Essential Training At Your Finger Tips

This session focuses on the need for a streamlined referral process, which ensures that patients are admitted promptly and that providers receive adequate reimbursement for the services provided. We will focus on securing all the necessary documentation to be compliant, including the pre-claim review documents required for the Medicare Review Choice Demonstration (RCD).  Read more

"The Centers for Medicare & Medicaid Services (CMS) has fully resumed all medical review activities. Getting selected for an audit has significant ramifications, including the need to devote resources to responding to and dealing with the results. Post-payment reviews, such as Unified Program Integrity Contractor (UPIC) audits, can put $100,000 on the line, potentially reaching into the millions. Providers must be aware of risk factors and trends in agency documentation that may prompt review or denial. It is crucial to reduce risk continuously and respond assertively to reviews. The Medicare Review Choice Demonstration (RCD) does not protect agencies from UPIC activity, and audits clearly show the provisional nature of pre-claim review affirmations. With numerous reviews of medical records and multiple contractor audits, prevention is the best course of action. In the face of financial disruptions resulting from a review, prompt positive actions and knowing your options are key to keeping your agency solvent. This presentation is based on 25 years of experience assisting agencies with medical reviews, as well as current UPIC audit trends."   Read more

Palmetto GBA's Charles Canaan and Michael Bibbins will reveal the mysteries of the Centers for Medicare & Medicaid Services (CMS) Review Choice Demonstration (RCD) during this workshop. They will shine light into dark corners you may not have looked at before. This includes recent RCD changes, trending topics, top denials, and selection statistics. Additionally, the speakers will share critical clues and tips about the recent changes in billing requirements that providers need to watch out for, such as new telehealth G codes and Notice of Admission (NOA) requirements. They will explore trending topics and dive deep into the scenarios that spur investigations and calls from providers, and generate education sessions. The top denials portion of the program will unveil the top Additional Documentation Request (ADR) denial reasons as well as the top non-affirmation reasons. Finally, the speakers will discuss Florida selection data and trends without too much foreshadowing. Establish your alibi by attending this workshop and don’t miss this opportunity to get in-person feedback about your RCD mysteries. Read more

Join Palmetto GBA representatives for a presentation on several key areas of the Medicare Review Choice Demonstration (RCD) program that providers will face. The speakers will cover RCD basics, tips for navigating each selection, and review the frequently asked questions from home care providers. The pair will also tackle common issues and take your questions. Read more

"Despite the COVID-19 public health emergency and the full resumption of the Medicare Review Choice Demonstration (RCD), medical review activities have been fully resumed. The triggering of a medical review poses an additional challenge to agency operations. Aside from the RCD, multiple Medicare, Medicare Advantage, and commercial insurance reviewers examine medical records for accuracy, including those that are newly billed and reopened claims. It is common for home health agencies to focus on survey compliance rather than reviewing their medical records from a compliance and payment perspective. Medical reviews, audits, or probes can pose great difficulties if you are selected to undergo one of these processes. Compliant clinical records are the key to success, whether it is through the RCD, the Unified Program Integrity Contractor (UPIC), the Recovery Audit Contractor (RAC), the Supplemental Medical Review Contractor (SMRC), or Comprehensive Error Rate Testing (CERT). The required rules and regulations should be incorporated into the content at the time of creation, not later. The presentation begins by outlining key coverage requirements from Medicare regulations and what they actually require. It then provides examples of how to reflect these in the home health record to address known denial reasons. These include both nursing and therapy medical necessity requirements. In linking what is actually needed with known denial reasons, it shows how proper documentation can prevent negative outcomes. This also applies to the RCD when the full record is not reviewed in pre-claim review or when it is reviewed under an Additional Documentation Request (ADR) option. This session provides a solid foundation for educating your staff to prevent future denials and audits. Your current staff can learn how to chart correctly, while new staff can learn from the actual regulations to start off right. The topics covered in this session can also be applied to Medicare Advantage medical reviews that are not subject to the RCD." Read more

While many home health providers dove into the Medicare Review Choice Demonstration (RCD) with trepidation, there are those who, after six months or more into the process, are finding that the documentation review program is not quite as bad as they thought it would be. So much so that these providers intend to continue participating in the Pre-Claim Review (PCR) process and never look back. This session will explore case studies to offer insights and lessons learned from providers who have successfully navigated the PCR process. Attendees will learn about the operational pitfalls to avoid and tips to help refine your organization's processes in order to improve your affirmation rate.  Speakers/Course Author - Lisa McClammy, BSN, RN, COS-C, HCS-D  Read more