Virtual Medicare PDGM Workshop
Speaker(s): Melinda A. Gaboury, CEO
Category: Speaking Engagement
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About the Event
This two-day workshop will take agencies through the current state of the Patient-Driven Groupings Model (PDGM) and move through all the aspects of Medicare home health reimbursement.
Day 1 Virtual Medicare PDGM Workshop
The PDGM has brought many changes to home health and the PDGM is not all that reimbursement is made up of. In addition to working through the fine details of the PDGM changes, the workshop will also cover extensive examples for Low Utilization Payment Adjustments (LUPAs), Partial Episode Payments (PEPs), and outlier adjustments. There will be a discussion of pre-billing claim reviews and the significance of them.
Day-to-Day Revenue Cycle Under the Patient-Driven Groupings Model with COVID-19 Updates
• Evaluate the PDGM Structure
• Detail the significant impact of intake on revenue cycle
• Health Insurance Prospective Payment System (HIPPS) code and episode exceptions review
• LUPA, PEP, and outlier calculations
• Describe the process for effectively auditing a chart for purposes of identifying pre-bill issues, including non-routine supplies
• Details of billing Requests for Anticipated Payment (RAPs) and final claims
• OASIS and ICD-10 coding impact on reimbursement
Day 2 Virtual Medicare PDGM Workshop
The impact of OASIS, ICD-10 coding, and medical review programs have the potential to more directly impact reimbursement than some of the other aspects of the PDGM, and this workshop will get you up to date on all of that as well. Additionally, with cash flow being one of the gravest areas of concern for providers in recent months, this workshop will take you through the basics of cash flow projections and how best to make that work in your organization.
Home Health Reimbursement: Beyond the PDGM with COVID-19 Updates
* OASIS and ICD-10 coding
* Medicare secondary payer
* Detail credentialing with managed care and issues surrounding getting paid
* Establish processes for effectively monitoring ADR/Recovery Audit (RA), and Unified Program Integrity Contractor (UPIC) reviews
* Monitoring and evaluating your Program for Evaluating Payment Patterns Electronic Report (PEPPER)
* Factoring the Review Choice Demonstration into the PDGM