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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.
About the Event
Value Based Insurance Design Model (VBID) | 04/04/23 | 2:30 PM
This session will cover the details of the Value-Based Insurance Design (VBID) Model – Hospice Benefit Component. Medicare Advantage (MA) has long had coverage for home health patients, but there has never been coverage for Hospice under the MA benefit. VBID is a demonstration that began January 1, 2021 and continues for 5 years. There are multiple Medicare Advantage Organizations (MAO) that are participating and have coverage in multiple states. In addition to Hospice care there is an expansion of Palliative Care services that are offered to patients through the MAO. CMS is testing how the hospice benefit component can improve beneficiary care through greater care coordination, reduced fragmentation, and transparency in line with recommendations by the Office of Inspector General (OIG), the Medicare Payment Advisory Commission (MedPAC) and others. Hospice must prepare as more and more MAOs are participating in VBID to offer the hospice benefit to their beneficiaries.
Hospice Medical Review & PEPPER Reports | 04/04/23 | 4:00 PM
This session will take agencies through the winding road of Medicare scrutiny. While billing the Medicare benefit and getting paid relatively easy, there is always a risk of things being reviewed at some point and what can you do to avoid denials. Participants will be able to define Targeted Probe & Educate (TPE) and outline the structure of how to respond to any level of medical review that may occur, including UPIC, RA, SMRC. 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 accurately documenting.