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The PDGM brings many changes to the billing process, including doubling 75% of the volume of claims for current Medicare episodes compared to 2019 that will be sent, as well as multiple changes to claims data. With RAPs (Requests for Anticipated Payment) and final claims now required every 30 days instead of 60 days, agencies may need to expand their revenue cycle teams. This webinar will cover details regarding the actual billing changes that will need to occur under the PDGM. We will take you through the details of billing under the PDGM and will review the process that the Medicare Administrative Contractor will go through to calculate the HIPPS code and pay claims. Lastly, this webinar will cover the proposed changes from a RAP to NOA (Notice of Admission) for 2021. There will also be a discussion of the overall impact on the revenue cycle under the PDGM. Course Author: Melinda Gaboury Read More

The Patient Driven Groupings Model (PDGM) became effective on January 1, 2020. This is the most significant change to the home health care industry reimbursement structure since the introduction of the current Prospective Payment System (PPS) in October 2000. The new payment model dramatically impacts agency operations, processes and performance. Home health agencies must develop and implement plans to successfully transition to the PDGM now. This webinar presentation will review key areas, strategies, and processes in preparing an agency for the PDGM. The speaker will focus on the changes to the 30-day payment model, which will bring significant back office changes, specific to the claims processing and collections.  Course Author: Melinda Gaboury Read More

For millions of seniors, long term care insurance is an integral part of their long term care plans. This presents a unique opportunity for home health providers. Providers well-versed in the nuances of long term care insurance can market to and better attract these types of clients. However, long term care insurance is nuanced and complicated and mistakes can end up being costly. Join us as we welcome Paradigm Senior Services' Steven Dunn and learn how to capture this particular market. 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 Read More

IMPACT Act reforms have come to the home health industry and they outline a new care path for the pending value era. The Patient-Driven Groupings Model (PDGM) installed for 2020 home health programming, is just the first of the reforms we will confront in the next few years. Medicare changes to the acute episode are affecting providers across the care continuum, from hospitals to home health agencies, and the PDGM is focused on preparing home health to address post-discharge patient needs. By examining the response of Medicare providers outside of home health, we can identify care development and delivery goals that fit the PDGM and subsequent reforms. Through this approach, we can identify where traditional home health care programs may fail to achieve the goals of the value reforms. But, success under the PDGM will require significant changes from how we have operated under the Prospective Payment System (PPS); these changes will challenge many home health industry beliefs we have operated within for years. Philosophical changes may be required, but the PDGM era is designed to morph traditional home health programs into a more value-based model. In addition, many of the PDGM-designed changes to the home health model are required for success under subsequent IMPACT Act reforms, such as pre-claim review and post-acute PPS. This progressive presentation will address how to achieve the PDGM success today as you prepare for future value-based IMPACT Act reforms. Course Author: Arnie Cisneros PT Read More

So, the Patient-Driven Groupings Model (PDGM) is effective as of January 1, 2020, and there's no doubt that coding has significantly changed under the new payment methodology. During this session, we will review issues that can arise with ICD-10-CM coding under the PDGM, primarily through case study analyses. We will then discuss action plans that home health agencies can implement in order to be viable under the PDGM. The transition may be bumpy so far, but we will look at where you need to go. Two of the five PDGM subgroups are directly coding-related: Clinical Grouping and Comorbidity. What happens when the only diagnosis you have from the physician is an unaccepted diagnosis? Do you use another diagnosis from the referral source/physician? What if the clinical record doesn’t align with the primary diagnosis? What alternatives are there?! What about comorbidities — how do you ensure that YOU get the high comorbidity adjustment? (Tip: You can’t! It depends on the patient and following the coding guidelines and physician documentation!). But, how do you know where to put the diagnosis, and what interaction conflicts exist? These and other head scratching scenarios will be reviewed in this session. Let's not let coding under the PDGM be rocket science! Course Author: Sharon M. Litwin, RN, BSHS, MHA, HCS-D Read More

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