Tatevik Melkumyan: Translating Regulatory Language into Medical Care

American home health and hospice agencies are undergoing a wave of regulatory changes. The Centers for Medicare and Medicaid Services (CMS) has updated quality service requirements for 2025, including new QAPI (Quality Assurance and Performance Improvement) standards and tighter documentation oversight. But the system faces a critical shortage of qualified compliance consultants.

The result: agencies are receiving G-tags, risking accreditation loss, and facing multimillion-dollar penalties due to documentation errors. Industry experts cite fragmented processes and a disconnect between clinical and administrative functions as major obstacles to compliance.

Tatevik Melkumyan, an endocrinologist and radiologist from Armenia, is offering a systematic solution. Founder of NT QA Inc. and a quality control consultant in home healthcare, she’s developed a structured QAPI methodology rooted in clinical thinking. Her approach helped one agency eliminate all of its violations within just six weeks.

“Doctors understand clinical reality. A manager without medical training sees only rules,” Melkumyan said.

My system turns compliance into a tool for better care, not just paperwork.

A Medical Mindset for Quality

Melkumyan graduated from Yerevan State Medical University and specialized in endocrinology and ultrasound radiology. She later served as a clinical instructor, where her reputation grew through peer referrals.

As a diagnostician, I was trained to see patterns and predict risks,” she said. “That mindset became the foundation for my audit methodology.” —Tatevik Melkumyan

She emphasizes that clinicians know how to justify care decisions in documentation, unlike administrators who often lack clinical insight.

Her system includes checklists, review tools, and practical step-by-step guides tailored to QAPI audits. It’s currently in use at several U.S. home health and hospice agencies.

Tatevik Melkumyan, Endocrinologist

Melkumyan has managed medical processes since 2014 and was frequently tapped for leadership roles. After immigrating to the United States in 2018, she founded NT QA Inc. in 2024.

In Armenia, we had limited resources. I learned to build efficient systems from scratch. That experience now helps me create simple but effective algorithms here.” —Tatevik Melkumyan

The Power of Structure

Her approach integrates clinical knowledge with regulatory compliance. Rather than simply checking forms, she designs templates and workflows that reinforce compliance as a daily mindset, not a one-time task.

“Each element is tied to clinical outcomes — from coding to pain assessments,” she said. “It’s not just about passing an audit; it’s about delivering better care.”

She notes that CMS has increasingly emphasized personalized care, with public-facing data now available through Medicare Care Compare. Adapting to these changes requires coordination across disciplines.

“Documentation, clinical data, and audits are often out of sync,” she said. “Agencies know the rules but struggle to connect the dots.”

And the shortage of QAPI specialists is worsening.

“This role requires both clinical judgment and regulatory knowledge. That’s a rare combination,” she said.

Living Algorithms and Real Results

Melkumyan’s materials translate regulatory language into practical tools for nurses and coordinators.

“Instead of legal jargon, my templates show exactly what to write, where, when, and why,” she said. “They’re built from CMS Conditions of Participation, CHAP, and state guidelines.”

Her system has already produced tangible results. One California agency faced losing its accreditation over seven G-tags. Within six weeks of implementing her process, all violations were cleared. Another agency avoided a Medicare fine after her documentation review corrected ICD-10 coding errors.

"Incorrect coding is one of the biggest audit risks,” she said. “It can trigger payment denials and CMS audits.”

Her method links diagnoses directly to clinical tasks and keywords that must appear in documentation. In one case, she replaced a vague diagnosis of generalized weakness with specific codes for chronic heart failure and diabetes, which supported skilled nursing visits and improved the care plan.

“It led to better treatment for the patient and a successful audit for the agency,” she said.

Fast Implementation, Lasting Change

Her system can be rolled out within four weeks. Early improvements include reduced documentation errors and staff confidence in CMS protocols.

Melkumyan’s experience training medical students also helps.

“I break down complex topics into digestible parts,” she said. “I adjust the training to the experience level of the staff.”

She frequently encounters outdated care plans, vague justifications, and duplicated records. Her background in endocrinology — where treatment depends on managing interconnected systems — helps her spot inconsistencies.

“Each part of the care plan should align, from the diagnosis to the visit notes,” she said.

To reduce stress before audits, she provides action plans and responsibility maps.

“If everyone knows their role and what to expect, anxiety drops,” she said.

Resilience and Human-Centered Care

Melkumyan’s approach is shaped by personal resilience. Navigating the U.S. immigration process taught her how to stay calm under pressure.

“You need a plan even when the situation is unclear,” she said. “That’s what I give my clients.”

For surprise inspections, she recommends three steps: audit the past 60 days, update all documentation, and conduct quick staff training.

She also teaches ethical care.

“Every record reflects care,” she said. “It must be honest, compassionate, and clinically sound.”

A member of the National Association for Healthcare Quality, the European Society of Endocrinology, and the Association of Pediatric Endocrinologists of Armenia, Melkumyan is also committed to professional development.

“Healthcare must be not only correct — but kind,” she said. “Especially in hospice or home care, patients need more than procedures. They need warmth.”

Looking Ahead

In the next five years, she expects more digital audits, patient engagement in quality scores, and tougher Medicare fraud enforcement.

“Agencies must prepare for full transparency,” she said. “Those who stay ahead of the changes will thrive.”

Melkumyan plans to expand her methodology into skilled nursing and behavioral health and hopes to obtain a U.S. medical license.

“Compliance doesn’t have to be a burden,” she said. “Done right, it enhances care.”

Her advice for future LTC quality consultants is simple.

Start with CMS guidelines. Shadow someone experienced. And spend time in real agencies. Quality care happens on the ground — not just on paper.” —Tatevik Melkumyan