Preparing your Home Care Agency for Reimbursement Rates Based on Quality Scores

Post - Preparing your Home Care Agency for Reimbursement Rates Based on Quality Scores

Beginning January 1, 2023, The Centers for Medicare & Medicaid Services will base all future reimbursement rates on each specific agency’s Quality Score. Up to a 5% negative adjustment on reimbursements is on the line. This is a lot of money to lose, and it will be hard to recover from this. The majority of agencies rely on these reimbursements for various reasons, and this change can greatly affect agencies like yours. However, you may be happy to know that not all hope is lost. There are simple things that you can do to prepare for this change that is rapidly approaching. In this blog, we will equip you with all of the tools and insight that you need to be ready for the new year changes. 

Quality care ratings compare how well your agency performs with others that are similar. The rating is between 1 and 5 stars, and is calculated based on seven measures that fall into one of two categories:

The Process of Care – How Often the Agency:
1. Initiates patient care quickly and effectively

Outcome of Care- How Often the Patient:

  1. Improved taking their medicine correctly 
  2. Improved mobility
  3. Got better at getting in and out of bed
  4. Improved bathing and grooming themselves
  5. Experienced less shortness of breath
  6. Required less hospitalization

These measures give a general overview of the agency’s performance and how they are handling most patients. Here are some things that you can do to increase your agency’s chances of receiving a five star rating. 


Caregivers must be properly trained on the job that they are performing in order to give the best care possible to their patients. Training can be improved one subject at a time, in an effort to not overwhelm caregivers. Agency staff will have a better understanding of the material being conveyed in training, and thus the care given to patients will improve. A specific training that can help ensure a five star rating is VBP training. VBP training is the perfect solution to help you protect your agency, avoid penalties and go after positive adjustments. offers VBP training, amongst other training subjects, that are easily accessible to you and can help your agency reach the five star rating goal. 

Data Accuracy

To provide the best possible care, caregivers should input accurate notes. This can be challenging with back to back visits all day, which is why digital solutions are worth considering. Using technology will allow caregivers to update data in real time, which can increase documentation accuracy. This benefits the agency because the agency is then able to submit all reports to the CMS quickly and as accurately as possible. 

Ask for Feedback

Ask for clients and client’s families to complete patient satisfaction questionnaires. This will offer a way for agency leaders to hear feedback about the care that is being provided. This allows the agency to have a comprehensive view of where improvement is needed and how the five star rating can be reached quickly. 


Agencies should always look for ways to improve, no matter what. With the new regulations in place, it is more important than ever to be prepared so that your organization does not have a negative reimbursement adjustment. To learn more about’s VBP training and to make sure you aren’t putting your reimbursement rates at risk, please click here to request a demo so that we can reach out to you! 


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