Rehabilitation Reimbursement & Documentation: Solutions to Avoid Costly Denials, Prove Medical Necessity & Protect YOUR Time by Megan Reavis
Duration:5 Hours 53 Minutes | Format:Audio and Video
Circuit:
Documentation And Medical Necessity
Medicare A and the upcoming changes around SNFs and home health care
Medicare B and outpatient reimbursement
Guided mindfulness
Lives well / bundled payments and change of therapy deliver
Estimates, Needs & Reimbursement
Reasons for assessment and how to justify medical necessity
Preexisting function level and what key components should be included
Comorbidities / complications and how they affect cost recovery
Writing a goal and what to add to make it measurable
Critical Terminology: What It Means For Your Documentation
Determining medical need
Rehabilitation terminology that should be included in your daily documentation
Qualified and unqualified terminology
Supporting Documentation
Case Study: Break Down the Components of a Treatment Plan
Pitfalls to Avoid
Dropdown menus are not your friend
If you didn’t write it, it didn’t.
Coding and diagnostics
CPT codes and what you get paid
Avoiding Red Flag Codes and Why They Deny Them
Diagnoses you won’t be paid for
Failure Management
Understanding RAC, MAC, ADR, Failure, and ZPIC Auditing
Reasons for refusal: top 10 reasons why we are not paid
Quality assurance audits used to reduce the number of unpaid claims.
Description:
Everything you are currently documenting is time stamped, and if that doesn’t add up, it could cost you work. Mary saw the patient earlier in the morning and did not complete her daily notes while she was with the patient. At the end of the day, she finished her note, but couldn’t remember how much time she spent with her patient. She recorded her time with the patient from 11:00 am to 11:45 am and went home for the day.
Mary arrives the next morning and is greeted by the director of the rehabilitation center, wanting to know how she saw her patient when he was not even in the building. The patient was taken to the hospital at 10.45, so Mary could not see her while she was writing. Mary is now under investigation for false documents because she did not find time to record her actual time spent and she risks losing her job and license.
Medical necessity is a big topic in our industry. It is a term that has adopted many definitions, and we are seeing an increase in the number of inappropriately issued invoices. We must now justify our clinical decisions by recording treatment accurately and effectively. Audits have become a day-to-day industry problem as we are faced with claims of “inappropriate billing.” There is an increased expectation to justify why we provide services and why our clinical expertise is needed. Standards have changed, challenges are growing, and patients still deserve the best leaving.
This record will provide a thorough understanding of the medical need and ”how-to” for effective documentation. Whether you are a therapist completing an assessment or an assistant completing progress notes, each area of therapy documentation is examined. Computerized documentation or paper versions never replace the clinical decision-making process used to determine a medical need.
Continuing learning and education is our greatest defense to ensure that our claims are paid for the therapeutic services that patients have used. Imagine being able to focus on your patients again without fear of what you might be missing out on in the documentation. Case studies focus on the patient’s typical, everyday situations with the opportunity to ask and discuss questions to enhance the learning experience.
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Course Features
- Lectures 0
- Quizzes 0
- Duration Lifetime access
- Skill level All levels
- Language English
- Students 123
- Assessments Yes
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