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Home Health Reimbursement Workshop – AHHC

Speaker(s): Melinda A. Gaboury, CEO

Category: Speaking Engagement

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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.

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Home Health Reimbursement Workshop – AHHC Jan 19
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About the Event

This workshop will take agencies through the significant updates to the PDGM reimbursement model and move through all the aspects of home health reimbursement. PDGM has brought many changes to home health and 2022 will see even more changes to the model. In addition to working through the fine details of PDGM changes the workshop will also cover examples for LUPA, PEP and Outlier adjustments. There will be a discussion of Pre-Bill claim reviews and the significance of that. The impact of OASIS & Coding and medical review programs have the potential to more directly impact reimbursement than some of the other aspects of PDGM and this workshop will get you up to date on all that.  In addition to Traditional Medicare, the Medicare Advantage plans have become a major part of home health reimbursement and this workshop will take you through some of the detail aspects of getting what you need in order to get paid.  Medical Review has emerged as one of the greatest concerns for home health.  This workshop will take you through the contractor asks and dig into the reasons behind review.  PEPPER reports are a large part of the data used to target agencies and this workshop will give you an up to date review of how to analyze your current PEPPER.  Whether you are a biller, collector or Administrator, this workshop is just what is needed to get you up to date on all things Home Health Reimbursement.


Program Goals: Day to Day Revenue Cycle Under PDGM 1. Evaluate the PDGM Structure 2. Detail the significant impact of Intake on Revenue Cycle 3. HIPPS Code & Episode Exceptions Review 4. LUPA, PEP & Outlier Calculations 5. Details of Billing RAP & Final Claim 6. OASIS & Coding Impact on Reimbursement 7. Detail Credentialing with Managed Care & Issues surrounding getting paid 8. Medical Review – all contractors 9. PEPPER Reports – monitoring and evaluating