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Speaker(s): Melinda A. Gaboury, CEO
About the Speaker(s)
Melinda A. Gaboury, with more than 30 years in home care, has over 22 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 as the Chair of the NAHC/HHFMA Advisory Board and Work Group and is currently serving on the Board of Directors for both the Home Care Association of Florida & Tennessee Association for Home Care. Melinda is also the author of the Home Health OASIS Guide to OASIS-E and Home Health Billing Answers, 2023.
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About the Event
Tuesday, May 21:
Hospice Medical Review
Speaker: Melinda A. Gaboury, CEO
10:15 am – 11:45 am PDT
Hospice is on the hot bed of Medical Review in 2024. This session will take agencies through the winding road of Medicare scrutiny. While billing the Medicare benefit and getting paid relatively easily, there is always a risk of things being reviewed at some point and what can you do to avoid denials. This session will also discuss PEPPER reports and other data analysis that agencies will need to review to ensure that their risk from medical review is limited. Don’t be caught in the comfortable position of believing that everything is okay. Attendees will take away information that will assist in assuring that your hospice truly is prepared for a call for medical review of their charts.
- Define the levels of Medical Review that are currently active – UPIC, SMRC, MAC ADR, and RAC.
- Review how to respond to any level of medical review, including top denials and how to avoid them.
- Discuss PEPPER reports and other data analysis that agencies need to review.
Wednesday, May 22:
Home Health Value Based Purchasing – Where Do We Stand in 2024?
Speaker: Melinda A. Gaboury, CEO
10:45 am – 12:15 pm PDT
HHVBP Expansion began January 2023 and continues, with changes proposed for 2025. This session will review the current status of the HHVBP outcome measures and the most recent IPR reports. 5% of agency reimbursement is at risk in this model for each year and this session will review the calculations and help agencies to determine where they stand. Objectives include:
- Detail analyze the current Interim Payment Reports.
- Outline specifics of the 2025 Proposed Changes.
- Review Best Practices for evaluating the agency’s ranking within their cohort.
Medicare Advantage: Digging in the Details
Speaker: Melinda A. Gaboury, CEO
3:30 pm – 5:00 pm PDT
Home Health providers are grappling with the shift in the Medicare eligible population into Medicare Advantage Plans (MA Plans). Providers are asking: What are the implications of current demographic trends? What operational and financial issues should providers expect as their payer mix shifts to mostly Managed Care? Being successful in this environment of these payer mix changes requires agencies to understand their costs of treating these patients and other impacts on their operations on an individual contract basis. The days of Original Medicare being the primary payer have passed. Agencies must determine how they will successfully participate with Medicare Advantage Organization benefit plans. Objectives include:
- Outline successful contracting review and how to decide a MAO contract is good for the agency.
- Review the details of verification and authorization of Medicare Advantage patients.
- Detail best practices for successfully maneuvering the Medicare Advantage program.