This insightful session will give you clarity on medical decision making versus medical necessity. What things are auditors looking to find when your records are being reviewed? How can I work with my clinician/physician to improve his/her documentation? Medical necessity means more than just "fluff" in the medical record. We will discuss how to justify the physician's care plan and avoid take backs from third party payers.
WHY SHOULD YOU ATTEND
It is vital for the entire care team to take part in adapting to the rules that we must follow when it comes to justifying the medical necessity of a visit or encounter. This is relevant to low level visits as well, ex: 99211. What is CMS' opinion of a low level visit and the medical necessity that must be stated in the medical record to justify the billing? Who can provide this level of care? What about services such as blood pressure checks, allergy injections, Coumadin clinic? How do I validate my notes for the auditors? It is imperative that we work together to improve the outcome of patient care.
We will look at the relevance of each part of an evaluation code. How does the medical decision making tie in with medical necessity? Areas of concern are copying, pasting, and cloning in the medical record. Addressing the history of the patient and the chief concern for the service. This Webinar is particularly useful for those wishing to maximize their revenue, see an older, sicker population, or currently report a high level of level IV and V office visit codes. How am I conveying to the payer that my services were in fact necessary? Is this being told on my claims reporting?
Learn how to bullet-proof your notes/medical records and be armed in case of an audit or prepayment review. Strategies discussed on how to selectively tell the story of the patient and how that leads to optimal reimbursement.
Learn how to document the Medical Record to support Medical Necessity based on actual examples. Gain insight from this expert auditor to help you avoid common errors that invariably trigger audits. Examine the challenges and pitfalls of using electronic medical record templates and understand how that information is documented from an auditor’s point of view. Clarify erroneous misconceptions surrounding Documentation Guidelines and receive an overview of Evaluation and Management Services as they relate to medical necessity.
WHO WILL BENEFIT
All participants that are involved with Patient Care. Ranging from the Appointment Staff to the Clinical Areas of a Practice or Facility. With prior approvals and precepts being on the rise, it is critical that each member of the work force understand how their role can impact medical necessity.
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