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 starts by exploring key Medicare rules and regulations as they relate to National Government Services (NGS) Local Coverage Determinations (LCD) to support hospice documentation, terminal prognosis, and level of care. By linking actual requirements with common denial reasons, it demonstrates how proper documentation can prevent a negative outcome, such as denied payment. Key hospice charting timepoints, including Certification of Terminal Illness (CTI), face-to-face encounters (F2F), and interdisciplinary meetings (IDT/IDG), are covered, along with specific signs, symptoms, labs, assessments, and indicators necessary to support hospice coverage.

Learning Objectives

After participating in the session, attendees should be able to:

• Understand current Medicare medical review activity.
• Gain knowledge of key hospice Medicare Benefit Policy Manual and NGS coverage requirements.
• Identify common denial reasons issued by Medicare reviewers.
• Acquire knowledge of key charting items to be generated and reviewed and the staff education needed for successful implementation.

Targeted Audience

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

Please click here to learn more about part one of the series, focusing on home health compliance. The session will be held on February 13, 2024, from 1:00 to 2:30 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.