Are you DOCUMENTING correctly? Protect Your License and Improve Claim Reimbursement

Documenting about your treatment used to be enough, but today we must also prove that every minute of therapy was MEDICALLY NECESSARY. In today’s current climate, rehab professionals must document in order to JUSTIFY their clinical decisions. RAC audits, MAC audits, ADR reviews, Denials, and Z-Pic audits have become everyday industry concerns as we are regularly subject to allegations of “inappropriately billed” claims. The expectations of the current documentation standards have changed substantially in the last few years. Yesterday’s methods are no longer able to meet today’s standards. This course will equip healthcare professionals with the tools necessary to master the challenges of the fluctuating regulatory environment, as well as continuing to meet company policy and procedure requirements.

You will also develop a thorough understanding of medical necessity and furnish the “how-to” guide to providing strong documentation. Whether you’re a therapist completing evaluations, or an assistant completing progress notes, every area of rehab documentation is examined. Computerized documentation or paper versions will never replace the clinical decision making used to determine medical necessity. ALL rehab settings are included, from hospitals to SNFs, home health, outpatient, and pediatric settings. Ongoing training and education are the best defense to ensure your claims get paid for the therapy services the patients required. Case studies will focus on typical everyday occurrences in an open format that promotes group discussion and enhances your learning experience. Excellent resource tools and reference materials will be provided to promote continued learning beyond the course itself.

Course Content

INTRODUCTION

• Exploring current industry trends

REGULATORY ISSUES AND CURRENT INDUSTRY TRENDS

• Regulatory Issues
  • current and upcoming changes in red flags and manual medical reviews
• Understanding RAC, MAC, ADR, Denials, and ZPIC audits

DEFINITION OF TERMS

• Defining Medical Necessity
• Defining Objective vs. Subjective
• Defining Rehab Terminology
  • skilled vs. unskilled terminology
  • prior level of function
  • rehab potential/reason for rehab

CODING AND DIAGNOSES

• Medical vs. Treatment Diagnoses
• Avoiding “Red Flag” Diagnoses

SUPPORTIVE DOCUMENTATION

• Chart review
• “How to” guide to find/receive supportive documentation

DENIAL MANAGEMENT

• Understanding the denial process
• Fighting and winning appeals
• Quality Assurance audits (clinical and technical documentation audits)

CASE STUDIES

• Clinical Decision Making
• Identifying Skilled Documentation