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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.
Sep 12
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About the Event
Hospice Medical Review & PEPPER
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 the different levels of medical review and outline the structure of how to respond to any level of medical review that may occur. 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.
- List the current edits being used in targeting hospices 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 a hospice’s performance
Home Health Medical Review & PEPPER
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