Melinda Gaboury will lay a strong foundation for your home health staff by providing a more effective approach to the Medicare PPS regulation requirements. She will discuss Medicare patient verification utilizing HIQH/HETS screen examples & review adjacent episode calculations - field by field on claim forms. She will also instruct on how to make Medicare claim adjustments.
Melinda will present on how to effectively audit a pre-bill for final claim purposes, both Medicare and Non-Medicare Payers, and review the details of billing for Non-Routine Supplies using billing guidelines.
As we all know, more and more scrutiny of agency records has been taking place in the form or ADR and RAC reviews. This session will outline the current risks and outline steps to manage that risk and include how to utilize PEPPER report data as a risk management tool.
- Review Key PPS Billing Highlights for 2018
- Calculate and evaluate the HHRG, HIPPS Code and Episode Exceptions
- Verify Medicare Eligibility of patients and calculate Adjacent Episodes. Complete a RAP and Final Claim form.
- Describe the process for effectively auditing a Chart for purposes of identifying pre-bill issues and Medicare Secondary Payor Issues.
- Describe how to effectively use data such as the Pepper Reports to mitigate financial risk
- Establish processes to improve revenue cycle management.
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Speaker: Melinda Gaboury is CEO of Healthcare Provider Solutions, which provides financial, reimbursement, clinical and cost reporting services to the home care, hospice and rehabilitation therapy industries. Prior to the inception of Medicare PPS, she began researching, auditing and reviewing processes with OASIS, ICD-10 Coding and clinical documentation. She has developed and taught clinician and billing Medicare PPS trainings in a variety of venues.