[Download Now] Rehabilitation Reimbursement & Documentation: Solutions to Avoid Costly Denials, Prove Medical Necessity & Protect YOUR Time – Megan Reavis

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Rehabilitation Reimbursement & Documentation: Solutions to Avoid Costly Denials, Prove Medical Necessity & Protect YOUR Time – Megan Reavis

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If your time stamp doesn’t add up, it could cost you your job. Mary didn’t complete a daily note while she was with the patient. She could not remember the time she spent with her patient at the end of the day. She went home for the day after logging her time with the patient.

Mary comes in the next morning and the Rehab Director wants to know how she saw her patient when he wasn’t in the building. Mary was unable to see the patient at the time she wrote down because he was taken to the hospital at 10:45. Mary is under investigation for false documentation because she didn’t take the time to write down her actual time spent.

Medical necessity is a big topic. We are looking at an increase in inappropriate billed claims because it is a term that has adopted a variety of definitions. Accurately and effectively capturing treatment is what we now need to justify our decisions. Audits have become an industry concern due to the allegations of inappropriately billed claims. We are expected to justify why we are providing services and why our clinical expertise is needed. Patients still deserve the best care even though standards have changed.

A thorough understanding of medical necessity and a how-to guide for effective documentation will be provided in this recording. Every area of therapy documentation is examined, whether you are a therapist or an assistant. The clinical decision making used to determine medical necessity will never be replaced by computerized documentation.

Our biggest defense is ongoing training and education to make sure we get paid for the therapy services the patients benefited from. Imagine being able to pay attention to your patients again, without fear of what is missing in the documentation. Case studies focus on typical, everyday patient situations with opportunity for questions and discussion to enhance the learning experience.

1. Examine practical application of integrating company policies in accordance with the most recent government regulations.
2. Maximize time by documenting in a clear and concise manner.
3. Distinguish the importance of correct supportive documentation as part of the overall claim review.
4. Complete a case study review to form smart goals and daily notes that capture medical necessity.
5. Demonstrate a deeper understanding of the various types of definitions in determining skilled therapy services.
6. Evaluate documentation samples to learn how to minimize denials going forward.

Documentation and medical necessity.

• Medicare A and the upcoming changes around SNFs and home health
• Medicare B and outpatient reimbursement
• Managed care
• ACOs/ bundled payments and the shift therapy deliver

There are evaluations, need and reimbursement.

• Reasons for evaluation and how to justify medical necessity
• Prior level of function and what key components to include
• Co-morbidities/Complexities and how they will impact reimbursement
• Goal writing and what to add to make it measurable

What does critical terminology mean to your documentation?

• Determining medical necessity
• Rehab terminology that must be included in your daily documentation
• Skilled vs. unskilled terminology

There is supportive documentation.

• Case study: Break down the components of the treatment plan
• Pitfalls to avoid
• Drop-down menus are not your friend
• If you didn’t write it, it didn’t happen

There are coding and diagnoses.

• CPT codes and what will get you paid
• Avoiding “Red Flag” codes and why they are denying them
• Diagnoses that won’t get you paid

There is denial management.

• Understanding RAC, MAC, ADR, denials, and ZPIC audits
• Reasons for denials: Top 10 reasons we are not getting paid
• Quality assurance audits used to decrease unpaid claims