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
is approved by the California Board of Registered Nursing, Provider #CEP 16668, for 2.4 contact hour(s). Full attendance is required to receive credit, variable credit for partial attendance may not be awarded.
is an approved provider by the Florida Board of Nursing, provider #50-466. This course is offered for 2.0 contact hour(s).
is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. This course is offered for 2 contact hour(s).
is an approved provider #50-466 with the Florida Department of Health Board of Occupational Therapy Practice. This course is approved for 2 contact hour(s) for Occupational Therapist and Occupational Therapy Assistants.
This educational offering qualifies for 2 continuing education hour(s) as required by many national, state and local licensing boards and professional organizations. Save your course outline and certificate of completion, and contact your own board or organization for specific filing requirements.
This program has been approved by the Arkansas State Board Of Physical Therapy for 2.0 contact hour(s) for Physical Therapists.
is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #:216.000309. This course qualifies for 2.0 CE Credit Hour(s).
This meets the IN-PT approval under 844 IAC 6-8-5 Approved Organizations #9, please contact IN Board or Association if you have questions.
For Kentcuky licensees, according to 201 KAR 22:045, this class may be applied toward Category 2 continued competency requirements. Please review the regulation to determine eligibility.
is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider for physical therapy and physical therapist assistant continuing education. This seminar is awarded 2.4 contact hour(s).
NCBPTE approval by virtue of approval by The New York State Education Department, Office of the Professions, State Board for Physical Therapy licensure board or state APTA chapter Approval good through 8/31/2021. This course qualifies for 2 continuing education hours.
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| Presentation (2.9 MB) | Available after Purchase |
LAURIE HINDS, OTR/L, is a board-certified licensed Occupational Therapist with more than 30 years of experience working in a variety of settings, primarily specializing in the treatment of neurological disorders in adults. Since 2011, she has worked at SavaSeniorCare Consulting, LLC as a medical review specialist in denials and appeals. Ms. Hinds' success at redetermination and reconsideration is due to her strong knowledge of Medicare documentation requirements and her detail-oriented documentation reviews. She has also represented SavaSeniorCare SNFs during more than 30 Administrative Law Judge hearings for denials of Part A RUG episodes of care and Part B outpatient therapy, where she received partial to fully favorable decisions 91% of the time. Due to the ever-shifting landscape of insurance and Medicare, Ms. Hinds has made it her mission to continually educate other therapists on what to expect in regards to minimizing denials and maximizing reimbursement.
Physical Therapists, Physical Therapist Assistants, Occupational Therapists, Occupational Therapy Assistants, Nurses
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