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Patient-Driven Groupings Model: Billing & Revenue Cycle Workshop

Wednesday, September 11, 2019 at 12:30pm to Wednesday, September 11, 2019 at 4:30pm Workshop
The Patient Driven Groupings Model (PDGM) will go into effect January 1, 2020. This is the most massive change to the home care industry reimbursement structure since the introduction of the current Prospective Payment System (PPS) in October 2000. The new payment model dramatically impacts agency operations, processes and performance. Agencies must develop and implement plans to successfully transition to PDGM. This workshop will discuss key areas, strategies and processes in preparing an agency for PDGM. This workshop will have a focus on changes to the 30-day payment model which will bring significant back office changes, specific to the claims processing and collections, including payment adjustments and proposed implementation of the Notice of Admission.


On-Site Seminar will Address:

Summarize key areas of agency operations affective d by PDGM.

1.  Provide guidance on evaluating an agency’s current preparation status.

2.  Outline implementation actions in each key area

3.  Discuss necessary modifications to the intake and referral process under PDGM

4.  Review Order Management


Identify data to assist in determining financial impacts of PDGM on an agency.

1.  Outline the new requirements for billing RAPs and Final Claims

2. Review HIPPS code structure and the plan for reconciling pay- ment differences

3. Review strategies for improved physician interaction to ensure timely 30-day billing


Review the complexity of determining LUPA thresholds under PDGM.

1.  Review visit count details related to LUPA adjustments & reimbursement rates

2. Review Partial Episode Payment Adjustments (PEP)

3. Review Outlier Calculation



Melinda A. Gaboury is co-founder and Chief Executive Officer of Healthcare Provider Solutions, Inc. (HPS). Melinda Gaboury and Mark Cannon founded the company in April 2001 to provide financial, reimbursement, billing, operational and clinical consulting to the home care and hospice industries.


With more than 27 years in home care, Melinda has over 17 years of executive speaking and educating experience, including extensive day-to-day interaction with home care and hospice professionals.  She routinely conducts Home Care and Hospice Reimbursement Workshops and speaks at state association meetings throughout the country.



Michigan HomeCare & Hospice Conference Room

2140 University Park Drive, Suite 220

Okemos, MI  48864


Fax:  517/349-8090


Workshop Fees:

Before August 23, 2019

MHHA Member                                  $80.00

Additional  MHHA Member                  $70.00

Non-Member                                     $160.00


After August 23, 2019             

MHHA Member                $100.00

Additional  MHHA Member $80.00

Non-Member                  $200.00




Information and Resources

Melinda Gaboury
MHHA Conference Room, 2140 University Park Drive, Suite 220, Okemos, MI 48864
Fee Options for Time frames
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Additional Resources

Additional Resources:
Download : PDGM Registration Form

Event Registration

Michigan HomeCare & Hospice Association
2140 University Park Drive, Suite 220
Okemos, MI 48864
Phone: (517) 349-8089 Fax: (517) 349-8090

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