Megan Reavis – Rehabilitation Reimbursement & Documentation

Everything you now are documenting has a time stamp and if it doesn’t add up, it could cost you your job. Mary had seen a patient earlier in the morning and hadn’t completed a daily note while with the patient.

Megan Reavis – Rehabilitation Reimbursement & Documentation

Documentation And Medical Necessity

• Medicare A and the upcoming changes regarding SNFs, home health, and Medicare A
• Medicare B and Outpatient Reimbursement
• Managed Care
• ACOs/ bundled payment and shift therapy deliver

Evaluations, Need & Reimbursement

• How to justify medical necessity and reasons for evaluation
• Priority level of function and key components
• Co-morbidities/Complexities and how they will impact reimbursement
• How to write a goal and add what you need to make it measureable

Important Terminology: What Does It Mean To You? Documentation

• Medical necessity determination
• You must include rehab terminology in your daily documentation
• Skilled terminology vs. unskilled terminology

Supportive Documentation

• Case Study: How to break down the components of a treatment plan
• Avoid these common pitfalls
• Drop-Down menus are not for you
• If you didn’t write it, it didn’t happen

Coding and diagnosis

• What will you get paid for your CPT code?
• Avoiding “Red Flag” Why codes are being denied
• Diagnoses that won’t get you paid

Management of Denial

• Understanding RAC, MAC and ADR denials and ZPIC audits
• Denials: The Top 10 Reasons We Aren’t Being Paid
• To reduce unpaid claims, quality assurance audits are used

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Description:

Everything you now are documenting has a time stamp and if it doesn’t add up, it could cost you your job. Mary had seen a patient earlier in the morning and hadn’t completed a daily note while with the patient. At the end of the day, she completed her note, but couldn’t remember the actual time she had spent with her patient. She recorded her time with the patient between 11:00 and 11:45 AM, then went home to finish 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 wasn’t even in the building. Mary was unable to see the patient when she wrote down her time. The patient had already been taken to the hospital at 10 :45. Mary is now under investigation for false documentation because she didn’t take the time to write down her actual time spent and she risks losing her job and her license.

Medical necessity is a hot topic in our industry. This term has many definitions, and we are seeing an increase in incorrectly billed claims. It is now up to us to justify our clinical decisions, while accurately and effectively capturing treatment. Audits are now an industry issue as we face allegations of “inappropriately billed” claims. Patients expect us to be able to justify why we offer services and why clinical expertise is so important. Standards have changed, there are new challenges and patients still deserve the best care.

This recording will give you a complete understanding of medical necessity. “how-to” guide for effective documentation. Whether you’re a therapist completing evaluations or an assistant completing progress notes, every area of therapy documentation is examined. It doesn’t matter if you use paper or computerized documentation, it will not replace clinical decision-making that is used to determine medical necessity.

Our best defenses against claims for reimbursement of therapy services that patients have received are continuing education and training. Imagine being free to focus your attention on your patients without worrying about what you might be missing in the documentation. These case studies cover everyday patient scenarios and offer the opportunity to ask questions and have a discussion to enrich your learning experience.

 Here’s what you’ll get in Megan Reavis – Rehabilitation Reimbursement & Documentation

Megan Reavis – Rehabilitation Reimbursement & Documentation Sample