Proposed CMS cuts. New hospice regulations. All-payer OASIS. The regulatory and financial landscape for post-acute care is shifting fast — and providers that don’t adapt risk leaving significant revenue on the table.
In a recent Forcura + Medalogix webinar, industry experts unpacked the biggest changes facing home health and hospice organizations, from the 6.47% proposed payment cut to the HOPE tool rollout on October 1. More importantly, they spotlighted the hidden operational and compliance gaps where agencies can take immediate action to protect — and even grow — revenue.
Here are the five most critical takeaways you need to know. 👇
1. All-Payer OASIS: Inaccuracy Is No Longer an Option
CMS now requires agencies to submit OASIS data for every patient, including Medicare Advantage (MA) and commercial. Historically, many agencies collected this data but never submitted it — a practice that is no longer compliant.
Amanda Fabozzi, Director of Clinical Services at Forcura + Medalogix, emphasized that OASIS accuracy has always influenced payment via HIPPS codes under PDGM, but with a 6.4% cut looming, agencies can’t afford errors. CMS is also using this data to evaluate differences in care between MA and traditional Medicare, making compliance and consistency crucial.
👉 Action: Tighten OASIS QA with products like Pulse Admissions, retrain clinicians on complex OASIS items (e.g., discharge function scores, bathing/dressing elements being reintroduced), and audit MA submissions for accuracy.
2. Hospice Agencies: HOPE Is Here — And It’s Mandatory
Starting October 1, the new HOPE tool brings eight required symptom assessments and follow-up rules. RN-led Hospice Update Visits (HUVs) must occur promptly when issues like pain or anxiety are documented. Miss these reassessments, and penalties are on the table.
Tom Maxwell, Chairman and co-founder of Maxwell TEC, urged agencies to train clinicians and update workflows now. Laura Brinkoetter, Chief Product Officer for Forcura + Medalogix, added that Pulse Muse now automatically alerts staff when follow-ups are needed, helping teams stay compliant without relying on memory or spreadsheets.
👉 Action: Train, map workflows, and leverage tech alerts so no symptom follow-up slips through the cracks.
3. Missed Visits = Lost Revenue & Negotiating Power
Missed visits don’t just affect care — they undercut payer relationships. Maxwell pointed out that missed Friday visits are especially common, and MA plans notice:
“If you asked for 10 visits last time but only used eight, why should they approve 10 next time?”
Beyond losing the direct reimbursement, agencies weaken their ability to secure future authorizations.
👉 Action: Use visit optimization tools to flag gaps in real time, spread visits throughout the week, and protect both revenue and payer leverage.
4. Overlooked Regulatory Changes Hold Real Revenue Potential
While headlines focus on payment cuts, less-publicized updates in the 2026 Home Health Proposed Rule can impact your bottom line:
• HHCAHPS survey updates that require clinician education
• New OASIS items and recalibrated functional impairment scoring that shift case-mix weights
• Medicare spend per beneficiary — a brand-new value-based purchasing metric
Agencies that prepare early can use these changes to offset payment reductions through improved quality scores and risk adjustment accuracy.
👉 Action: Run internal education campaigns and mock audits. Early movers can turn regulatory change into revenue resilience.
5. Technology: Your Competitive Multiplier
From referral intake delays to documentation errors, technology gaps directly translate to lost revenue. Brinkoetter outlined why tech is no longer optional:
• Ensures accurate coding & compliance
• Drives staff efficiency amid workforce shortages
• Delivers real-time insights for payer mix and staffing decisions
• Speeds order turnaround
• Enables scaling without proportional headcount increases
A top priority for Forcura + Medalogix’s product team: automating referral intake via robotic integrations to cut delays and keep patients from waiting days for start of care — a key revenue leakage point.
👉 Action: Evaluate whether your current tech stack can support 2026 demands. If not, strategic investments now will pay dividends quickly.
The Bottom Line: Act Early, Win Later
The panel closed with a clear message: financial resilience in 2026 will come from proactive moves made in 2025.
• Build financial and operational action plans now (Fabozzi)
• Rely on trusted compliance partners to stay ahead (Sorensen)
• Prioritize clinician efficiency and visit optimization (Maxwell & Brinkoetter)
👉 Watch the full webinar recording to hear the experts break down these strategies and see real-world workflow examples that can help your agency stay profitable and compliant — no matter what CMS finalizes this fall.
