EVENTS
CAHSAH Home Health Billing Series 2024
Speaker(s): Melinda A. Gaboury, CEO
Category: Home Care
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
CAHSAH 3-Part Home Health Billing Series
Tuesday, October 15
Home Health Billing Series: Part 1: Details of Patient Driven Groupings Model (PDGM) & its Impact on Billing
New and experienced home health billers should periodically review eligibility requirements and recent reimbursement clarifications. January 2025 promises big changes based on the 2025 Home Health Proposed Rule with rate changes for home health, multiple PDGM adjustments and the Value-Based Purchasing Model changes. This first webinar in the series will discuss key areas, strategies and processes in assisting an agency in staying ahead of PDGM changes and reimbursement rates. This webinar will be all inclusive of 2025 home health proposed changes.
- • Discuss necessary modifications to the intake and referral process under PDGM
- • Present data to assist in determining financial impacts of PDGM on an agency.
- • Evaluate the specificity requirements of coding under PDGM
- • Review strategies for improved physician interaction to ensure timely 30-day billing
- • Explain the importance of clinical review of each 30-day payment period under PDGM
Wednesday, October 16
Home Health Billing Series: Part 2: Submission of the NOA and Specifics of Billing 30-day Final Claims
This webinar will have a focus on best process improvement practices including the referral, intake and timely documentation, physician communication strategies as related to claims processing. Details of the Notice of Admission and Final claims will be addressed in this session. Getting reimbursed timely and correctly is of major importance and will require tightly managing the 30-day payment periods.
- • Detail requirements of submitting the NOA
- • Explain scheduling strategies to prevent penalties for Late NOAs
- • Outline the exceptions request process for the NOA
- • Detail the requirements for submitting Final claims
- • Review the complexity of determining LUPA thresholds under PDGM
- • Review the reconciliation process after posting payments for claims
Thursday, October 17
Home Health Billing Series: Part 3: Medicare Advantage How Do We Get Paid Correctly
This webinar will focus on the details of Medicare Advantage – from determining the plans that you want to get in network with to the process of ensuring that you bill and collect appropriately. Payer Setup is one of the greatest challenges with billing for Medicare Advantage and we will touch on the details. Successfully obtaining authorization is key in receiving that payment you have worked so hard for, but does authorization does NOT equal payment.
- Evaluate the most important questions to ask before signing an in-network agreement
- Detail the impact of Medicare Advantage Plans on the Medicare Program
- Outline the process of accurately obtaining authorization for MA patients
- Review the most common claim denial reasons and working through those
- Review the most common roadblocks in getting MA claims to appropriately process & pay