What You’ll Discover in Megan Reavis Rehabilitation Reimbursement & Documentation
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
Medical necessity: Reasons for evaluation
What key components should be included?
Co-morbidities/Complexities and how they will impact reimbursement
What to do to make your goal measurable?
The Meaning of Critical Terminology Documentation
Medical necessity determination
You must include rehab terminology in your daily documentation
Skilled vs. unskilled terminology
Supportive Documentation
Case Study: How to break down the components of a treatment plan
Avoid these Pitfalls
Drop-You should not be able to eat from down menus
If you didn’t write it, it didn’t happen
Coding and diagnosis
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What CPT codes will get you paid?
Avoiding “Red Flag” Codes and the reasons they are denied
Diagnoses that won’t get you paid
Denial Management
Understanding RAC, MAC and ADR denials and ZPIC audits
Denials: The Top 10 Reasons We Aren’t Being Paid
Unpaid claims can be reduced by quality assurance audits
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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 couldn’t have seen the patient in the time she had recorded. 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.
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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. Patients still deserve the best care, even though the standards have changed and the challenges are increasing.
This recording will allow you to understand the medical necessity of your condition and how it can be addressed. “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. Either paper or computerized documentation will not replace the clinical decision-making used to determine medical necessity.
Our biggest defenses are ongoing training and education to ensure that our claims get paid for therapy services our patients received. 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 situations that patients face, and offer the opportunity to ask questions and have a discussion to enhance your learning experience.
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Here’s what you can expect in the new book Rehabilitation Reimbursement & Documentation
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