Essential Training At Your Finger Tips

Demonstrating and supporting medical necessity is not only essential for patient-centered care but also directly impacts submission compliance and affirmation rates under CMS’s Home Health Review Choice Demonstration (RCD). This session will provide providers with strategies to document, review, and communicate medical necessity effectively—reducing denials, improving affirmation rates, and ensuring compliance with Medicare payment requirements.   By the end of this session, participants will be able to: Clearly define Medicare’s requirements for medical necessity in the home health setting. Apply best practices for documenting and supporting medical necessity throughout the episode of care. Conduct effective internal QA reviews to identify and correct documentation gaps before submission. Strengthen compliance with the Review Choice Demonstration by linking documentation to affirmation success. Recognize and respond to recertification trends within their agency to ensure services remain justifiable.  Support medical necessity during recertification—including when it is appropriate to continue or discharge. Navigate difficult conversations with patients and families who desire ongoing services without meeting criteria. Identify the most common RCD denial reasons and apply strategies to avoid them. Understand the purpose and process of the Notice of Medicare Non-Coverage (NOMNC) and the Quality Improvement Organization (QIO) appeal process.   Speakers/Course Authors - J'non Griffin & Kimberly Wilkerson Read more

In this recording of a live, in person class, experts from Palmetto GBA provide an in-depth look at the latest CPILs and hot topics in Review Choice Demonstration (RCD). This course will also cover the most common medical review denials and non-affirmations in Florida, with a focus on homebound status and medical necessity as key challenges. Learn how to avoid these top issues and ensure compliance. Gain valuable insights and strategies to reduce denials and improve patient outcomes in Medicare-certified home care.   Speakers/Course Authors - Elizabeth Brogdon, Michael Bibbins Read more

More than 75% of agencies under the Review Choice Demonstration choose Pre Claim Review (PCR). Medical necessity was one of those things that we never really had to think much about under PCR.  It was the one thing that Palmetto wasn’t focused on during their reviews…Well…now that RCD has been extended another 5 years, there is a renewed focus on the it by Palmetto. So, are your PCR submissions ready for the increased scrutiny? This session will cover the basics of Medical Necessity under the Medicare benefit and we will learn what Palmetto is looking for and how to provide the information needed to get those quick affirmations.  All this while using what you already have in your charts and without spending more time on the overall process.  Discussion will include the “ new” wound care and Hand-Off requirements. Medical necessity…it’s baaack!   Speakers/Course Authors - Kim Wilkerson Read more

More than 75% of agencies under the Review Choice Demonstration choose Pre Claim Review (PCR). Medical necessity was one of those things that we never really had to think much about under PCR.  It was the one thing that Palmetto wasn’t focused on during their reviews…Well…now that RCD has been extended another 5 years, there is a renewed focus on the it by Palmetto. So, are your PCR submissions ready for the increased scrutiny? This session will cover the basics of Medical Necessity under the Medicare benefit and we will learn what Palmetto is looking for and how to provide the information needed to get those quick affirmations.  All this while using what you already have in your charts and without spending more time on the overall process.  Discussion will include the “ new” wound care and Hand-Off requirements. Medical necessity…it’s baaack!   Speakers/Course Authors - Kim Wilkerson Read more

The Medicare Review Choice Demonstration (RCD) has introduced several compliance tools, yet Unified Program Integrity Contractor (UPIC) audits often reveal shortcomings in RCD implementation. By integrating RCD best practices with UPIC findings, agencies can pinpoint areas for optimizing clinical documentation and deliver cost-effective care. This approach aims to yield positive outcomes in the Home Health Value-Based Purchasing (HHVBP) program while minimizing financial disruptions from UPIC or other payer reviews. It encompasses both agency record generation processes and care management principles. Don't miss this opportunity to enhance your agency's compliance efforts and drive excellence in home health care. Speakers/Course Authors - Joe Osentoski Read more

Join us for an insightful workshop led by Palmetto GBA representatives, where we’ll delve into various updates on Medicare home health programs. Explore changes in the Review Choice Demonstration (RCD), along with program trends and selection statistics. Gain valuable insights into recent billing requirement modifications, including new telehealth G codes and Notice of Admission (NOA) mandates. Discover common investigation triggers and provider concerns, as well as key denial reasons and non-affirmation issues. Don’t miss this chance to stay informed and address your RCD queries firsthand.   Speakers/Course Authors - Michael Bibbins & Elizabeth Brogdon Read more