PDGM Workshop – Monroe, LA
Speaker(s): Melinda A. Gaboury, CEO
Category: Speaking Engagement
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About the Event
The Patient Driven Groupings Model (PDGM) will go into effect January 1, 2020. This is the most massive change to the home care industry reimbursement structure since the introduction of the current Prospective Payment System (PPS) in October 2000. The new payment model dramatically impacts agency operations, processes and performance. Agencies must develop and implement plans to successfully transition to PDGM. This workshop will discuss key areas, strategies and processes in preparing an agency for PDGM. This workshop 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 shorter 30-day payment period. The change to a 30-day payment model will also bring significant back office changes, specific to the claims processing and collections, which will be one emphasis of this workshop. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised quality care delivery under the PDGM program! Lastly, this workshop will review the details of billing changes that will impact RAPs, Final Claims and Cash Flow.
• Summarize key areas of agency operations affected by PDGM.
o Provide guidance on evaluating an agency’s current preparation status.
o Outline implementation actions in each key area.
o Explain scheduling strategies to prevent missed visits
o Discuss necessary modifications to the intake and referral process under PDGM
• Review the complexity of determining LUPA thresholds under PDGM
o Discuss relevance of front-loading, missed visits and refusals of care and services to LUPA prevention
o Review clinical management responsibilities related to LUPA prevention
• Review the Impact of ICD-10 coding under PDGM
o Explain the relevance of timely OASIS review, coding completion and clinician documentation under PDGM
o Evaluate the specificity requirements of coding under PDGM
o Outline the Impact on case-mix weight with one code versus another
• Review strategic planning for implementation of clinical episode management best practices within the agency
o Identify the significance of the removal of therapy thresholds under PDGM
o Establish how providers with lower therapy utilization are able to maintain quality outcomes both clinically and financially
• Present data to assist in determining financial impacts of PDGM on an agency.
o Explain the importance of changing from 60 to 30-day payment periods under PDGM
o Outline the new requirements for billing RAPs and Final Claims
o Review HIPPS code structure and the plan for reconciling payment differences
o Review strategies for improved physician interaction to ensure timely 30-day billing