Budgeting – Why Do It?
Home Health is presented with many challenges including a changing reimbursement model, staffing issues, and ongoing regulatory and compliance updates at the national and state level. Agencies must budget appropriately each year and use key performance indicators on a regular basis to track and measure performance. The budget and KPI process is an essential step to communicate the financial impact of key decisions to clinical management and operations. Finance must collaborate with all functional areas to identify key revenue and cost drivers and develop realistic projections to drive the budget process. This session will focus on preparations of a Home Health budget and methods to track and measure the agency’s progress through key performance indicators and dashboards.
Efficiencies for Documentation Management – RCD & TPE
Documentation Management can include multiple layers of intricate policies and processes, with the end result being documents that are shared, organized, stored, and retrieved efficiently for consistency in responding to audits and maintaining accurate medical records. The Review Choice Demonstration (RCD) requires the Medicare MAC detail review certain components of the medical record that can lead to denials if the agency is missing the mark. Targeted Probe and Educate (TPE) includes a sample of claims being reviewed for full compliance with Medicare regulation and can lead to denials and eventually to a focused review. Agencies must simplify, but ensure that processes are in place to collect the paperwork that meets all Medicare requirements, but does so in a timely manner. Internal reviews of said documentation must be efficient and effective.
HHVBP – Deep Dive into the Data and CY 2019 Changes
In the CY 2019 Home Health Final Rule, CMS dramatically changed the scoring methodology for the Home Health Value-based Purchasing Program (HHVBP) pilot. The new Composite Measures have not been well defined and the reweighting changes the emphasis on which measures will impact your TPS scores. CMS recently provided some additional insights into the HHVBP first year performances. Join our presenters as they take a deeper dive in the rule changes, insightful TPS analyses, and the trends over the past three years.
Managed Care – How to Overcome the Operational Challenges within a Deep Managed Care Environment
Medicare Advantage plans continue to build market share with an attractive array of benefits. In most cases, they offer a lower cost alternative to Medicare, which attracts enrollment. These plans operate much differently than Medicare episodic payment for home health and you will need to adjust how you operate. Careful attention must be given to adapting your operations in home health in order to be successful under these Medicare Advantage and other managed care contracts.
Managed Care Panel Discussion
Medicare and Medicaid Advantage Plans continue to build market share and agencies need to adapt to these changes by improving operations to minimize waste while increasing the value of services. This panel of industry experts will discuss their experiences operating and succeeding within the managed care environment.
Revenue Cycle Management
Managing the home health revenue cycle is daunting. While cash flow efforts must be successful, agencies must also guard against potential compliance threats. With Medicare Advantages Plans at an all-time high and new payers continuing to flock to the industry, the revenue cycle becomes more complex. If processes are not effectively managed the consequences to cash flow can be dire. The onslaught of PDGM is just around the corner and with Targeted Probe and Educate (TPE), as well as the Review Choice Demonstration (RCD), agencies are at increased risk with poor revenue cycle or documentation management practices. This session will take a deep look into best practices for Revenue Cycle teams.
Review Choice Demonstration
CMS has revised prior authorization to, in their words, offer more flexibility and choice for providers in the five states (Illinois, Ohio, North Carolina, Florida and Texas) required to provide information supporting the care provided to home health patients. CMS notes three options – a Pre-Claim review that allows for unlimited resubmissions of non-affirmed requests, post-payment review of all claims (which is the default option), or minimal review with a 25 percent payment reduction – and the specifics of these options will be reviewed in detail. This session will also review the subsequent options (Selective Post-Payment review or Spot Check) for those choosing either of the first two options with a greater than 90 percent affirmation rate. It will review the outcomes of the Pre-Claim Review demonstration in Illinois and provide the attendee with the tools and resources to be able to identify the best option for their agency, should they be in one of the five states (or should CMS expand the demonstration).