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Home Health Reimbursement: PDGM & Beyond
Recorded October 28, 2020
This workshop will take agencies through the current state of PDGM and move through all the aspects of home health reimbursement. PDGM has brought many changes to home health and PDGM is not all that reimbursement is made up of. In addition to working through the fine details of PDGM changes the workshop will also cover examples for LUPA, PEP and Outlier adjustments. There will be a discussion of Pre-Bill claim reviews and the significance of that. The impact of OASIS & Coding and medical review programs have the potential to more directly impact reimbursement than some of the other aspects of PDGM and this workshop will get you up to date on all that. Cash flow has been one of the gravest areas of concern in recent months….let us take you through the basics of cash flow projections and how best to make that work in your organization. Whether you are a biller, collector or Administrator, this workshop is just what is needed to get you up to date on all things Home Health Reimbursement.
Program Goals: Day to Day Revenue Cycle Under PDGM
1. Evaluate the PDGM Structure
2. Detail the significant impact of Intake on Revenue Cycle
3. HIPPS Code & Episode Exceptions Review
4. LUPA, PEP & Outlier Calculations
5. Details of Billing RAP & Final Claim
6. OASIS & Coding Impact on Reimbursement
7. Detail Credentialing with Managed Care & Issues surrounding getting paid
8. Targeted Probe & Educate
9. PEPPER Reports – monitoring and evaluating
Presenter: Melinda Gaboury, CEO/Co-Founder, Healthcare Provider Solutions Melinda A. Gaboury, with more than 29 years in home care, has over 18 years of executive speaking and educating experience, including extensive day-to-day interaction with home care and hospice professionals. She routinely conducts Home Care and Hospice Reimbursement Workshops and speaks at state association meetings throughout the country. Melinda has profound experience in Medicare PPS training, billing, collections, case-mix calculations, chart reviews, and due diligence. UPIC, RA, ADR & TPE appeals with all Medicare MACs have become the forefront of Melinda’s current impact on the industry. She is currently serving on the NAHC/ HHFMA Advisory Board and is Associate Director on the Home Care Association of Florida Board of Directors. Melinda is also the author of the Home Health OASIS Guide to OASIS-D1.
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