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
Home Health Value Based Purchasing ‐ The IPR Reports Detail Review
Wednesday, April 10
2:15 pm – 3:30 pm CST
HHVBP began January 1, 2023. This session will detail the process of the Value-Based Purchasing Model. The Interim Performance Reports began being issued July 2023 and this session will detail review these reports. The session will also review the calculation methodology of VBP Expansion and what agencies should be doing to be successful in 2024 and beyond. The HHVBP changes for 2025 will be detailed in this session.
Medicare Advantage: Digging in the Details
Thursday, April 11
10:30 am – 11:45 am CST
Home Health providers are grappling with the shift in the Medicare eligible population into Medicare Advantage Plans (MA Plans). Providers are asking: What are the implications of current demographic trends? What operational and financial issues should providers expect as their payer mix shifts to mostly Managed Care? Being successful in this environment of these payer mix changes requires agencies to understand their costs of treating these patients and other impacts on their operations on an individual contract basis.
Hospice Special Focus Program (SFP) & Provisional Period of Enhanced Oversight (PPEO)/VBID – Hospice and Medicare Advantage
Thursday, April 11
12:00 pm – 1:15 pm CST
Hospice Special Focus Program (SFP) & Provisional Period of Enhanced Oversight (PPEO)
Major scrutiny of the Hospice Benefit is well underway nationwide. This session will review the details of both programs and what Hospices can expect. The Special Focus Program (SFP), will monitor hospices identified as poor performers based on selected quality indicators. Hospices selected for the SFP will be under additional oversight to enable continuous improvement. This required program includes the development and implementation of enforcement remedies for noncompliant hospice programs, as well as procedures for appealing determinations regarding these remedies. These enforcement actions can be imposed instead of, or in addition to, termination of the hospice program’s participation from the Medicare program. Through the PPEO, new providers or suppliers are subject to prepayment medical reviews designed to address improper billing practices right out of the gate. This program is for newly certified hospices as well as change of ownership. This is a must attend session
VBID – Hospice and Medicare Advantage
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. There are 13 Medicare Advantage Organizations (MAO) participating in 2024 with 78 benefit packages, down from 2023. In addition to Hospice care there is an expansion of Palliative Care services that will be offered to patients through the MAO. The differences in coverage for an in-network vs. out-of-network provider will be reviewed. CMS requires that MAOs provide beneficiaries with broad access to the complete original Medicare hospice benefit. This session will cover all known aspects of the demonstration and will prepare hospices for the reality that Medicare Advantage is now in the Hospice world.