Documentation And Medical Necessity
Medicare A and the upcoming changes around SNFs and home health
Medicare B and outpatient reimbursement
Managed care
ACOs/ bundled payments and the shift therapy deliver
Evaluations, Need & Reimbursement
Reasons for evaluation and how to justify medical necessity
Prior level of function and what key components to include
Co-morbidities/Complexities and how they will impact reimbursement
Goal writing and what to add to make it measurable
Critical Terminology: What It Means To Your Documentation
Determining medical necessity
Rehab terminology that must be included in your daily documentation
Skilled vs. unskilled terminology
Supportive Documentation
Case study: Break down the components of the treatment plan
Pitfalls to avoid
Drop-down menus are not your friend
If you didnât write it, it didnât happen
Coding and Diagnoses
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CPT codes and what will get you paid
Avoiding âRed Flagâ codes and why they are denying them
Diagnoses that wonât get you paid
Denial Management
Understanding RAC, MAC, ADR, denials, and ZPIC audits
Reasons for denials: Top 10 reasons we are not getting paid
Quality assurance audits used to decrease unpaid claims
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Description:
Everything you now are documenting has a time stamp and if it doesnât add up, it could cost you your job. Mary had seen a patient earlier in the morning and hadnât completed a daily note while with the patient. At the end of the day, she completed her note, but couldnât remember the actual time she had spent with her patient. She logged her time with the patient from 11:00 am to 11:45 am and went home for the day.
Mary comes in the next morning and is met by the Rehab Director wanting to know how she saw her patient when the patient wasnât even in the building. The patient had been taken to the hospital at 10:45, making it impossible for Mary to have seen the patient at the time she had written down. Mary is now under investigation for false documentation because she didnât take the time to write down her actual time spent and she risks losing her job and her license.
Get immediately download Megan Reavis – Rehabilitation Reimbursement & Documentation
Medical necessity is a big topic in our industry. It is a term that has adopted a variety of definitions and we are looking at an increase in inappropriately billed claims. We now must justify our clinical decisions while capturing treatment accurately and effectively. Audits have become everyday industry concerns as we face the allegations of âinappropriately billedâ claims. There is an increased expectation to justify why we are providing services and why our clinical expertise is needed. The standards have changed, the challenges mount and patients still deserve the very best care.
This recording will provide a thorough understanding of medical necessity and a âhow-toâ guide for effective documentation. Whether youâre a therapist completing evaluations or an assistant completing progress notes, every area of therapy documentation is examined. Computerized documentation or paper versions will never replace the clinical decision making used to determine medical necessity.
Ongoing training and education are our biggest defenses to ensure our claims get paid for the therapy services the patients benefited from. Imagine being able to put your attention back on your patients, without fear of what you are missing in the documentation. Case studies focus on typical, everyday patient situations with opportunity for questions and discussion to enhance the learning experience.
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Course Requirement: Megan Reavis – Rehabilitation Reimbursement & Documentation
Real Value: $219.0000
One time cost: USD65.0000
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