Essential Training At Your Finger Tips

"Home health is in a constant state of flux. When we’re not dealing with the day to day of our clients and their needs, the industry is constantly bombarded with new regulations. CMS says this is to curb the rampant fraud in the industry. Home health, however, says that the federal government is out of touch, and has no idea of the importance home health serves our larger health care system. Navigating the compliance requirements of the payor while meeting the needs of patients and staff can only be done through system-ness and adherence to standardized patient care. As we navigate the waters of VBP, the Home Health Groupings Model (HHGM), and the additional Alternative Payment Models mandated by CMS, we need to evolve or retire our provider numbers. Ultimately, we need to look carefully at how we provide care, reduce costs, and increase outcomes. Changing our processes to be proactive rather than reactive we need to learn the lessons of those who have gone before us, to not only save our businesses, but grow them." - Kristi Bajer and Michael McGowan Read more

Accrediting agencies are looking at the Conditions of Participation (CoPs), however, the Centers for Medicare & Medicaid Services (CMS) uses the Medicare benefit policy manual which contains the conditions of payment; your agency needs to understand both. Backend Quality Assurance (QA) and Performance Improvement (PI) slows down both identification and resolution of issues and pushes the timeline for improvement in stars, Value-Based Purchasing (VBP) to a year or more. Agencies are often blind sided with Additional Documentation Reviews (ADR), Recovery Auditor Contractor (RAC), and Zone Program Integrtity Contractor (ZPIC) audits despite high marks on surveys because they are auditing from accrediting guidelines, not CMS triggers. CMS is using algorithms to look at every OASIS you submit. Top triggers are over utilization and indications that medical necessity and homebound status are questionable. New CoPs are only meeting the requirements accrediting agencies are already using. Course Instructor - Kristi Bajer and Michael McGowan Read more

Many private duty agencies struggle in managing the nuances between non-medical and medical care. Oversight of private patients can be a high risk area for non-compliance with state law and licensing requirements. In this session, the speaker will outline the role of the case manager within the private duty agency, as well as detail how the position functions within the team. Read more

This session will take a deep dive into the contractual requirements of Medicare managed care plans. This session will outline the necessities of the verification/authorization processes and appropriate coding/billing practices in order to get paid by these managed care plans. Significant missteps often leave agencies in the situation of writing off balances instead of collecting payment. This session will highlight some key components of working with plans such as CareCentrix to get the claim paid the first time you bill it. Don’t be left in the dark regarding Medicare managed care! Read more

This session addresses non-compete agreements in the context of the home healthcare industry: (i) whether they make sense for certain employees; (ii) the extent of their enforceability; (iii) important provisions that are often missing; (iv) steps to assess potential breaches and to enforce the agreement; and (v) best practices for onboarding and defending hires who are subject to another non-compete. Read more

Cybercrime is one of the top economic crimes in the world, with cost estimates soon to reach into the trillions. Not only have victim demographics expanded from the large well-known organizations to the small and mid-sized, healthcare providers are now a consistent target. The recent ransomware attacks, and threats of more to come, have raised questions regarding security and available protection mechanisms.  This presentation will review the critical areas of concern within your environment, provide insight, and offer tools to defend against these attacks. It will also focus on recovery and the importance of preparing for data loss. Read more