Melinda A. Gaboury, COS-C

Melinda A. Gaboury, COS-C
Melinda A. Gaboury, COS-C Chief Executive Officer
Publications written by Melinda A. Gaboury, COS-C
  • Home Health Pocket Guide to OASIS-C2 View
Recent articles written by Melinda A. Gaboury, COS-C
  • OASIS D – What is on the Horizon? View
  • Targeted Probe and Educate – What We Have Learned So Far View
  • CAHPS – Home Health & Hospice View

Upcoming Events

Tue 22

2018 CAHSAH • CHAPCA Annual Conference & Expo

May 22 - May 24
Monterey CA
United States
Speaker: Melinda Gaboury and Katie Wehri

We are pleased to announce that the 2018 Annual Conference & Expo will be sponsored by the California Association for Health Services at Home (CAHSAH) and by the California Hospice and Palliative Care Association (CHAPCA). We hope you’ll join in on the fun this year, as we celebrate expanding relationships and even more educational and networking opportunities than ever before!

Melinda Gaboury, HPS CEO, will speak at the following sessions:
M100 | Tuesday, May 22 | 10:15 am – 11:45 am, Home Health Groupings Model (HHGM). HHGM is the most industry-shaking event since IPS in 1998. The model as proposed would stand to cause agencies to receive 15% less in reimbursement than in 2017. Therapy will no longer receive increased reimbursement, coding will be more important than ever, and LUPAs are going to be significant. Learning Objectives: • Review the changes to PPS for 2018 • Detail the intricacies of HHGM
• Detail calculations of the current system versus HHGM using actual patient episodes

H200 | Tuesday, May 22 | 1:45 pm – 3:15 pm. Hospice PEPPER Reports- Only 40% of hospices across the country have accessed their PEPPER Reports. PEPPER reports are produced from claims data and compare the agency to the National 80th Percentile as well as to all agencies in their Medicare MACs Jurisdiction. If you are above the National average you are targeted for additional reviews by the Medicare MAC, Recovery Auditors and ZPIC auditors, Learning Objectives: • List the reasons for the PEPPER and how to access it • Detail the Target Areas that are calculated and compared within the reports • Review reports and identify areas that the hospice needs to work on for improvement

M400 | Wednesday, May 23 | 10:45 am – 12:15 pm OASIS: What Else Is There? OASIS is the most important piece of documentation agencies must complete. It initiates reimbursement, controls outcomes calculations, effects 5-Star Rating and is the controlling factor in Value Based Purchasing. OASIS is the tool that must be tweaked to become an instrument of Post-Acute Care outcome measures due to the IMPACT ACT. Do you really know its total impact? Learning Objectives: • List the different aspects of the agency’s day-to-day that is impacted by OASIS • Discuss the effect that the IMPACT Act is set to have on OASIS • Evaluate the impact of OASIS on outcomes and determine areas of needed improvement

Katie Wehri, HPS Director of Operations Consulting will speak at the following session:
H300 | Tuesday, May 22 | 3:30 pm – 5:00 pm, Hospice Quality Update – HIS, CAHPS, and HEART. This session will be fully developed after the release of the proposed CMS FY2019 Hospice Payment Rate and Quality Reporting Program update is released at the end of April 2018. It is expected that there will be more information on HEART, a standardized comprehensive assessment tool for hospices, in the April release. This session will explain the details learned in the proposed rule and review the impact on HIS and the hospice quality reporting program as well as discuss how hospices should be preparing for compliance with the changes. Updates to the CAHPS Hospice Survey will also be discussed. As time permits, suggestions for how hospices can improve in their HIS and CAHPS Hospice Survey outcomes will be shared and discussed. Learning Objectives: • Explain the current status of HEART and its impact on HIS • Review and discuss the updates to the HIS and CAHPS Hospice Survey as proposed for FY2019 and beyond • Share suggestions for how hospices can improve their HIS and CAHPS Hospice Survey outcomes

Thu 24

2019 Hospice Proposed Rule

May 24 @ 11:00 am - 12:30 pm CDT
Nashville TN
United States
Speaker: Katie Wehri

The proposed rule is used to by CMS to relay the proposed payment rates for hospices for the next fiscal year, provide an update on the hospice quality reporting measures, and to propose additional or revised rules. The FY2019 hospice proposed rule is expected at the end of April with the following potentially addressed in the proposal:
1. Physician assistants as attending physicians for hospice patients
2. Possible claims based measures added to the hospice quality reporting program
3. More information on HEART – the standardized comprehensive assessment instrument CMS is developing for hospices
4. More information on possible future payment refinements as CMS has more data from hospice cost reports and another year of payment data upon which to draw conclusions
5. Comments from CMS regarding ongoing data analysis and concerns
This webinar will focus on what is in the proposed rule, the potential impact on hospices, and how hospices should respond

Jun 06

The Home Care & Hospice Association of NJ’s 2018 Annual Conference and Exhibition

June 6
Atlantic City NJ
United States
Speaker: Katie Wehri

The Home Care & Hospice Association of NJ’s Annual Conference and Exhibition offers timely educational programs, networking and exhibit opportunities that will help attendees tackle current industry challenges and succeed within their organization. Join home health, hospice and health care service firm leaders to learn strategies and gain insights to position your agency for success and growth!

Over 200 professionals, including top leadership, from more than 100 agencies attend the conference year after year. Come and join us at Caesar’s Atlantic City!

Melinda A. Gaboury is co-founder and Chief Executive Officer of Healthcare Provider Solutions, Inc. (HPS). Melinda Gaboury and Mark Cannon founded the company in April 2001 to provide financial, reimbursement, billing, operational and clinical consulting to the home care and hospice industries.

With more than 27 years in home care, Melinda has over 17 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 PPS training, billing, collections, case-mix calculations, chart reviews and due diligence. ZPIC, 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 as ex-officio and is Associate Director on the Home Care Association of Florida Board of Directors. Melinda is also the author of the Home Health Pocket Guide to OASIS-C2: A Reference Guide for Field Staff.

Melinda attended Cumberland University in Lebanon, Tennessee and received her Bachelor of Business Administration in Accounting.  She began her career in 1991 with a large Tennessee based homecare chain as a staff accountant and later joined a national healthcare consulting firm as their Reimbursement Manager.   

Prior to the inception of Medicare PPS, Melinda began researching, auditing and reviewing processes with OASIS, ICD-9 Coding and clinical documentation. She has developed and taught clinician and billing Medicare PPS Training and Hospice Training Workshops in a variety of venues. Melinda’s priority remains bridging the gap between clinical and financial issues in home health and hospice agencies.   The one unique thing that Melinda brings to the industry is the development of very effective compliance education while being able to also teach the reimbursement aspect and how they are directly related.

Melinda has many years of firsthand experience in the following key areas: 

  • Medicare PPS Billing Training
  • Medicare Hospice Billing Training
  • Chart Reviews as a result of OIG Corporate Integrity Agreements
  • Chart Reviews for Billing, ICD-10 Coding & OASIS Integrity Issues
  • Coordination of Clinical and Financial Staff Communications
  • Home Health PPS & Hospice Billing, Collections & Case Mix Calculations
  • Medicare Revenue Recognition Models
  • Operations Reviews and Process Improvement
  • Due Diligence Procedures
  • Staffing Pattern Analysis
  • Management of a Medical Billing Department
  • Financial Feasibility Studies/Certification Applications
  • Correspondence and Appeals with Medicare Administrative Contractors