Megan Reavis – Rehabilitation Reimbursement & Documentation: Solutions to Avoid Costly Denials, Prove Medical Necessity & Protect YOUR Time

Outline

Documentation And Medical Necessity

• Medicare A and the upcoming changes around SNFs and home health
• Medicare B and outpatient reimbursement
• Managed care
• ACOs/ bundled payments and the shift therapy deliver

Evaluations, Need & Reimbursement

• Reasons for evaluation and how to justify medical necessity
• Prior level of function and what key components to include
• Co-morbidities/Complexities and how they will impact reimbursement
• Goal writing and what to add to make it measurable

Critical Terminology: What It Means To Your Documentation

• Determining medical necessity
• Rehab terminology that must be included in your daily documentation
• Skilled vs. unskilled terminology

Supportive Documentation

• Case study: Break down the components of the treatment plan
• Pitfalls to avoid
• Drop-down menus are not your friend
• If you didn’t write it, it didn’t happen

Coding and Diagnoses

• CPT codes and what will get you paid
• Avoiding “Red Flag” codes and why they are denying them
• Diagnoses that won’t get you paid

Denial Management

• Understanding RAC, MAC, ADR, denials, and ZPIC audits
• Reasons for denials: Top 10 reasons we are not getting paid
• Quality assurance audits used to decrease unpaid claims