Skilled Nursing Facilities have seen a significant increase in Medicare Part A reviews and denials related to nursing documentation. In particular, lower 14 RUGs have been under scrutiny.
FY2014 changes may increase the likelihood of the provision of a skilled level of care in these highly reviewed categories. In addition, nursing documentation anchors skilled rehabilitation services. Limited documentation of medical complexity by nursing may result in denials for medical necessity and need for a SNF level of care.
The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation.
Join this vital audio conference for an insight into recent national trends in Medical Review, reasons for increased review, and details about the various Medical Review programs. You’ll learn about specific denial trends with examples of denial statements. Finally, you’ll review the critical elements to responding to a medical record request and appeal tips and strategies.
This session will help you:
Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.
Who should attend? Administrators, Nursing Management, Direct Care Nurses in a SNF, MDS Coordinators and Business Office Managers.
- Toni G. Cesta
Elisa Bovee, MS, OTR/L, is the Senior Vice President of Operations for Harmony Healthcare International, a nationally recognized, premier Healthcare Consulting firm specializing in C.A.R.E. (Compliance, Audits and Analysis, Reimbursement and Regulations, Education and Efficiency). In her role, Elisa manages a diversified team of HealthCARE Specialists who have extensive knowledge in the areas of Corporate Compliance, MDS 3.0, RUG-IV, Documentation, Therapy Program development and state-specific Medicaid Case Mix. Elisa...
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