Medical Necessity at Recertification: Documentation Tips, Common Gaps, and Real-World Scenarios

<p>In this episode of <strong>AHCC Talk</strong>, we break down what Medicare expects when it comes to <strong>medical necessity at recertification</strong> — and where agencies most often fall short. </p><p>Host <strong>Jan Milliman, HCS-D</strong> is joined by <strong>Lisa McClammy, BSN, RN, COS-C, HCS-D, HCS-O</strong>, Senior Clinical Education Consultant at MAC Legacy, to discuss:</p><ul><li>What documentation must show to justify continued skilled care</li><li>Key elements that support recertification and homebound status</li><li>Common documentation gaps that put agencies at risk</li><li>Practical examples of when skilled services are — and are not — reasonable and necessary</li><li>How progress to goals, functional status, and risk factors support compliance</li></ul><p>This episode also features a <strong>Scenario Spotlight</strong> focused on OASIS M1033.1 - History of Falls, helping listeners apply guidance to real-world documentation decisions.</p><p>Links Mentioned in the Episode </p><p>🔗 AHCC certification study guides: decisionhealth.com/studyguides </p><p>🔗 If you&#39;re an AHCC member, register for the AHCC Member&#39;s Call on January 28 at 1pm EST: <a href="https://register.gotowebinar.com/register/8915984221266150240">https://register.gotowebinar.com/register/8915984221266150240</a></p><p>🔗 Learn more about AHCC and how to become a member:store.decisionhealth.com/join-ahcc</p><p>⬇️ Downloadable slides from this discussion: <a href="https://ahcc.decisionhealth.com/ahcc-talk-episode-86-medical-necessity-at-recert/">https://ahcc.decisionhealth.com/ahcc-talk-episode-86-medical-necessity-at-recert/</a> </p><p> </p><p>📧Have a question, episode request, or suggestionsfor a future panel guest? Email Jan at jan.milliman@decisionhealth.com</p><p></p>