Audits are Inevitable, But Denials are Not
Today's therapists and therapy assistants are often called upon to manage Medicare claims through the Recovery Audit Contractors (RAC) and Medicare Administrative Contractors (MAC) audits and denials. Audits are inevitable, but denials are not, and most therapists fear denials and are eager for knowledge to decrease their risk.

This webinar educates attendees on audits, different auditors, and documentation submission (what and when). It will then address what to do if denied – steps for a critical review of documentation to determine if appealable (coverage criteria and documentation requirements). Lastly, Ms. Hinds covers the appeal process and writing an appeal letter.

Course Content

AUDITS/AUDITORS
• Pre-Pay
• Post-Pay
• Automatic issues/triggers
• Complex issues/triggers
MEDICARE COVERAGE CRITERIA
• Medical necessity
• Reasonable and necessary, applicable standard of medical care
• Skilled
• Restorative
MEDICARE DOCUMENTATION REQUIREMENTS
• M.D. certifications (Part A and B)
• Therapy: daily documentation, progress notes, G-codes
• MDS and nursing
CRITICAL CHART REVIEW
• Technical review
• Resource Utilization Group (RUG) review
• Medical necessity and skilled review
APPEALS
• Phases: auditors, timelines
• How to write an appeal letter