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Disciplines: Nursing
Hours: 3 Contact Hours
Author(s): Lisa Gorski, MS, HHCNS-BC, CRNI®, FAAN
Peer Reviewer(s): Kathleen Ruane, MS, RN, CPHQ, COS-C
Item#: N1746
Contents: 1 Course Book (38 pages)
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Home Health Nursing: Reimbursement of Services

Price $22.95
Item # N1746
When available, the Online Course format is included with the hard copy, eBook, or audio book formats!

Release Date: December 21, 2016

Expiration Date: December 31, 2019

The role of the professional home health nurse encompasses skills beyond providing comprehensive clinical care to patients. Perhaps more so than in any other care delivery setting, the home health nurse is held accountable for providing patients with a clinically appropriate level of service in the context of understanding reimbursable care.

Nurses must be able to differentiate between the wants and needs of patients. They must create plans informed by evidence-based research and standards that meet the individual needs of patients, drive positive outcomes, and ensure quality. Nurses must also educate patients and families regarding the cost of care. It is important that the nurse, as care coordinator, engage in a positive synergy when creating a comprehensive, multidisciplinary/multiservice approach that can be reimbursed while also supporting the viability of the home health agency or Accountable Care Organization.

This course addresses current payment mechanisms under Medicare, Medicare Advantage plans, a description of fee-for-service payment systems, and an overview of the impact of the Affordable Care Act, focusing on upcoming changes in Medicare reimbursement for home care. This course prepares the nurse in coordinating and planning services in a cost effective and efficient manner and enables them to educate and support patients and families.

This course is an extract of, and should not be taken in conjunction with, Home Health Nursing: A Comprehensive Review of Practical and Professional Issues, 4th Edition (N1727).

Course Objectives

  • Discuss payment mechanisms for home healthcare reimbursement.
  • Describe the importance of OASIS accuracy in establishment of home health agency reimbursement.
  • Describe the principles of reimbursement under the Medicare prospective payment system.
  • Explain the impact of the Affordable Care Act on future home care reimbursement.


Lisa Gorski, MS, HHCNS-BC, CRNI®, FAAN, worked for over 30 years as a Clinical Nurse Specialist (CNS) for Wheaton Franciscan Home Health & Hospice in Milwaukee, Wisconsin. She received her bachelor’s and master’s degrees from the University of Wisconsin-Milwaukee College of Nursing. Lisa serves on the Editorial Board of Home Healthcare Now. She served on the American Nurses Association 2014 Task force for Home Health Nursing: Scope and Standards of Practice. She is the author of over 50 journal articles addressing home care and home infusion therapy and is the author/editor of several books addressing infusion therapy, including 3 books specific to home infusion care. Lisa was inducted as a Fellow into the American Academy of Nursing in 2006, was the 2003 CRNI of the Year by INS, and the 2011 CNS of the Year by the National Association of Clinical Nurse Specialists.


Kathleen Ruane, MS, RN, CPHQ, COS-C, has over 25 years of experience in community health care, including progressive management experience leading home health quality improvement and clinical programs. She currently is the Director of Quality and Compliance at Lahey Health at Home based in Massachusetts. Her areas of expertise include data analysis and the design and implementation of strategies to improve patient satisfaction and quality outcomes.

  • Courses must be completed on or before the expiration date noted in the course description above.
  • You must score 75% or higher on the final exam and complete the course evaluation to pass this course and receive a certificate of completion.
  • Through our review processes, Western Schools ensures that this course content is presented in a balanced, unbiased manner and is free from commercial influence. It is Western Schools’ policy not to accept commercial support.
  • All persons involved in the planning and development of this course have disclosed no relevant financial relationships or other conflicts of interest related to the course content.