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.

Learning 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.

Targeted Audience

• Administrators/directors
• Clinical supervisors/managers
• Quality assurance, quality improvement, and education staff

Please click here to learn more about part two of the series, focusing on hospice compliance. The session will be held on February 15, 2024, from 1:00 to 2:00 PM ET.

Meet the Speaker

Joe Osentoski, BAS, RN, GERO-BC, brings over 29 years of expertise in home health and hospice, with a focus on clinical quality assurance and regulatory compliance. He has extensive experience working with various Medicare contractors, Medicare Advantage plans, and commercial payers, handling probes, audits, reviews, denials, and appeals. U.S. Administrative Law Judge Robert Soltis has praised Joe's credibility in his book, How to Handle Your Medicare Hearing, stating it is "beyond reproach." Additionally, Joe authored Home Health ADRs and Appeals Answers, First Edition, published by Decision Health.

Continuing Education

This program provides 1.5 continuing education units for skilled nursing, occupational therapy, and speech-language pathology.

Sponsors Welcome

HCAF offers a multitude of ways for home care industry vendors to promote products and services, including through educational program sponsorships. Click here to learn about the benefits of sponsorship, or contact us by calling (850) 222-8967 or sending us a message.