Essential Training At Your Finger Tips

Home health providers are nearly two months into the “Volume to Value” transition marked by the installation of the Centers for Medicare & Medicaid Services (CMS) Patient-Driven Groupings Model (PDGM). Adapting to the new care production and delivery model presents challenges for the entire agency as traditional home care protocols will fail to produce the desired outcomes. As a result, all departments must be included in a successful PDGM value transition. Addressing intake and scheduling concerns are just the first steps to value outcomes, as they set the stage for an efficient clinical episode. Rewiring start of care OASIS admissions for accuracy in clinical profile deliver data for value-based plan of care production, identifying an initial care path to be managed on an in-episode basis for skill and value by quality assurance and utilization review personnel. By addressing the Low Utilization Payment Adjustment (LUPA) and Not Taken Under Care (NTUC) through compliance with CMS home health regulations, missed visits for value compromise, and patient scripting for outcomes and satisfaction, providers rewire areas that must be addressed for optimal outcomes. This webinar will present initial PDGM results from providers seeking optimal outcomes through assertive management of the value areas listed above. Focusing on the basics of the IMPACT Act’s “Volume to Value” philosophy, they have seen promising clinical and fiscal results of early PDGM episodes. By assuming care responsibility of value elements of the Medicare model, they have been able to reduce clinical staff stress while managing programs successfully with an in-agency model. Value results in case-mix, plan of care costs and management, clinical outcomes have all improved, and significant gains have been seen in missed visits and timely documentation for coverage. Don’t miss this progressive webinar to learn about initial clinical and financial results being posted during the PDGM “Volume to Value” transition.   Course Author: Arnie Cisneros, PT  Read more

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 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

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 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