SNF Coverage: Avoiding Denial Of Rehab Claims In An Age Of Compliance

Event Information
Product Format
Prerecorded Event
Presenter(s)
Elisa Bovee, MS, OTR/L
Length
60 Minutes
Product Description

Understand Medicare Reimbursement System, Medical Review And Trends -- To Avoid Denials

Skilled Nursing Facilities have seen a significant increase in Medicare Part A Therapy denials. 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. Our presenter Elisa Bovee, MS OTR/L, will begin this audio conference by discussing recent National trends in Medical Review, reasons for increased medical reviews and the various Medical review programs. She will help you understand specific denial trends with examples of denial statements. The session will culminate in a review of the keys to responding to a medical record request, appeal tips and strategies.

This program will enable rehabilitation professionals to provide quality healthcare through an understanding of the Medicare Reimbursement System in a skilled nursing facility.


The attendees will be able:

  • To grasp and summarize goals of Medicare Medical Review.
  • To identify and articulate examples of the Medicare Medical Review Process.
  • To learn about the strategies for interdisciplinary management of Medicare documentation requests and appeals.

Highlights of the session are:

  • Medicare Documentation Review Trends
  • Zone Integrity Contractor (ZPIC)
  • 2012 Office of Inspector General (OIG Report)
  • What is your PEPPER telling CMS and your Medicare Contractor
  • Technical Denial Reasons and Trends
  • Clinical Denial Reasons and Trends
  • Additional Documentation Response (ADR)
  • Appeal Rights and Process
  • Keys to Success

Who should attend? People associated with therapy management, occupational therapists, physical therapists, speech pathologists, administrators, nursing management, MDS coordinators and business office managers.

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About Our Speaker

Elisa Bovee - Medicare Billing Expert

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...   More Info
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