Skilled Service or Not? Avoid Top Home Health Denials

What truly counts as a skilled service in home health? This episode of AHCC Talk breaks down Medicare’s requirements for skilled services — and the common mistakes that lead to costly denials.

Host Jan Milliman, HCS-D is joined by home health experts J’non Griffin, RN, MHA, HCS-D, HCS-H, HCS-C, COS-C and Apryl Swafford, RN, BSN, COS-C, HCS-D, HCS-H, HCS-O from SimiTree Healthcare Consulting to walk through:

✅ What qualifies as a skilled service
✅ CMS Chapter 7 rules & documentation must-haves
✅ Top Medical Review denial reasons in 2025
✅ Skilled nursing, PT, SLP & OT — by definition

This is an essential breakdown for clinicians, auditors, QA staff, and leaders who want to ensure compliance, defend services in review, and protect revenue.

⏱️ Chapters
0:45 Our Panel
1:03 Defining Skilled Service
1:36 Conditions to be Met for Home Care Services (Ch. 7, Benefit Policy Manual, Section 30)
3:59 Not homebound / No qualified provider / No skilled service
4:35 Medical Necessity
6:15 Medical Review Top Denial Reason Codes for Home Health from January to March 2025
6:51 What are Skilled Services?
8:29 Med box fill / Superficial injury / No available caregiver
9:21 Nursing Skilled Services - Observation and Assessment (Ch. 7, Section 40.1.2.1)
11:00 Nursing Skilled Services - Management and Evaluation (Ch. 7, Section 40.1.2.2)
12:17 Nursing Skilled Services - Teaching and Training Activities (Ch. 7, Section 40.1.2.3)
15:32 Nursing Skilled Services (cont.)
19:08 Nursing Skilled Services (cont.)
19:37 Skilled Physical Therapy Services
20:59 Skilled Speech - Language Pathology Services
22:47 Skilled Occupational Therapy Pathology Services
24:22 Dependent Services
25:03 Scenario Spotlight
31:10 September Scenario
31:38 September Scenario Answer
32:53 October Scenario
33:42 Strengthen your agency's bottom line with AHCC credentials
34:13 Tell us what you want in the AHCC Member Survey

Links Mentioned in the Episode
🔗Medicare Benefit Policy Manual, Ch. 7 - Home Health Services: https://www.cms.gov/regulations-and-g...
🔗Learn More About AHCC credentials: decisionhealth.com/credentials
🔗 If you're an AHCC Member, please take the Member Survey!: https://www.surveymonkey.com/r/7SKBX2J
⬇️ Downloadable slides from this discussion: https://ahcc.decisionhealth.com/ahcc-...

📧Have a question, episode request, or suggestions for a future panel guest? Email Jan at [email protected]