Volume 8, Number 39 May  29, 2019




Dear Healthcare at Home Colleague,

Our lead news story this week concerns an investigative finding by the HHS Office of Inspector General that extrapolated a $55,000 overpayment into a $7.5 million repayment demand. You will want to read how the accused Illinois HHA is fighting back in court. Many agencies hit with unreasonable overpayment demands have chosen the Chapter 11 route and closed their doors. Click below on "OIG Uses Homebound Status and Skilled Care Need to Target Providers" to read the official OIG statement.

We accompany this story with one of our occasional editorial comments, believing the details needed some elaboration and interpretation. We interviewed an attorney and a former CMS employee to try to understand how reviewers' extrapolation power started to spiral out of control. In the process, we think we found the source of the problem. You'll be surprised to discover who it is. But a solution may be on the horizon. Apparently, CMS has decided it is as much of a victim of the situation as the accused HHAs are. When an agency shuts down instead of paying, CMS is left with nothing.

This is important because it could happen to any home health agency, in fact, to any Medicare provider. In our opinion piece, we think the experts we interviewed gave us a solid understanding of not only how this happens but why extrapolation became a death sentence. Click on "What Does the OIG vs EHS Story Mean?" As always, let us know what you think by writing to editor@homecaretechreport.com.

In our continuing examination of strategies to prepare for the major Medicare reimbursement changes coming in January, we invited a guest author to discuss the advantages of outsourcing coding and billing functions. Though Kristin Donar is Director of Revenue Cycle Management for HEALTHCAREfirst, she has sent us a vendor-neutral argument in favor of letting professionals take over certain tasks in order to improve accuracy and timeliness and, consequently, increase episode payment levels.

News for non-medical providers:
While the news is heavily oriented toward Medicare skilled providers this week, private duty providers will be interested in our Vendor Watch column, especially you who are searching for value to add to your services. GrandCare is a technology company that places large-screen communication systems into homes to allow designated family members and professional caregivers to remotely monitor and communicate with clients in their residences. The Wisconsin company announced the appointment of a new CEO this week, longtime friend of and occasional contributor to this publication, Laura Mitchell, who started in marketing and rose up through the ranks to take the reins.

It was good to see so many regular readers in New York, Colorado, and Pennsylvania this month. I get to stay home for a while but am looking forward to meeting more of you at the NAHC Financial Managers conference in July, the LincolnHealth Senior Living 360 gathering in August, and the HCAOA Annual Meeting in September.

Senior staff reporter Darcey Trescone and I wish you a great week and a great summer. Keep making a difference!

 

Editor signature
Tim Rowan



OIG Uses Homebound Status and Skilled Care Need to Target Providers
A Chicago-area HHA received a $7.5 million overpayment bill from the OIG. This is the OIG statement on one example case among many.

What Does the EHS vs. OIG Story Mean?
This could happen to any HHA. Understand the financial and political motivations on all sides before it happens to you.

Outsourcing Coding and Billing: Key to PDGM Success?
As PDGM will demand a higher level of accuracy and timeliness, it may make sense to outsource coding and billing to experts.

CMS News: Hospice Compare and PACE Improvements
— National Training Program Monthly Update Webinar
— May 2019 Hospice Compare refresh of quality data is now available; now includes additional information on hospice characteristics to complement existing quality and patient experience metrics.
— Final rule removes redundancy, reduces administrative burden on PACE providers.

Vendor Watch
— GrandCare Systems appoints Laura Mitchell as new CEO, expands executive team

 
When you click on these ads,
you make sure HCTR continues to come to you for free.

























During the 3rd Quarter of 2019, web sites of the above advertisers were visited by home care and hospice executives and staff 2767 times.

To inquire about placing your message here, contact:

Kristin@rowanresources.com

Last Week's Most-Read Stories:
PDGM Vendor Perspectives and Preparations
Casamba and Thornberry discuss their PDGM perspectives and preparations.
 
Music as Medicine to Improve Patient Outcomes
Singfit is using music as medicine to address the needs of dementia and COPD patient's in home care.

As of this date, approximately 33,781,000 Baby Boomers have become Medicare eligible.



Notable Upcoming Conferences Free Webinars

WEBINAR: 5 Crucial Ways to Prepare for PDGM

Sponsored by: HealthCare Synergy

Featuring: Michael Tidd, LVN, COS-C, COS-D
Dates: November 13
Time:
10:00 am PST / 1:00 am EST

Information and Registration

Agencies are rapidly trying to prepare for the PDGM payment model. We will show you the most crucial ways an agency can prepare for the internal changes needed for PDGM. While most agencies are focusing on how to instruct clinicians on the change, PDGM has the most impact on office functions. Attend and gain insight on the things the agency needs to be doing now to prepare for January 1, 2020.

Objectives:
1. Learn agency level changes that can be implemented to be successful in 2020
2. Understand how to approach budgeting and finances under PDGM
3. What do your clinicians really need to know to ensure the agencies continued success

Michael Tidd has over 19 years of experience in the Home Care Industry and is a frequent speaker at HealthCare Synergy Workshops and Webinars. He is a Software Developer, LVN and Certified in ICD-9/10 Coding and OASIS (COS-C, HCS-D). As the Clinical Manager for HealthCare Synergy, he directs the Outsourced Management Services, assists in directing the development of the Healthcare Assistant Web Edition, oversees the Clinical Documentation Auditing provided to clients and directs the Clinical Form Development for the Healthcare Assistant Web Edition. Michael continues to educate agencies in the ongoing regulations that CMS produces, the proper application of the Medicare Conditions of Participation and completing timely, accurate and defendable clinical documentation to survive in the current Medicare Reimbursement Model.


Free Webinar: Your path to 99 - An Actionable Webinar on Achieving 99% Claims Reimbursement

Presented by: Complia Health

Date: November 13, 2019

Time: 1:30 PM EST

Reserve Your Webinar Seat

Billing is complex. Improving your billing and claims filing process doesn't have to be.

Getting on the path to a 99% claims acceptance rate can be simple, but the key is in understanding, and then overcoming, the common pitfalls that create problems for home health care agencies in the first place.

Join industry expert Scott Brashears to learn how to better identify potential problems in your agency processes and get the insights into solving for more accurate and timely filings that will put your agency on the path to 99.



Webinar: Post-Acute Care Quality Reporting Programs

Presented by: CMS

Date: Thursday, November 14

Time: 2:00 - 3:00 pm EST

Fee: Free

Description: The Centers for Medicare & Medicaid Services (CMS) will be hosting a webinar for Medicare-certified hospice providers to provide an overview on Hospital Quality Reporting Program (HQRP) requirements.

During this webinar, CMS subject matter experts will provide information on the following topics:

  • Hospice Item Set (HIS) reporting requirements;
  • HQRP compliance cycle;
  • How to achieve hospice compliance;
  • CAHPs survey requirements; and
  • How to switch CAHPS survey research vendors.

CMS will answer questions at the end of the webinar as time permits.

Register

Conference: Two Sales Training Boot Camps: Home Health and Hospice & Palliative Care

Presented by Healthcare Strategica, LLC

Featuring: Michael Ferris
Location: Westin Lake Las Vegas Resort

Bootcamp 1: PDGM Home Health Sales
Date: November 12-13

Bootcamp 2: Hospice & Palliative Care Sales
Date: November 14-15


Register with code "HCTR" for $100 off.

Michael Ferris brings 20+ years of experience to your sales team!

Home Health Sales Training Bootcamp

The Home Health Sales Training Bootcamp has an extensive training related to Success Under PDGM.  We will cover what the Sales Professionals need to know about PDGM and more importantly what the referral partners need to know!  How to have those conversations to drive more referrals and avoid the pitfalls experienced by hospices when "failure to thrive" was no longer an acceptable primary diagnosis to qualify for hospice services.

Hospice Sales Training Bootcamp

The Hospice and Palliative Care Sales Training Bootcamp is new and improved with the best of class sales training for hospice with the addition of How to Conduct Family / Patient Meetings for Maximum Success and How to Sell Palliative Care.  Send your Hospice Sales Representatives to us and we will send them back to you ready to drive significant incremental growth in quality admissions.

Each Sales Professional Will Receive:

  • Class Workbook
  • Laminated Field Cards
  • Copy of Definitive Guide to Home Health Sales: Achieve Superstar Success - PDGM Success Edition ($79 value)
  • One on one coaching
  • 90-day sales campaign planning tool
  • Lunch each day

WEBINAR TRAINING: PDGM for Marketers & Liaisons

Sponsored by "Home Care Sales"

Date: November 19
Time: 11:30 am - 1:00 pm CST

Information and registration

Join us for 90 mins of proven strategy and tactics for your marketers and liaisons to lead the charge in the field and gain the "right" referrals for PDGM!


 

WEB-BASED EDUCATION: Virtual Growth Summit

Sponsored by "Home Care Sales" 

Date: November 21
Time: 10:00 am - 5:00 pm CST

Information and Registration

Join renowned agency mentors Cheryl Peltekis and Melanie Stover for an owner's and executive's only event focusing on how to survive and thrive in this rapidly changing environment. Get the inside advantage from the comfort of your own office! No Travel Expense - Just real-world solutions for navigating the new Medicare payment system!


Conference: Successful Home Health Transformation

Hosted Dixon Healthcare Solutions, Inc.

Date: December 5-6
Location
: Bally's, Las Vegas
Time: 7:00 am - 4:00 pm
Speakers: Richard K. Dixon, Cheryl Peltekis, RN, Meaghan McCormick, Esq., Donna Floyd, RN, BSN, J'non Griffin, RN, MHA, HCS-D, BCCH-C, COS-C, WCC; Annette Lee, RN, MS, HCS-D, COS-C; Cory Mertz, managing partner for a leading healthcare M&A firm.

Information and Registration

Approved for up to 10 hours of Continuing Nursing Education by Corexcel, an accredited provider by the American Nurses Credentialing Center's Commission on Accreditation.

 


Conference: Successful Hospice Transformation

Hosted Dixon Healthcare Solutions, Inc.

Date: December 5-6
Location
: Bally's, Las Vegas
Time: 7:00 am - 4:00 pm
Speakers: Richard K. Dixon, Cheryl Peltekis, RN, Meaghan McCormick, Esq., Donna Floyd, RN, BSN, Annette Lee, RN, MS, HCS-D, COS-C; Cory Mertz, managing partner for a leading healthcare M&A firm.

Information and Registration

Approved for up to 10 hours of Continuing Nursing Education by Corexcel, an accredited provider by the American Nurses Credentialing Center's Commission on Accreditation.

 


Seminars: PDGM Success Seminars hosted by Axxess *
Sponsored by: BKD, Aegis Therapies, HealthCare ConsultLink, Home Health Care News, Gateway Home Health Coding and Consulting, Worldview, Connected Home Living, Laengrich Healthcare Partners and Swift Medical

Dates and Locations (open to all Home Care providers):
  • Dallas, TX Tuesday, September 24
  • Houston, TX Thursday, September 26
  • Boston, MA Tuesday, November 5
  • Fort Lauderdale, FL Thursday, November 14
  • Chicago, IL Tuesday, October 22
  • Columbus, OH Thursday, November 12
  • Las Vegas, NV Friday, October 4
  • McAllen, TX Tuesday, December 3
  • San Antonio, TX Thursday, December 5
Information and Registration (early bird discount code: Axxess2020)
The one-day seminars will focus on the following learning objectives:
  • The PDGM impact numbers that matter most, along with operational strategies to ensure proper reimbursement                   
  • Specific actions to take for each PDGM risk factor, including coding, non-groupable diagnoses, LUPA avoidance and management, chronic care management, and therapy management
  • How to drive growth for your organization through institutional referral strategies and the use of specialty programs, including wound care and complex nursing
Including specifics such as:
  • How to get the most important OASIS information you need in five minutes
  • Implementing maintenance therapy programs and telemonitoring
  • Setting up visit schedules that prevent avoidable LUPAs 
  • How each component of PDGM builds the case weight 
  • Restructuring intake processes to obtain necessary billing information

Seminar: "COM-CARE-CON" First Annual Technology Deep Dive

Sponsored by: Ohio Council for Home Care & Hospice

Date:
December 12
Time: 9:00 am - 5:00 pm
Location: Crown Plaza North, Columbus

Information and Registration
Com-Care-Con is a one-day conference that will highlight new technologies in the Home Care and Hospice Industries with speakers, exhibitors, and demonstrations of new technologies.

Speakers:

Tim Rowan - Keynote
Healthcare Advisory Network discussing Telehealth
Medline discussing AI in Wound Care
Complia discussing Alternative EVV

FREE WEBINAR: Quarterly Home Health Topics Discussion: The Truth about PDGM Reimbursement

Sponsored by: Healthcare Synergy

Date: December 18

Presented by: Michael Tidd, LVN, COS-C, COS-D

Information and Registration


Conference: The 17th Annual World Health Care Congress

17 Years of Empowering and Connecting Leaders in Health Care Transformation

Date: March 29-April 1, 2020
Location
: Washington, DC

Information and Registration

It’s never too soon to begin planning your experience at the 2020 World Health Care Congress. View the agenda snapshot and gain access to 100+ sessions across 15+ learning tracks:

  • Payer Transformation
  • Member Engagement and Retention
  • Provider Transformation
  • Care Delivery Integration
  • Medicaid & Health Policy
  • Behavioral Health - NEW IN 2020!
  • SDoH Business Strategy
  • SDoH Tech
  • Pop Health Analytics
  • AI & ML Applications - NEW IN 2020!
  • Innovation & Investments
  • Front Line Leadership
  • Women Leaders in Health Care
  • Self-Insurance Strategy
  • Worksite Clinics
  • Direct Contracting
  • Workplace Mental Health
  • Benefits Adviser Leadership
  • Medical Travel


*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
Date(s)
Hotel or Conference Center, City, State
URL

Interoperability for Service Providers through CMS’s EMDI Initiative

Presented by: ElevatingHOME and VNAA

Featuring: Pallavi Talekar, Project Manager, Scope Infotech, Inc.; Ray Wilkerson, Sr. Business Analyst, Scope Infotech, Inc.; Nandini Ganguly, Business Analyst, Scope Infotech, Inc.; Kishan Patel Business Analyst, Scope Infotech, Inc.; Briana Barnes, Project Coordinator, Scope Infotech, Inc.

Date: Tuesday, July 30
Time:
12:00 pm EDT
Fee:
Free to ElevatingHome, VNAA, and Alliance for Home Health Quality Improvement members

Registration

Representatives from the EMDI Initiative team will discuss interoperability using health IT standards, including Fast Healthcare Interoperability Resources (FHIR). Participants will learn about pilot opportunities with CMS to enhance provider workflow using three critical use cases. Participants will:
  • Gain knowledge of interoperability concepts and use of latest standards, including FHIR;
  • Gather information on three critical use cases in the post-acute care setting to reduce provider burden and enhance their interoperability footprint; and
  • Identify next steps for participation in an upcoming pilot opportunity with CMS.


Security Risk Assessment Tool Overview and User Feedback Session

Presented by: CMS

Date: Wednesday July 17

Time: 1:00 pm EDT

Fee: Free

ONC and the HHS Office for Civil Rights are holding a training session and overview of the Security Risk Assessment (SRA) Tool. The tool is designed to assist small to medium providers in conducting an internal security risk assessment. This assessment will aid providers with their security risk analysis as required by the HIPAA Security Rule and the CMS EHR Incentive program. Following the webinar, participants will have the opportunity to ask questions and provide feedback.
 
Register


PDGM’s Behavioral Adjustments - What You Need to Know Now

Sponsored by eSolutions

Featuring: Karri Wright, Sr. Director, Product Management at Homecare Homebase

Date: Thursday, August 29
Time: 2:00 pm CDT
Fee: Free

REGISTER NOW

The webinar covers:

  • CMS assumptions and intended adjustments and their impact on:
    • Upcoding
    • Comorbidities
    • LUPA Avoidance
  • Considerations for HHAs
  • Evaluating your HHA data now to assess tomorrow based on today’s reality


A QUALITY JOB: Clinical Management & Care Coordination Under PDGM

Hosted by VNAA
Sponsored by MatrixCare/Brightree
Presented by Simione Healthcare Consultants

Featuring: Laura Wilson, RN, BSN, Sr. Manager, Simione Healthcare Consultants
Date: Wednesday, September 11
Time: 12:00 pm EDT

Free Registration

PDGM is so much more than a billing change! Home health agencies preparing for payment reform need to look closely at clinical operations to make accommodations that will uphold quality, including care alternatives that add value to the equation. In this webinar, we’ll share insights based on the findings of gap analyses to help your organization make a successful transition under the new requirements. Recommended Attendees: Clinical Managers, Intake Staff, Coders / QA, Finance & Billing personnel Hosted by VNAA, sponsored by MatrixCare/Brightree, presented by Simione Healthcare Consultants



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

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