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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
The Patient Driven Groupings Model (PDGM) went into effect January 1, 2020. This is the most massive change to the home care industry reimbursement structure since the introduction of the Prospective Payment System (PPS) in October 2000. The new payment model has dramatically impacted agency operations, processes and performance. January 2022 brings even more changes with the Notice of Admission (NOA) replacing the NO Pay RAP. Agencies must develop and implement plans to continue to succeed under PDGM. This workshop will discuss key areas, strategies and processes in preparing an agency for PDGM changes that will continue into 2022. This workshop will have a focus on best episode management and process improvement practices including the referral, intake and scheduling processes, timely documentation, physician and patient communication strategies, all of which are required to more tightly manage care within the shorter 30-day payment period. The change to a 30-day payment model has brought significant back-office changes, specific to the claims processing and collections, which will be one emphasis of this workshop. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised quality care delivery under the PDGM program! Lastly, this workshop will review the full-blown emphasis of ICD-10 coding under PDGM and how agencies will have to monitor to ensure the specificity of coding for their patient care plans.