Volume 7, Number 41 October  17, 2018

Dear Healthcare at Home Colleague,

Medicare Advantage now accounts for nearly one-third of Medicare beneficiaries and is expected to grow. More and more, certified providers will be dealing with insurance companies for payment rather than with a CMS contractor such as a MAC and an auditor such as a ZPIC or UPIC. That means they need to know how these payers operate. We have two important articles this week that should help. One is an analysis by home care attorney Elizabeth Hogue of a new OIG report that has made scathing accusations against MA companies. Another is our own commentary on Elizabeth's analysis, from the point of view of a Medicare beneficiary and taxpayer. You'll want to read both, so click below, first on "What Providers Should Do About Denials From Medicare Advantage Plans" and then read "A Patient and Taxpayer Looks at the OIG MAO Report."

Other news this week: Keeping an eye on tech vendors for you, we report on a new release by Brightree in the Home Medical Equipment sector, and a partnership of note by e-Caregiving that will enhance patient engagement and family caregiver support. Regular readers will remember that we profiled e-Caregiving a couple of weeks ago in "Experts Release Software for Staff Retention/Recruiting; Training Family Caregivers." Longtime home care nurse Tina Marrelli saw a need, family caregiver burnout, and found a creative way to address it.

Private Duty agency owners will want to watch this space next week. We have been researching the resurrection of Honor Health, the San Francisco startup that famously failed with its attempt over the last two years to "uberize" home care. Their second attempt to find the best use of the technology they developed is to partner with small- to medium-sized non-medical agencies. We have heard pros and cons and have spoken with early adopters and with Honor president Nita Sommers. We'll tell you what we think next week.

Compliance, compliance, compliance
Anybody old enough to remember Frankie Ford? I've had his 1959 hit on my mind lately. "Come and let me take you on a Sea Cruise..." In January, I will be joining a host of other consultants and attorneys on the 8th annual Compliance Cruise and I encourage you to consider it. Three solid days of rules and regulations and how to follow them to keep your agency safe from payment denials and accusations of fraud, all from presenters who know the regs better than anyone. Between those three days, get away from winter on the Royal Princess, with several stops in the Caribbean. What is more, all of the experts are available the entire week for consultations, and the policy of the organizers, Pearson & Bernard Law, is that they are not allowed to charge you for their consulting while on the ship. Take a look at the brochure here.

I am on my way to address the good people of the New York State Home Care Providers association next week in Uniondale. I look forward to seeing my great New York friends there.

Have a great week. Keep making a difference!

Editor signature
Tim Rowan

What Providers Should Do About Denials From Medicare Advantage Plans
Guest author Elizabeth Hogue, Esq. looks at the OIG report on abusive insurance practices and finds the familiar refrain "always appeal" applies to Medicare Advantage plans as well as Medicare MACs and UPICs.

A Patient and Taxpayer Looks at the OIG MAO Report
Editor Tim Rowan takes a deeper dive into the OIG report on Medicare Advantage Organization abuses.

ICmed and e-Caregiving Partner
Medicare estimates 66 million lay caregivers in the US. New partnership formed to bolster patient-caregiver engagement.

Brightree Releases "Patient Hub" for HME Providers
App to enhance patient communication introduced at Medtrade conference.

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During the 3rd Quarter of 2018, web sites of the above advertisers were visited by home care and hospice executives and staff 1726 times.

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Last Week's Most-Read Stories:
Software Company Fined $115 Million
Could it happen in post acute care?
Telehealth Giants MIA but RPM Startups Make A Splash at NAHC Conference
In spite of some surprising absences, remote patient monitoring was a strong theme at this year's NAHC Conference and Expo.

As of this date, approximately 31,317,000 Baby Boomers have become Medicare eligible.
Notable Upcoming Conferences Free Webinars

New York Association of Health Care Providers
Annual Management Conference and Exhibition

October 23-24
Uniondale, NY
Information and registration

The 8th Annual Medicare Compliance Cruise *

Presented by Pearson & Bernard, PSC

January 12-19, 2019
Departs from Ft. Lauderdale

Information and registration

*The Rowan Report will see you there.

Your state or national association meeting not listed? Send the details to Conferences@RowanResources.com using this format:

Conference Title
Sponsoring Association
Hotel or Conference Center, City, State

QAPI 101

Presented by HealthcarefirstHosted by ElevatingHOME & HHQI
Date: Wednesday, November 14
Time: 1:00 pm EST
Audience: Home Health Agencies
Register Here

ElevatingHOME and HHQI will review the 5 Standards that are required to be included into an agency’s QAPI program. They will discuss possible activities, tools, and resources for each standard, as well as infection prevention and patient safety.

Public Policy Leadership Series

Presented by: ElevatingHOME


• Joy Cameron, Vice President, Policy and Innovation, ElevatingHOME and VNAA
• Bill Dombi, President, National Association for Home Care & Hospice
• Sarah Myers, Partnership for Quality Home Healthcare

Schedule: Wednesdays, October 3 - November 7
Session 1: October 3
Time: 1:00 pm EDT
Fee: Free to ElevatingHome, VNAA, and Alliance for Home Health Quality Improvement members

Click here for complete schedule and registration

Hospitalization Performance Improvement Projects (PIPs)

Presented by HealthcareFirst
Hosted by ElevatingHOME & HHQI

Date: December 12
Time: 1:00 pm EST

Information and registration

In this webinar, ElevatingHOME and HHQI will explore how to develop hospitalization avoidance Performance Improvement Project (PIP) for your Quality Assurance & Performance Improvement (QAPI) program. This will include data collection, goals, interventions, rapid-cycle testing, spread, and sustainment. They will review several key strategies to reduce avoidable hospitalizations and emergent visits.

PDGM is on the Horizon - What Now?

Presented by Netsmart

Featuring: Chris Attaya, President, Rapid Recovery Center; AJ Peterson,Netsmart VP of Interoperability

Date: Thursday, October 25
Time: 2:00 pm EDT
Fee: None

To thrive in the regulatory climate today, it’s important to stay ahead of the changes and adjust your business model to face the challenges. That is why we invited Strategic Healthcare Programs (SHP) to share the latest updates from CMS and to review the components of the proposed Patient-Driven Groupings Model (PDGM) program.  
Using data from the SHP national database, Chris Attaya, vice president of product strategy, and Zeb Clayton, vice president of client services, will identify the expected winners and losers of the new model. They will share insights around the operational and clinical changes you need to consider to remain a vital organization. Teresa Craig, director of client strategy for Netsmart, will join the discussion to outline what you should expect from your EHR partner as you prepare for the new PDGM requirements.
Key Takeaways:
  • The latest updates from CMS and the components of the proposed PDGM model
  • Insights to help your agency prepare for a PDGM-like model
  • How to work with your EHR partner to prepare for new requirements

OASIS-D: Ensuring Consistency & Accuracy

Presented by Curaport
Melissa Abbott, RN, MSN, MHA, of 5 Star Consultants

Date: Thursday, October 18
Time: 2:00 p.m. EDT

Fee: $99 (per attendee)

Information & Registration

* This education session is approved for one (1) contact hour of Continuing Education for Nursing.

OASIS! Possibly the most spoken word, or acronym, in the Home Health industry. And just when you get to grips with the current version, the next set of changes arrive before you know it, this time in the form of OASIS-D. In this webinar, you will gain an understanding of the significant changes D brings to OASIS and how to ensure consistencies and accuracy within your agency.


*Curaport, LLC is an approved provider of Continuing Education by the California Board of Registered Nursing. All states accept this certification for their licensing requirements. No refund shall be given, except for any change in date or time of the webinar. In such case, a full refund shall be given to the registrant upon request.

Webinar hosts, send your announcements to: Conferences@RowanResources.com

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