Patient-Driven Groupings Model (PDGM) Workshop - Virtual

PROGRAM OVERVIEW

The Patient Driven Groupings Model (PDGM) is the payment model that has dramatically impacted agency operations, processes and performance. January 2024 brings even more changes with the updates to the Value-Based Purchasing demonstration.  Agencies must develop and implement plans to continue to succeed under PDGM. This workshop will discuss key areas, strategies and processes in assisting an agency with continued success in 2024.  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 PEPPER data will be reviewed that holds vast importance as it impacts medical review.  Lastly, this workshop will review the full-blown emphasis of ICD-10 coding under PDGM and how agencies will have to monitor to ensure the specificity of coding for their patient care plans.  Lastly, the workshop will include a session on being successful with Medicare Advantage.

Program Topics:

Summarize key Revenue Cycle Operations affected by PDGM

• Explain scheduling strategies to prevent penalties for Late NOAs
• Discuss necessary modifications to the intake and referral process under PDGM

 Review the Specifics of calculations for HIPPS code under PDGM

• Explain the relevance of timely OASIS review, coding completion and clinician documentation under PDGM
• Evaluate the specificity requirements of coding under PDGM
• Outline the Impact on case-mix weight with coding and OASIS
• Present data to assist in determining financial impacts of PDGM on an agency
• Explain the importance of clinical review of each 30-day payment period under PDGM

 Review the impact of PEPPER data on home health medical review

• Analyze targets on PEPPER reports
• Detail the impact of PEPPER on medical review

 Review the details of Medicare Advantage Success

• Provide Detail statistics on where Medicare Advantage is active
• Planning for strategic and longer-term sustainability in partnering with MA Plans.

FACULTY

Melinda Gaboury, COS-C
Chief Executive Officer
Healthcare Provider Solutions, Inc.

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. Melinda is currently serving as Chair of the NAHC/HHFMA Advisory Board and Work Group, is serves on the Home Care Association of Florida and Tennessee Association for Home Care Board of Directors. Melinda is also the author of the Home Health OASIS Guide to OASIS-E and Home Health Billing Answers, 2023.

CANCELLATIONS

Cancellations are subject to 20% handling fee. There will be NO REFUNDS issued for cancellations received within 10 business days prior to program. Cancellations must be in writing. Refunds will not be made for no-shows. However, substitutions will be allowed. Should CAHSAH® cancel the program, a full registration fee refund will be issued.

CERTIFICATE OF COMPLETION & CONTINUING EDUCATION UNITS (CEUs)

Provider approved by the California Board of Registered Nursing (Provider #CEP17394) for five and one half (5.5) contact hours of continuing education. You must be present for the entire workshop to earn Continuing Education Units. No partial credits can be given. Certificates are distributed at the close of the program.