The new payment model dramatically impacts agency operations, processes and performance. Agencies must develop and implement plans to successfully transition to PDGM. This workshop will discuss key areas, strategies and processes in preparing an agency for PDGM. This workshop will have a focus on best episode management and process improvement practices including the referral, intake and scheduling processes, timely documentation, physician and patient communication strategies, all of which are required to more tightly manage care within the shorter 30-day payment period. The change to a 30-day payment model will also bring significant back office changes, specific to the claims processing and collections, which will be one emphasis of this workshop. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised quality care delivery under the PDGM program! This workshop will bring emphasis to the fact that every discipline is valued the same and extra therapy visits does not equal higher payment. Lastly, this workshop will review the full blown emphasis of ICD-10 coding under PDGM and how agencies will have to monitor to ensure the specificity of coding for their patient care plans.
Summarize key areas of agency operations affected by PDGM.
Present data to assist in determining financial impacts of PDGM on an agency
- Provide guidance on evaluating an agency’s current preparation status.
- Outline implementation actions in each key area.
- Explain scheduling strategies to prevent missed visits
- Discuss necessary modifications to the intake and referral process under PDGM
Review the complexity of determining LUPA thresholds under PDGM
- Review strategies for improved physician interaction to ensure timely 30-day billing
- Explain the importance of changing from 60 to 30-day payment periods under PDGM
- Provide North and South Carolina specific data with comparisons from CMS LDS 2018 database
Review the Impact of ICD-10 coding under PDGM
- Discuss relevance of front-loading, missed visits and refusals of care and services to LUPA prevention
- Review clinical management responsibilities related to LUPA prevention
Review strategic planning for implementation of clinical episode management best practices within the agency
- Explain the relevance of timely OASIS review, coding completion and clinician documentation under PDGM
- Evaluate the specificity requirements of coding under PDGM
- Outline the Impact on case-mix weight with one code versus another
- Identify the significance of the removal of therapy thresholds under PDGM
- Establish how providers with lower therapy utilization are able to maintain quality outcomes both clinically and financially
- Review appropriate therapy utilization practices, discuss methods to evaluate current practices and implement changes, including alternative approaches to ensure patients are receiving appropriate, cost-effective quality care
- Discuss strategies to enhance communication and collaboration between all disciplines
See Program for Details
Nurse Contact Hours will be offered.
EARLY REGISTRATION ENDS 10/25/2019
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.