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Part 1 of 2: Home Health
“Defensible documentation” is charting that can withstand scrutiny of the many medical reviewers seeking to take back payment for unneeded or inappropriate care. In case of legal scrutiny, it also contains clear proof of what care was provided, by whom, and when. Simply following an electronic medical record (EMR) template will not do this.
This presentation takes actual denial examples, breaks down what caused them, and provides charting examples to address them. An abbreviated listing of key home health coverage requirements for nursing and therapy (Medicare Benefit Policy Manual, Chapter 7, Section 40 and 42 CFR) is provided to provide regulatory baseline knowledge to attendees. Demonstrating the link between what is required from Medicare rules and regulations and what needs to be charted allows clinicians to demonstrate compliance. Implementing meaningful, documented skilled visits generates favorable 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 will also apply to support Medicare Advantage services and Medicaid claims.
Learning Objectives
Presentation attendees will take back to their agency:
- Understanding of current CMS, Medicare Advantage, and commercial payer medical review activity
- Knowledge of key CMS Medicare Benefit Policy Manual coverage requirements
- Application strategies for staff to implement these requirements into documentation
- Knowledge of care management skills to prevent denials and achieve improved patient outcomes
Who benefits Most by Attending This Presentation
- Administrators/Directors
- Clinical Supervisors/Managers
- QA/QI/Education Staff
Part 2 of 2: Hospice
“Defensible documentation” is charting that can withstand scrutiny of the many medical reviewers seeking to take back payment for unneeded or inappropriate care. In case of legal scrutiny, it also contains clear proof of what care was provided, by whom, and when. Simply following an electronic medical record (EMR) template will not do this.
This presentation starts with key Medicare rules and regulations as the basis for how they interact with National Government Services (NGS) Local Coverage Determination (LCD) to support hospice documentation, terminal prognosis and level of care. By linking what is actually required with known denial reasons, it shows how proper documentation can avoid a negative outcome (denied payment). Key hospice charting timepoints of Certification of Terminal Illness (CTI), face-to-face encounter (F2F), and interdisciplinary meetings (IDT/IDG) are covered along with the specific signs, symptoms, labs, assessments, and indicators that must be addressed to support hospice coverage.
Learning Objectives Presentation attendees will take back to their agency:
- Understanding of current CMS medical review activity
- Knowledge of key hospice CMS Medicare Benefit Policy Manual and NGS coverage requirements
- A list of common denial reasons issued from Medicare reviewers
- Knowledge of key charting items to be generated, reviewed and the staff education needed to successfully implement
Who benefits Most by Attending This Presentation
• Administrators/Directors
• Clinical Supervisors/Managers
• QA/QI/Education Staff
Meet the Speaker
Joe Osentoski, BAS, RN, GERO-BC has 29+ years in home health and hospice with a specialty in clinical quality assurance and regulatory compliance. This includes experience with all types of Medicare contractors, Medicare Advantage plans, and commercial payers for probes, audits, reviews, denials, and appeals. He has been lauded by retired US Administrative Law Judge Robert Soltis in his book, How to Handle Your Medicare Hearing: “…His credibility is beyond reproach.” Joe is the author of Home Health ADRs and Appeals Answers, First Edition, published by Decision Health.
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