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Speaker(s): Melinda A. Gaboury, CEO
About the Speaker(s)
Melinda A. Gaboury, with more than 29 years in home care, has over 20 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 PDGM 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 Work Group and is Treasurer on the Home Care Association of Florida Board of Directors. Melinda is also the author of the Home Health OASIS Guide to OASIS-D1 and Home Health Billing Answers, 2021.
About the Event
Home Health PEPPER & Medicare Medical Review
This session will take agencies through the winding road of Medicare scrutiny. This session will discuss PEPPER reports and other data analysis that agencies will need to review to ensure that their risk from medical review is limited. This session will review some State specific PEPPER data so you can tell where you stand compared to others in the state. Don’t be caught in the position of believing that everything is just okay or that the Public Health Emergency is a shield from medical review. While billing the Medicare benefit and getting paid relatively easy, there is always a risk of things being reviewed at some point and what can you do to avoid denials. Participants will be able to define the levels of Medical Review that are currently active: including, UPIC, SMRC, MAC ADR, RAC and the reinstated Targeted Probe & Educate. The session will review how to respond to any level of medical review that may occur. Attendees will take away information that will assist in assuring that your home health truly is accurately documenting.
- Outline the targets that are calculated on the PEPPER Reports
- Detail the targets and other data from the PEPPER reports specific to the state
- Outline the Multiple Post Payment Review Contractors
- List the current edits being used in targeting home health agencies across the nation
- Detail the requirements for successfully submitting medical records for review
- Hospice PEPPER – What does your update look like?
- PEPPER Reports have swiftly become the forefront of everyone’s concern when it comes to Medicare Medical Review. The PEPPER which is data that is gathered strictly from the from processed claims information, carries a very heavy weight in the decision – to Medically Review an agency or NOT. Many of the targets calculated within the PEPPER give hospices detail insight into the claims’ details that may have been overlooked causing issue with the target calculations. Hospices should be heightened aware that everyone they do not want to review their PEPPER data, indeed are! This session will take you through key elements in the PEPPER targets and how to review the data in your organization to determine how they can be improved, if needed.