzes CMS Fiscal Year (FY) 2023 data to assess the operational, financial, and governance implications of RCD for home health agencies.

Read the full article below

01/20/2026

ADR's and Appeals

Home Health and Hospice Providers, we can help you at any point during the process. You have the ability to pick and choose so we can fit within your budget and still offer the best chance of success at any level of appeal.

10/31/2025

Happy Halloween Everyone!

Contact us for your Halloween discounts on Coding & QA Services OR take the scary out of your ADRs & Appeals.

09/11/2025

Today we take a moment of silence to remember the people that lost their lives and praise those that rushed in to rescue the helpless.