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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: A Reference for Field Staff; 2023 and Home Health Billing Answers, 2022.
About the Event
Hospice – VBID Demonstration (1 session)
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 – PEPPER Reports
This session will discuss PEPPER reports and other data analysis that agencies will need to review to ensure that agency 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. This session will also review some State specific PEPPER data so you can tell where you stand compared to others in the state.
Home Health – Value Based Purchasing Update (2 Sessions)
The Centers for Medicare & Medicaid Services (CMS) Home Health Value-Based Purchasing (HHVBP) National Expansion has agencies pitted against each other and given incentives for better quality care under the HHVBP while being forced to survive under the rate cuts and constant scrutiny of the PDGM model. CMS simultaneously seeks to enhance the current public reporting process and the outcome measures associated. January 2023 was the first month of the nationwide HHVBP rollout, how will your agency fare? This session will include a look at the pre-implementation reports from HHVBP and how agencies can use those moving forward and analyze how the HHVBP model affected outcome scores for every provider. Melinda Gaboury of Healthcare Provider Solutions will present her knowledgeable, very frank, and clear insights and suggestions on how to implement improvements within your agency.
Hospice – Revenue Cycle Keys to Success
The 2023 Hospice Rule brought changes in reimbursement as well as the content of other regulatory clarifications. This session will examine eligibility verifications, Election Statement and Addendum and Notice of Election requirements under recent regulatory updates. It will walk through the Late Notice of Election and the exceptions process of appeal. Face-to-Face requirements, Certificate of Terminal Illness, and the aggregate cap self-reporting requirement are a few among many of the daily reimbursement related challenges that we will cover in this session.
Hospice – Medical Review – UPIC, SRMC 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.
Home Health – Revenue Cycle Keys to Success
2023 has already brought about some significant concerns with the resurrection of error codes and reduced rates. This session will take you through where we are today with the NOA and what agencies need to do to ensure they are timely. In addition, this session will look at the entire process of the Home Health Revenue Cycle from Intake through the Collections of the payment. You need your revenue cycle team members involved. All of them!
Home Health – PEPPER Reports
This session will take agencies through the winding road of Medicare scrutiny. This session will discuss PEPPER reports and other data analysis that agencies will need to review to ensure that their risk from medical review is limited. This session will review some State specific PEPPER data so you can tell where you stand compared to others in the state.