Preventing & Combating Medical Review with Chrtine Twombly, R.N., R.A.C.-M.T., Harmony Healthcare International
October Season Ticket
The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based appropriate documentation. To aid staff in successfully insulating revenue, facility leadership and staff must learn strategies for ensuring MDS 3.0 scheduling and coding accuracy as well as principles of skilled documentation that supports the care provided. By identifying and correcting themes that expose the facility to financial risk, revenue is not only enhanced but also insulated.
The speaker will begin this seminar by discussing the goals of Medical Review and various Medical Review programs including Recovery Audit Contractor (RAC) and Carrier (Medicare Administrative Contractor or Fiscal Intermediary) Medical Review programs. After reviewing the technical and clinical Medicare Part A coverage requirements, the speaker will focus on revenue enhancement and insulation strategies. MDS 3.0 scheduling to avoid facility liability and ensure optimal revenue will be discussed. Strategies for MDS 3.0 accuracy will be identified and coding of key MDS 3.0 areas will be reviewed. Key points of therapy and nursing documentation to support skilled care will be imparted to the audience. A review of the all-important triple check for accuracy and keys to responding to a medical record request will be discussed as will appeals tips and strategies.
Objectives
Learner will be able to summarize goal of Medical Review.
The learner will be able to describe clinical and technical requirements for Medicare coverage in the SNF.
The learner will be able to identify and articulate examples of documentation to support skilled nursing and rehabilitative care in the SNF.
The learner will be able to identify audit strategies for insulation of revenue.
Target Audience: MDS Staff, NHAs, DONs, Clinical Reimbursement Staff, Rehabilitation Director
Certificate of Attendance: 5 CEUs
