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Home Health - February 18, 2020
Financial Impacts of the Patient-Driven Groupings Model (PDGM)
This presentation will provide the impact of PDGM to reference changes to the unit of payments from a 60 day episode to a 30 day episode, 30-day periods, requests for anticipated payments (RAPs), occurrence codes to include billing and claims overview.
Clinical Impacts of the Patient-Driven Groupings Model (PDGM)
This presentation will cover the documentation to include the admission source and timing, clinical groups, functional impairment levels, comorbidity group, case-mix weights, other adjustments and how OASIS data will be used.
Review Choice Demonstration
This presentation will provide an overview of RCD and how the model can work in your favor. RCD is a demonstration that would help make sure that payments for home health services are appropriate through either pre-claim, prepayment or postpayment review.
Denials and Appeals
This presentation will cover the top five billing denials and the steps your agency would take to avoid the denials. This session will include the appeals process and ensuring your agency responds to ADRs in a timely manner.
Hospice - February 19, 2020
Disclosing and Recouping Medicare Overpayments for Hospice Providers
This presentation will focus on voluntary refunds, credit balance reports and extended repayment schedules to include highlighting the financial features in eServices.
Is Alzheimer’s Disease Not Otherwise Specified the New Debility, Unspecified?
This presentation will focus on the changes in the diagnosis patterns among Medicare hospice enrollees. Specifically, there have been notable increases between 2002 and 2016 in neurologically-based diagnoses, including diagnoses of Alzheimer’s disease. In Fiscal Year 2017, “Alzheimer’s Disease, unspecified” was the number one principal diagnosis reported on Medicare Hospice claims (CMS 1692-F). Ten percent of hospice claims had ICD-10 G30.9 (Alzheimer’s disease, unspecified) listed as the principal diagnosis (n=155,066), nearly twice the second-place ICD-10 diagnosis J44.9 [COPD (n=77,758)]. This presentation will discuss the increased utilization of Alzheimer’s disease, unspecified (ICD-10 G30.9) and the associated changes in the Non-Cancer Length of Stay (NCLOS) Rates for the ICD-10 category Diseases of the Nervous System.
Hospice Documentation - Denials and How to Avoid Them
This presentation will cover issues related to hospice patients receiving no visits in the last 7 days and the Service Intensity Add-On (enhanced payments the last 7 days). The session will also cover the appeal process and problems with records not being submitted, the Notice of Election being invalid, and continual issues with Face-to-Face.
Direct Data Entry (DDE) and the Notice of Election (NOE)
This presentation will focus on basic navigation for inquiries, claims submission and claims correction in the Direct Data Entry (DDE) system. The presentation will also include information on the requirements for submitting the Notice of Election (NOE) through DDE and the electronic claims audience.
FACULTY
Charles Canaan, Senior Provider Relations Consultant, Provider Outreach and Education, Palmetto GBA
Charles Canaan has over 30 years of diverse nursing experience in a variety of healthcare settings, to include inpatient, outpatient, home and organizational settings. His education includes a Bachelor of Science Degree in Nursing from Old Dominion University in Norfolk, Virginia, a Master of Public Health Degree in Health Promotion and Education and a Graduate Studies Certificate in Alcohol and Drug Studies from the University of South Carolina, and a Coding for Health Care Professionals Certificate from Trident Technical College. He reviews medical utilization data and trends. He currently provides education and consultation to Medicare Part A and Part B providers with learning needs.
Dan George, Senior Provider Relations Representative,Provider Outreach and Education, Palmetto GBA
Dan George has been with the Medicare program since 2004. In 2008, he became part of Palmetto GBA’s Congressional Unit. This unit handled complex inquiries for Part A, Part B and Home Health and Hospice. His experience is extensive in, but not limited to, coverage polices, compliance, billing, enrollment, and systems. In 2007 and 2008, he was a manager for Palmetto GBA’s Beneficiary Call Center. Prior to working with Medicare, Dan worked in skilled nursing facilities for 12 years. He directed Dietary Departments, which included participation in nutritional assessments, care planning, wound rounds, and patient documentation. Since late 2012, he has been a part of Palmetto GBA’s Provider Outreach & Education Department, focusing on Home Health & Hospice.
MaKisha Pressley-Callaham, Senior Provider Relations Representative, Provider Outreach and Education, Palmetto GBA
MaKisha is a graduate of Nova Southeastern University with a Doctoral degree in Education with an emphasis in Instructional Technology and Distance Education. She has over 20 years of experience with the Medicare program. In her current role as Senior Provider Relations Representative in Palmetto GBA’s Provider Outreach and Education department, she is the point of contact (POC) for outreach and education activities related to home health and hospice billing guidelines and regulations. MaKisha also has the responsibility to organize and develop educational materials, collaborate with providers and CMS regarding updates and changes to the Medicare program. With experience in Medicare communications, her expertise and knowledge enables her to explain complex statutes, legislative mandates, billing procedures, and policies in a manner easily understood by key stakeholders and program participants.
Joe Strickland, Director, Finance and Accounting, Palmetto GBA
Joe Strickland is a graduate of Augusta State University with a Bachelor of Business Administration degree in Accounting with over 20 years of experience with the Medicare program. In his current role as Director in Palmetto GBA’s Finance and Accounting department, his staff is responsible for all aspects of Medicare Financial Management, including Debt Collection, Extended Repayment Schedules, Debt Referral, Appeals, Voluntary Refunds, and Financial Reporting.
Harry Feliciano, MD, MPH, Senior Medical Director, Medical Review, Palmetto GBA
Dr. Feliciano is a specialist in internal medicine, geriatrics, preventive medicine and public health and currently serves as Senior Medical Director for Palmetto GBA. He received his medical degree from the Albert Einstein College of Medicine and his Masters of Public Health degree from the Columbia University School of Public Health. Dr. Feliciano leads an interdisciplinary group of associates (including physicians, nurses, and business analysts) dedicated to reducing the Medicare claims payment error rate through collaborative process improvement.
Sheri Mertins, HHH MR Operations Manager, Jurisdiction M (JM), Palmetto GBA
Sheri Mertins is the HHH MR Operations Manager for Jurisdiction M at Palmetto GBA. She is responsible for the Home Health and Hospice Medical Review team as well as Medical Review training and quality assurance. Ms. Mertins has been employed with Palmetto GBA for the past year. Sheri has a Master of Science in Nursing from Grand Canyon University and has more than 21 years of comprehensive clinical and leadership experience in various settings. Sheri is also a member of numerous professional organizations including American Nurses Association and Sigma Theta Tau International Honor Society of Nursing.