Event Calendar

Tuesday, June 8, 2021

Medicare Home Health Reimbursement with Melinda Gaboury

Start Date: 6/8/2021 9:00 AM EDT
End Date: 6/9/2021 5:00 PM EDT

Venue Name: Virtual Event

Organization Name: Ohio Council For Home Care and Hospice

Ryan Crawford
Email: ryan@ochch.org
Phone: (614) 885-0434

This workshop will be virtual!!
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.

Registration Fee:

OCHCH Member                                                        Non-Member
o 6/8 1 – Day - $99 (Per Attendee)                            o 6/8 1 – Day - $179 (Per Attendee)
o 6/9 1 – Day - $99 (Per Attendee)                            o 6/9 1 – Day - $179 (Per Attendee)
o 2 – Day Pass - $179 (Per Attendee)                       o 2 – Day Pass - $325 (Per Attendee)  
Try our NEW Unlimited Attendee Pass! – Fees are per agency allowing you to have as many staff members attend as you would like for on low rate!

 OCHCH Member                                                        Non-Member
o Unlimited Agency Pass - $299                                o Unlimited Agency Pass - $445  

Printable Registration Flyer - CLICK HERE!!