Home Health Reimbursement: PDGM & Beyond

 Home Health Reimbursement: PDGM & Beyond

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Price: $299.00

This two-day 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 extensive 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.

COVID - 19 Updates:

What is billable and non-billable in today’s COVID-19 Pandemic World? Can you bill for telehealth visits? Does your physician and NPP telehealth F2F encounter contribute to your patient eligibility for HH? These and many other questions will be answered in this information packed two day workshop. Don’t miss the opportunity to hear strategies and lessons learned during this public health emergency from national speaker. In this workshop providers will learn why it’s so important to understand the billing flexibilities that were afforded to Medicare providers to ensure cash flow doesn’t stop. If one, or more, of these billing parts are missing or are incorrect, agencies set themselves up for denials, ADRs and a host of other billing dilemmas that should be avoided. Participants will walk away with a much clearer understanding of Medicare billing practices under PDGM and COVID-19.

Program Goals:

Day 1: Day to Day Revenue Cycle Under PDGM

Evaluate the PDGM Structure
Detail the significant impact of Intake on Revenue Cycle
HIPPS Code & Episode Exceptions Review
LUPA, PEP & Outlier Calculations
Describe the process for effectively auditing a Chart for purposes of identifying prebill issues, including NonRoutine Supplies
Details of Billing RAP & Final Claim
OASIS & Coding Impact on Reimbursement

Day 2: Home Health Reimbursement: Beyond PDGM

OASIS & Coding
Medicare Secondary Payer
Detail Credentialing with Managed Care & Issues surrounding getting paid
Establish processes for effectively monitoring ADR/RA & UPIC reviews
Targeted Probe & Educate
PEPPER Reports – monitoring and evaluating

About the Presenter:

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.