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OCHCH Home Health Billing Series Part 3

Speaker(s): Melinda A. Gaboury, CEO

Category: Home CareSpeaking Engagement

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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 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, 2022.

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OCHCH Home Health Billing Series Part 3 Nov 04
11:30 am - 1:00 pm EST
Hosted by

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 2023 brings even more issues with rate changes that have been proposed for home health and the impending Value-Based Purchasing Nationwide Rollout.  This workshop will discuss key areas, strategies and processes in assisting an agency in staying ahead of PDGM changes and reimbursement rates.  This webinar series 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 30-day payment period. The Notice of Admission (NOA) will be reviewed in detail with examples of exceptions and how agencies should respond.  Lastly, this series will review the 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.  Lastly this series will review the impact of Medicare Advantage claims on the Home Health Revenue Cycle.

Program Topics

Webinar #1 (Oct. 18th) – PDGM Model Review & Impact on Billing

  • Summarize key Revenue Cycle Operations affected by PDGM
  • Discuss necessary modifications to the intake and referral process under PDGM
  • Present data to assist in determining financial impacts of PDGM on an agency.
  • Evaluate the specificity requirements of coding under PDGM
  • Review strategies for improved physician interaction to ensure timely 30-day billing
  • Explain the importance of clinical review of each 30-day payment period under PDGM


Webinar #2 (Oct. 26th) – Submission of the NOA and Specifics of Billing 30-day Final Claims

  • Detail requirements of submitting the NOA
  • Explain scheduling strategies to prevent penalties for Late NOAs
  • Outline the exceptions request process for the NOA
  • Detail the requirements for submitting Final claims
  • Review the complexity of determining LUPA thresholds under PDGM
  • Review the reconciliation process after posting payments for claims


Webinar #3 (Nov. 1st) – Medicare Advantage and Getting Paid

  • Outline the credentialing process with Medicare Advantage Plans
  • Evaluate the most important questions to ask before signing an in-network agreement
  • Detail the impact of Medicare Advantage Plans on the Medicare Program
  • Review the most common claim denial reasons and working through those
  • Review the most common road blocks in getting MA claims to appropriately process & pay
  • Review MSP policies and practices