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Conference Agenda


PDGM: What You Need to Know to Win Under the New Payment Model

8:00 – 9:00 a.m.

Registration, continental breakfast

9:00 – 10:30 a.m.

Make Way for PDGM

J’non Griffin, RN, MHA, WCC, HCS-D, HCS-H, COS-C, AHIMA-Approved ICD-10-CM Trainer/Ambassador, president of Home Health Solutions, LLC, Carbon Hill, Ala.

Understanding how the Patient-Driven Groupings Model (PDGM) will work is crucial to understanding the model’s potential impact on your agency’s bottom line. This session will provide a deep dive into CMS’ plans for a new payment model beginning Jan. 1, 2020 — explaining why CMS feels a need to revise the way agencies get paid and how PDGM will be a sea change from the existing Prospective Payment System (PPS).

Among other things during this session, Griffin will detail how agencies will be affected by CMS’ decision to shift to 30-day payment periods and not factor the number of therapy visits provided into agencies’ payment.

Griffin will provide attendees with specific examples about how minor differences in variables might change a patient’s case-mix weight. She also will provide examples about how the new payment model could affect traditional thinking about the provision of care.

TOOL  How states overall compare now to PDGM

10:30 – 10:45 a.m.


10:45 a.m. – 12:00 p.m.

Speed up your billing processes under PDGM

Laura Page-Greifinger, RN, BSN, MPA, president and CEO of Quality in Real Time (QIRT), Floral Park, N.Y.

Because CMS has decided to shift payment periods for home health from 60 days to 30 days, it’s essential that agencies identify ways to speed up processes so they can bill faster. Under the Prospective Payment System (PPS), many agencies take 18 to 21 days to submit requests for anticipated payment (RAPs). And it might take agencies 20 to 30 days post-discharge to submit a final bill. But under PDGM, cash flow will be king. Page-Greifinger will offer strategies to help agencies submit RAPs in five to seven days and final bills within five to 10 days under PDGM.

TOOLS  Dashboard tools and RAP/final bill monitor

12:00 – 1:00 p.m.


1:00 – 2:15 p.m.

Adapt to survive under PDGM — but don’t adapt too much

J’non Griffin, RN, MHA, WCC, HCS-D, HCS-H, COS-C, AHIMA-Approved ICD-10-CM Trainer/Ambassador, president of Home Health Solutions, LLC, Carbon Hill, Ala.

Under PDGM, agencies will receive more money for treating certain types of patients than others. For example, agencies will be paid more for care provided during early episodes than late and more for patients from institutional settings as opposed to community settings.

Agencies also must pay close attention to their bottom lines in the wake of CMS’ decision to eliminate bonus payments for high therapy.

Agencies that analyze their current patient mix may identify marketing changes they could make to ensure they’ll be as profitable as possible under PDGM. They could shift gears, for example, with their marketing efforts and attempt to take on fewer patients from the community and more from the hospital. But agencies must recognize the risks they take by making significant changes to their patient mix. Sharp changes in billing may raise a red flag to CMS about potential fraud and abuse.

Griffin will explain how agencies should adapt — making themselves more profitable under PDGM — while not creating a separate problem when it comes to fraud. She’ll also explain how agencies should adapt when it comes to the provision of therapy.

TOOLS  PDGM case mix weights and LUPA thresholds

2:15 – 2:30 p.m.


2:30 – 3:45 p.m.

Improve your productivity, accuracy as you prepare for PDGM

Laura Page-Greifinger, RN, BSN, MPA, president and CEO of Quality in Real Time (QIRT), Floral Park, N.Y.

While agencies will feel an urgent need for speed when it comes to billing under PDGM, they also must consider the increased importance of having intake staff and clinicians gathering detailed, accurate information. Without that kind of information, coding won’t be as accurate as possible. In some situations, claims will be kicked back or denied. In other situations, agencies will leave money on the table.

During this session, Page-Greifinger will explain the key questions and documents intake staff will need to ask and gather under PDGM. Intake will play a huge role in coding accuracy, from identifying admission source to avoiding questionable encounter codes through diagnosis specificity at referral.

In addition to the need to improve intake under PDGM, it will be even more important to have clinicians document information thoroughly, efficiently and accurately. Page-Greifinger will describe the increased importance of clinicians documenting in the home — and how that leads to increased accuracy on the OASIS.

TOOL  Intake query tool

3:45 – 4:45 p.m

Get ahead of PDGM: Key marketing, sales strategies to set your agency up for success

Melanie Stover, owner of Home Care Sales, which has offices in Fairhope, Ala., Philadelphia and Nashville.

With a major payment model change barreling toward the home health industry, are your marketing efforts ensuring your agency is positioned for success? Hear from home health sales and marketing expert Melanie Stover on ways to strategically position your agency ahead of PDGM through relationship building and partnerships. Understand the mix of providers and the types of patient referrals that your agency should target to best survive and thrive under the new payment model.

TOOLS  Checklist of key marketing / sales strategies for PDGM

5:00 – 6:30 p.m.

Exhibit Hall Grand Opening/Networking Reception

Who Should Attend?

  • Administrators
  • Owners
  • CEOs / Presidents
  • COOs
  • CIOs / Technology Directors
  • CFOs / Directors of Finance
  • Business Developers
  • Care Managers
  • Directors of Marketing & Sales
  • HR Directors
  • Office Managers
  • Consultants
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