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GAHHA 2023 Annual Meeting

Speaker(s): Melinda A. Gaboury, CEO

Category: Home CareConference

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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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GAHHA 2023 Annual Meeting Sep 19
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About the Event

Tuesday, September 19 | 9:00 – 11:00am | Home Health PEPPER Reports and Medical Review  

PEPPER Reports have swiftly become the forefront of everyone’s concern when it comes to Home Health 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 home health agencies detail insight into the claims’ details that may have been overlooked causing issue with the target calculations.  Home Health Agencies 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.  With the switch to PDGM there has been an update to PEPPER Targets….don’t miss the update.  

  • List the current edits being used in targeting home health agencies across the nation for medical review 
  • Discuss the top 5 denial reasons for medical review and the documentation requirements to avoid those denials 
  • Outline the targets that are calculated on the PEPPER Reports  
  • Detail the targets and other data from the PEPPER reports that is used to evaluate an agency’s performance 


Tuesday, September 19 |12:30 – 2:30pm | Home Health Revenue Cycle – Getting Paid, Including Medicare Advantage  

Times are changing and one of the most significant shifts for home health providers over the years is the trajectory of Medicare Advantage patients to begin to outweigh the volume of Traditional Medicare patients.  This session will discuss the current concerns in the Home Health Revenue Cycle and how providers can get paid and stay compliant. Medicare Advantage credentialing and working through the process of payer setup to the eventual payment receipt for Medicare Advantage covered patients.  Will providers have a future in a world where MA Plans also offer home-based services and products?  

  • Review the current pulse of the Home Health Revenue Cycle 
  • Provide Detail statistics on where Medicare Advantage is in what appears to be a take-over 
  • Planning for strategic and longer-term sustainability in partnering with MA Plans. 
  • Outline boots on the ground details of getting paid