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

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Speaker: Megan Reavis Nuesch, MBA, BS, COTA/L
Format: Audio and Video
Media Type: Digital Seminar

Description
Everything you now are documenting has a time stamp and if it doesn’t add up, it could cost you your job. Mary had seen a patient earlier in the morning and hadn’t completed a daily note while with the patient. At the end of the day, she completed her note, but couldn’t remember the actual time she had spent with her patient. She logged her time with the patient from 11:00 am to 11:45 am and went home for the day.

Mary comes in the next morning and is met by the Rehab Director wanting to know how she saw her patient when the patient wasn’t even in the building. The patient had been taken to the hospital at 10:45, making it impossible for Mary to have seen the patient at the time she had written down. Mary is now under investigation for false documentation because she didn’t take the time to write down her actual time spent and she risks losing her job and her license.

Medical necessity is a big topic in our industry. It is a term that has adopted a variety of definitions and we are looking at an increase in inappropriately billed claims. We now must justify our clinical decisions while capturing treatment accurately and effectively. Audits have become everyday industry concerns as we face the allegations of “inappropriately billed” claims. There is an increased expectation to justify why we are providing services and why our clinical expertise is needed. The standards have changed, the challenges mount and patients still deserve the very best care.

This recording will provide a thorough understanding of medical necessity and a “how-to” guide for effective documentation. Whether you’re a therapist completing evaluations or an assistant completing progress notes, every area of therapy documentation is examined. Computerized documentation or paper versions will never replace the clinical decision making used to determine medical necessity.

Ongoing training and education are our biggest defenses to ensure our claims get paid for the therapy services the patients benefited from. Imagine being able to put your attention back on your patients, without fear of what you are missing in the documentation. Case studies focus on typical, everyday patient situations with opportunity for questions and discussion to enhance the learning experience.

Speaker
Megan Reavis, MBA, BS, COTA/L, has worked primarily in the geriatric setting for the past 20 years as a clinician and in management roles, including work as a Rehab Director and Area Director. Megan is a national educator and has written and taught continuing education courses to rehab audiences around the country on a variety of clinical, documentation and reimbursement topics that draw from her areas of expertise. Additionally, Megan has worked as a consultant for Outpatient PT companies and Skilled Nursing Facilities to maximize outcomes and reimbursement, perform auditing and manage denials.

Speaker Disclosures:
Financial: Megan Reavis has employment relationships with MCR Seminars, LLC and LW Consulting. She receives a speaking honorarium and recording royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Megan Reavis has no relevant non-financial relationships.

Objectives

1. Analyze practical application of integrating company policies in accordance with the most recent government regulations.
2. Maximize time by documenting in a clear and concise manner.
3. Distinguish the importance of correct supportive documentation as part of the overall claim review.
4. Complete a case study review to form smart goals and daily notes that capture medical necessity.
5. Demonstrate a deeper understanding of the various types of definitions in determining skilled therapy services.
6. Evaluate documentation samples to learn how to minimize denials going forward.

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

Target Audience

• Occupational Therapists
• Occupational Therapy Assistants
• Physical Therapists
• Physical Therapy Assistants
• Speech-Language Pathologists
• Nursing Home Administrators
• Billing/Finance Department Staff 

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