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While 2020 began with the change to the Patient-Driven Groupings Model (PDGM) for reimbursement taking up home health agencies’ attention, the expansion of Review Choice Demonstration (RCD) was soon to follow. Both of these have been affected by the onset of the Covid-19 pandemic and resulting Public Health Emergency (PHE). At some point the PHE will expire, followed by a resumption of medical review activities by Medicare contractors. Medicare contractors normally use Targeted Probe and Educate (TPE), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), and Supplemental Medical Review Contractor (SMRC) reviews to evaluate claims for coverage and payment. How the PDGM provides payment will also have a significant impact on review results. This presentation will walk attendees through the PDGM payment model and how it affects medical reviews and denials. The impact of RCD activity on medical reviews is significant, both for agencies who choose a Pre-Claim Review option or an Additional Development Review (ADR) choice. This presentation will focus on agency actions to lower risks of being chosen for medical review and high-risk areas for denials. The status of the RCD and preparation tasks for when the RCD is started will be addressed. Finally, the PHE changes are also covered with suggestions for compliant documentation during the PHE to prevent problems after the PHE has ended. This program benefits home health agency Administrators/Managers, Clinical Supervisors/Managers, Directors of Nursing, and QA/QI staff. Course Instructor - Joe Osentoski Read more

The Medicare Review Choice Demonstration (RCD) begins in Florida on May 4, 2020, coinciding with the novel coronavirus (COVID-19) outbreak and the new Patient-Driven Groupings Model (PDGM) payment overhaul. Prepare now for RCD success with a webinar presentation by Palmetto GBA for home health providers that will review the basics of this five-state demonstration. This presentation will demonstrate how providers can select the review choice option through Palmetto GBA's online eServices portal during the 30-day window, March 20 through April 19. Additionally, lessons learned from the RCD in Illinois, Ohio, and Texas will be examined. Don't miss this opportunity to hear directly from your Medicare Administrative Contractor and get answers to your questions before the May 4th implementation.  Course Author: Cara Mia Wilkins, Charles Canaan, Dan George, Elizabeth Brogdon  Read more

In less than four months, Medicare's Review Choice Demonstration (RCD) will begin in Florida. This presentation will help home health providers understand the review choice selection options and implications of each, as well as what happens when an agency reaches the 90-percent affirmation threshold. Get prepared for yet another federal initiative coming to Florida that is designed to reduce billing errors, waste, fraud, and abuse. Additionally, this presentation will review how the Patient-Driven Groupings Model (PDGM) and RCD processes will have to be in sync in order to have optimal revenue cycle management. Course Author: J’non Griffin, RN, MHA, WCC, HCS-D, HCS-H, COS-C PT credits awarded for course completions are approved for 1 year and expire at the end of the calendar year unless otherwise stated. For a complete list of courses offering PT credits for this year, click here. Read more

The Review Choice Demonstration (RCD) has officially been approved and implementation is imminent in the first of five states to be affected. RCD is basically a repurposed Pre-Claim Review (PCR) and in fact, if indeed the information was affirmed, PCR is one of three options that agencies get to choose from. This session will detail and review the current status of RCD, share experiences from PCR and discuss some of the prevalent processes within your agency that may need to be tweaked. Course Author:  Melinda A. Gaboury, COS-C​ Read more

Effective clinical management in your office amidst the torments of the Patient-Driven Groupings Model (PDGM) and Review Choice Demonstration (RCD) will be crucial for long-term stability and success. Managing a home health agency has never been easy, however the upcoming PDGM and RCD programs will make it feel that way. These programs create more obstacles for clinical supervisors who will now have to become SEAL and stealth like to navigate through. Success will require strong processes, diligent monitoring, and constant change management to continue to perfect the agency operations and outcomes. This program will provide the SEAL (Success Equals Always Learning) training and/or sharpen the skills necessary to become a clinical supervisor to overcome and effectively run a home health agency. More specifically, the speaker and participants will focus on three areas of management, which include episode and patient management, staff management, and office management.  Speaker/Course Author - Christina Crumbley RN MSN HCS-D HCS-O  Read more

The Medicare home health benefit has undergone significant policy changes over the past several years, and the future will be no different as we face the overhaul of the payment methodology system, continued scrutiny by auditors, and more demonstrations. Attend this informative session for a look at how Washington is reforming long-term care and explore myriad legislative and regulatory issues impacting providers, including the Patient- Driven Groupings Model, the Review Choice Demonstration, and more. Course Author:  William A. Dombi, Esq. Read more

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