Description
"Defensible documentation" refers to charting that can withstand scrutiny from various medical reviewers aiming to recoup payments for unnecessary or inappropriate care. In legal contexts, it provides clear evidence of the care provided, by whom, and when. Simply following an electronic medical record (EMR) template may not suffice.
This presentation examines real denial examples, identifies their causes, and offers charting examples to address them. A condensed overview of essential home health coverage requirements for nursing and therapy, as outlined in the Medicare Benefit Policy Manual (Chapter 7, Section 40) and 42 CFR, equips attendees with foundational regulatory knowledge. Linking Medicare rules and regulations to charting requirements enables clinicians to demonstrate compliance effectively.
By implementing meaningful, well-documented skilled visits, agencies can achieve favorable outcomes in various reviews, including the Home Health Value-Based Purchasing Model (HHVBP), Targeted Probe and Educate (TPE), Unified Program Integrity Contractor (UPIC), Supplemental Medical Review Contractor (SMRC), Recovery Audit Contractor (RAC), and Comprehensive Error Rate Testing (CERT) reviews. Defensible documentation is also crucial in supporting Medicare Advantage services and Medicaid claims.
Speaker/Course Author - Joe Osentoski, BAS, RN, GERO-BC
Objectives
After participating in the session, attendees should be able to:
- Understand the current Medicare, Medicare Advantage, and commercial payer medical review activities.
- Under key Medicare Benefit Policy Manual coverage requirements.
- Implement effective strategies for staff to integrate these requirements into documentation.
- Comprehend care management skills aimed at preventing denials and achieving improved patient outcomes.
Certificate
By completing/passing this course, you will attain the certificate HCAF Course Certificate
Learning Credits
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