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SCHCHA Annual Conference

Speaker(s): Melinda A. Gaboury, CEO

Category: Speaking EngagementConference

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Speaker(s): Melinda A. Gaboury, CEO

About the Speaker(s)

Melinda A. Gaboury, with more than 29 years in home care, has over 20 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.

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SCHCHA Annual Conference Oct 25 - Oct 26, 2021
hotel location icon Sonesta Resort Hosted by

About the Event

Speaker: Melinda A. Gaboury
Value-Based Purchasing: Nationwide Rollout (two part)

A Value-Based Purchasing (VBP) Demonstration for home health was conducted in nine states and ended December 31, 2020. This session will review the impact of VBP on agencies in these nine states. In addition, there was an announcement by the Centers for Medicare & Medicaid Services (CMS) that a nationwide rollout of VBP is likely. We will look at what a nationwide rollout would look like and how the states that have been through the demonstration might fare as compared to states that were not in the demonstration.

Part 1
• Detail the aspects of the Value Based Purchasing System – what was used in Demo and what will be used Nationwide
• Review statistics from the Demonstration and evaluate this demonstration’s impact on the Star Ratings.

Part 2
• Review the details of the specific elements to be used in calculating the outcomes in the VBP Nationwide Rollout
• Outline a game plan for agencies to prepare for the coming Nationwide Rollout

Speaker: Melinda A. Gaboury
Hospice Medical Review in a Medicare Certified World

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. 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 – Targeted Probe & Educate has returned
• Detail the requirements for successfully submitting medical records for review
• Discuss the top 5 denial reasons for medical review and the documentation requirements to avoid those denials
• Detail the targets and other data from the PEPPER reports that is used to evaluate a hospice’s performance