Outline

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