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Validity : 20th Apr'24 to 30th Apr'24
Medical Necessity: Can you define it? Capture it? Document it? Focus for OIG and other auditors
- How is Medical Necessity Defined
- Documentation needed to demonstrate Medical Necessity
- Rational behind documentation supporting coding
- Necessity for documentation to show progression of medical changes
- Interdepartmental documentation to show medical need for services
Overview of the webinar
This webinar will address the various methods of ensuring appropriate documentation to identify Medical Necessity for services provided. An area that is often overlooked is the significance of the medical coding from Hospitalization to Home Care and the Skilled Nursing facility between. With the new coding guidelines for ICD-10; our use of documentation is essential, as we are required to support the services we provide with not only the correct coding but the documentation to match the coding. We will look at how the identification of correcting coding will allow our nursing, rehab and support staff to correctly document the services provided.
By ensuring that the documentation written by your staff matches the Diagnosis selected it will ensure that medical necessity of services is demonstrated. By looking at how our staff is completing documentation, at the wording used and supportive documentation from all department, we can target areas of weakness in documentation and continue to improve in areas that are functional but not optimal. All CMS guidelines and regulation are based on the definition of “Medical Necessity”. If the medical need for the services rendered is not present or identified, services can and will be denied. If Nursing relies solely upon therapy to demonstrate the medical need of services or vice versa, this creates an opening for the denial of services. When Medical Necessity is demonstrated then services are optimized. When department's documentation is supportive of the medical necessity of the services being provided, the risk for denial of services is significantly reduced.
Who should attend?
- Director of Nursing
- Director of Rehab
- Managers
- Nurses
- Therapists
Why should you attend?
Documentation of Medical Necessity has always been important but as the intensity of audits continues, with all aspects of healthcare looking to reduce misuse of healthcare funding it has become even more important. The OIG has been looking at Hospitals, Skilled Nursing facilities and Home Health Care to determine if admissions/readmissions and stay at such facilities are warranted and the area that they find to be most lacking is the documentation of Medical Necessity. Managed Care companies will deny coverage based on the lack of Medical Necessity. Without appropriate documentation, your organization is at risk for loss of payment or reclamation of payment without appropriate documentation. This webcast will provide you with the information needed to support your efforts to document and demonstrate Medical Necessity of services
Faculty - Ms.Laura S Hargraves
Laura S Hargraves MS CCC- SLP has been working in all aspects of HealthCare Industry for the past 28 years. Ms. Hargraves has been providing compliance and oversight of documentation to meeting changing guidelines during this period. She has a background in education, which helps her maximize her ability to communicate these changes to the various professionals that she works with. She is a professional presenter on topics related to Medicare, MDS 3.0, and Documentation.