Home Health care is facing audit and denial scrutiny from a number of directions in the near future. RACs, Fiscal Intermediaries, and ZPICK contractors are in place to help CMS protect the integrity of the Home Health benefit, and all providers and clinicians will modify their care programming and delivery to assure their qualified services will remain reimbursable. All agencies currently providing homecare will re-wire their protocols and practices in response to this new (and permanent) level of claim scrutiny. Only by thorough re-examination of how and why we provide care will successful Home Health providers continue their care mission in the future.
This level of CMS control is historically present in other care environments. By reviewing how acute care and sub-acute rehab providers responded to similar refinements in their care models, homecare agencies are able to establish new and contemporary care approaches that are reflective of PPS requirements and other healthcare advances. The introduction of a UR-type QA process; SURCH, allows providers the opportunity to assess care plan production before we provide un-focused levels of programming that may receive partial or entire claim denials. This presentation will demonstrate how to control care delivery required by the OASIS Start of Care document before you or your clinicians embark on an un-needed (and non-reimbursable) program.
As a means of gaining in-episode clinical control often lacking in today’s Home Health programs, OBQI Case Conference, a twist on the standard multi-disciplinary case conference model, will be introduced. This exciting methodology allows agencies and front-line clinicians the opportunity to craft care that addresses individual patient response and goal progression. Interactive demonstrations of both SURCH and OBQI Case Conference protocols make this session exciting for all attendees. Don’t miss his exciting presentation; this will be the most important seminar you will attend this year!
Learning Objectives
Care Production Session
- Identify challenges facing the HHA as they confront OASIS-C, Pay for Performance, and RAC era.
- Discuss methods employed by other provider types (hospitals, SNFs) to adapt care to meet requirements of reforms in their care delivery.
- Evaluate findings from audit/denial patterns experienced in other states, determine care modifications required for the audits
- Outline action plans to survive these challenges
- Cite contemporary concerns and incorporate needed reforms to achieve quality outcomes
- Propose methodologies that incorporates management principles utilized in other care sectors
OBQI Case Conference Session - A new and productive twist on multi-disciplinary case conferences
- Utilization Review history in Medicare
- OASIS Review re: OASIS based programming strategies
- Demonstration of the S.U.R.C.H. model
- Review of clinical/fiscal opportunities
- Contemporary Case Management Model
- Distinction from Multi-disciplinary Case Conference
- Clinical scripting/skilled progression demonstration
Who Should Attend?
This workshop is recommended for CEOs, Presidents, Owners, Administrators, Managers, DONs, and clinicians. |
