Medicare Home Health Reimbursement with Melinda Gaboury
June 8 @ 9:00 am - June 9 @ 5:00 pm
This two-day workshop will take agencies through the current state of the Patient-Driven Groupings Model (PDGM) and move through all the aspects of Medicare home health reimbursement.
June 8th – Day 1 Virtual Medicare PDGM Workshop
The PDGM has brought many changes to home health and the PDGM is not all that reimbursement is made up of. In addition to working through the fine details of the PDGM changes, the workshop will also cover extensive examples for Low Utilization Payment Adjustments (LUPAs), Partial Episode Payments (PEPs), and outlier adjustments. There will be a discussion of pre-billing claim reviews and the significance of them.
Day-to-Day Revenue Cycle under the Patient-Driven Groupings Model with COVID-19 Updates
- Evaluate the PDGM Structure
- Detail the significant impact of intake on revenue cycle
- Health Insurance Prospective Payment System (HIPPS) code and episode exceptions review
- LUPA, PEP, and outlier calculations
- Describe the process for effectively auditing a chart for purposes of identifying pre-bill issues, including non-routine supplies
- Details of billing Requests for Anticipated Payment (RAPs) and final claims
- OASIS and ICD-10 coding impact on reimbursement
June 9th – Day 2 Virtual Medicare PDGM Workshop
The impact of OASIS, ICD-10 coding, and medical review programs have the potential to more directly impact reimbursement than some of the other aspects of the PDGM, and this workshop will get you up to date on all of that as well. Additionally, with cash flow being one of the gravest areas of concern for providers in recent months, this workshop will take you through the basics of cash flow projections and how best to make that work in your organization.
Home Health Reimbursement: Beyond the PDGM with COVID-19 Updates
- OASIS and ICD-10 coding
- Medicare secondary payer
- Detail credentialing with managed care and issues surrounding getting paid
- Establish processes for effectively monitoring ADR/Recovery Audit (RA), and Unified Program Integrity Contractor (UPIC) reviews
- Monitoring and evaluating your Program for Evaluating Payment Patterns Electronic Report (PEPPER)
- Factoring the Review Choice Demonstration into the PDGM
Melinda Gaboury- is co-founder and Chief Executive Officer of Healthcare Provider Solutions, Inc., an organization out of Nashville, TN that provides financial, reimbursement, clinical and operation services to the home health and hospice industries. With more than 27 years of experience in Medicare Home Health, she is a presenter at both the state and national levels, and is interviewed frequently for national home health publications. Ms. Gaboury is also the author of “Home Health Guide to OASIS D: A Reference for Field Staff.” Ms. Gaboury has no conflict of interest in regard to this program.