Outline

There are provisions for compliance with documentation standards in the code of conduct of the code of conduct of the code of conduct of the code of conduct of the code of conduct of the code of conduct of the code of conduct of the code of conduct of the code of conduct of the code of conduct

• Provides credentialing resources
• Explore the Revenue Cycle
• Evaluations and Re-Evaluations for Physical Therapy, Occupational Therapy and Speech Services. ( Includes tools for changes in criteria.)
• Orders
• Plan of Care, Certification/Re-certification Rules Checklist
• CPT Procedure codes used in Therapy and Rehab
  • Evaluations, re-evaluations, and assessments
  • Supervised modalities
  • Guidelines for billing therapy minutes
  • Constant attendance modalities
  • Therapeutic procedures, included changes in orthotic and prosthetic management and training and development of cognitive skills
  • Speech Pathology Services
  • Neuromuscular procedures
  • Debridement, application of strapping, splints, casts
  • Using HCPCS Level II codes for DME
  • Orthotics billed by hospitals and other providers
  • Lymphedema Service
  • Woundcare
  • Physical Performance Testing
• Daily Session Note Checklist
• Discharge Checklist
• NCCI Edits
• Modifiers
• HCPCS II Procedure codes used in Therapy and Rehab
• Functional Limitation Requirements G-codes for functional limitations and severity modifiers – required for outpatient claims filed to Medicare
• Place of Service Codes

There is a correlation between density and cholesterol.

• New tools to prepare for ICD-10-CM – Bring your WI-FI enabled device
• Discuss chapters that effect Therapy and Rehab
• Laterality documentation requirements

There are rules for Medicare and special payer news.

• Medicare Therapy Cap
• Documentation to meet Medical Necessity in Therapy and Rehab
• Understand changes with congressional changes and their impact on Therapy and Rehab
• Understanding Value-Based Payment issues: (i.e. MACRA, MIPS and APM)
• Explore resources pertaining to CMS MAC, RAC, ZIP, and CERT program guidelines
• OIG audit focus on behavioral health services
• Medicare’s “incident to” guidelines, definition of “incident to” services vs payer supervision
• Overview of Commercial Plans and Therapy Coverage
• Common forms of health care fraud and abuse

COMPLIANCE

• Components of an effective compliance plan
• Understanding recent reports from CMS MAC, RAC, OIG, and GAO to reduce error rates in documentation

Understanding the evaluation process is important.

• Understanding the claim content 837p and 837i resources
• Explore common revenue codes used with the 837i claims formats
• Learn about the Medicare Learning Network

The appeal process.

• Understanding reasons for denials
• Systematic steps of responding to an appeal
• Formats for appeal letters