HCAF: Denials and Charting in a PDGM, RCD & PHE World (SN, OT, & ST - 1.0 CEU)

Content
1 module

Rating

Course Length
70 mins

Instructor
Aaron Timmer

Price
$29.00

Description

While 2020 began with the change to the Patient-Driven Groupings Model (PDGM) for reimbursement taking up home health agencies’ attention, the expansion of Review Choice Demonstration (RCD) was soon to follow. Both of these have been affected by the onset of the Covid-19 pandemic and resulting Public Health Emergency (PHE). At some point the PHE will expire, followed by a resumption of medical review activities by Medicare contractors.


Medicare contractors normally use Targeted Probe and Educate (TPE), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), and Supplemental Medical Review Contractor (SMRC) reviews to evaluate claims for coverage and payment. How the PDGM provides payment will also have a significant impact on review results. This presentation will walk attendees through the PDGM payment model and how it affects medical reviews and denials.


The impact of RCD activity on medical reviews is significant, both for agencies who choose a Pre-Claim Review option or an Additional Development Review (ADR) choice. This presentation will focus on agency actions to lower risks of being chosen for medical review and high-risk areas for denials. The status of the RCD and preparation tasks for when the RCD is started will be addressed. Finally, the PHE changes are also covered with suggestions for compliant documentation during the PHE to prevent problems after the PHE has ended. This program benefits home health agency Administrators/Managers, Clinical Supervisors/Managers, Directors of Nursing, and QA/QI staff.


Course Instructor - Joe Osentoski

Objectives

Attendee will learn about: 

  • Understanding of the PDGM payment model and their relation to claim denials
  • Documentation needs within the PDGM payment model to lower chance of causing a review ordenials in case of review
  • Reminders on best compliance within the RCD
  • PHE waivers to care and how to best implement them during the PHE and transition after the PHEhas ended.

Certificate

By completing/passing this course, you will attain the certificate HCAF Course Certificate

Learning Credits

CE
1.0
1.
HCAF Course: Denials and Charting in a PDGM, RCD & PHE World
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