Additional Document Request Workshop


Home Health and Hospice Tracks



DESCRIPTION

The workshop will begin with a general overview of Additional Document Requests (ADRs) by expert faculty Annette Lee, who worked for over a decade with a MAC in medical review and education. This session will review the different types of audits and the processes followed by Medical Review, CERT, and RACs. Attendees will gain a better understanding of the medical review process, Medicare’s Additional Development Request, and Progressive Correction Action processes. Additionally, Ms. Lee will discuss the appeals process and documentation that would support the medical necessity for both home health and hospice.

HOME HEALTH BREAKOUT
This Home Health breakout session features NGS Home Health Clinical Consultant, Lauri Domingo RN, who will be reviewing tips on responding to an ADR, the top medical review denials, and tips on avoiding those denials. This session will also cover Documentation of all five eligibility requirements to include the Face-to-Face Encounter, the Plan of Care, Homebound Status and the Need for Skilled Services.

HOME HEALTH PROGRAM TOPICS:
  • Identify top denial reasons for Home Health Medicare claims
  • Develop an understanding of how physician documentation supports patient eligibility for Medicare Home Health Services
  • Overview of all five certification requirements
  • Up to date references and resources for 2018 Medicare Home Health Regulations
  • Discuss the Targeted Probe and Educate Medical Review Activities

HOSPICE BREAKOUT
Would your documentation pass a Medicare audit? Does your documentation support the services you are billing to Medicare? With increasing regulatory requirements and scrutiny of documentation to ensure services billed to Medicare are reasonably and medically necessary and meet the statutory requirements it is imperative that providers understand the requirements and the documentation required to support Medicare coverage.

Come hear firsthand from your Medicare Administrative Contractor Provider Outreach and Education Consultant about how to strategize to survive a medical review audit. Corrinne Ball has fifteen years of experience with Medicare documentation, and she will be providing firsthand knowledge about the Targeted Probe and Educate process, responding to a hospice ADR, and documentation requirements. During this session we will examine the targeted probe and educate (TPE) process, data that drives medical review audits and top medical review denials. This session is designed to give providers the tools, and information to design and implement a strategy to be successful during a medical review audit.

HOSPICE PROGRAM TOPICS:
  • Gain an understanding of the targeted probe and educate (TPE) process
  • Identify top denial reasons for medically reviewed Hospice Medicare claims
  • Develop an understanding of how documentation plays a key role in supporting terminal prognosis
  • Gain an understanding of the documentation requirements to support services billed for Hospice


BOOKSTORE SPECIALS

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ADR Response Guide for
Home Health Organizations

ADR Response Guide for
Hospice Organizations




This guide is designed to assist your organization in preparing for and responding to CMS Additional Development Requests (ADRs). The guide discusses all aspects of the ADR process that your organization can incorporate into your organizational processes. Includes: ADR tracking logs, staff roles in the ADR process, compiling of the ADR packet, audit tools and the necessity of staff education. Produced by The Corridor Group.

Save $20 on this resouce by ordering your copy when you register for this ADR Workshop! To order resources at reduced pricing please order via phone at (916) 641-5795 x 113 or fax registration form to (916) 641-5881.

FACULTY




Annette Lee
RN, MS, COS-C, Cahaba GBA, CGS

Provider Insights, Inc.

Annette is a registered nurse, with a Masters in Health Care Administration, practicing since 1990, with the majority of her nursing experience in home health. For over a decade she worked with the CMS intermediary where she provided review of, and education on home health documentation. Annette then began providing outreach and provider education regarding Medicare reimbursement issues and effective documentation strategies, assisting providers with ADRs and appeals. Today she marries together her experience in the real world and the inside knowledge of Medicare to ensure providers can meet the requirements of CMS, and ensure compliant, efficient operations. She presents nationally on OASIS, PPS, documentation and coverage and provides content expertise to the CMS OASIS Q&A Mailbox. Annette holds both the Certificate for OASIS Specialist-Clinical and the Home Care Coding Specialist-Diagnosis certification. She is an AHIMA approved ICD-10-CM Coding Trainer.




Corrinne R. Ball
RN, CPC, CAC

Provider Outreach and Education Consultant
National Government Services

Corrinne is a Registered Nurse and graduate of Lamar University with a Bachelors Degree in nursing. Corrinne is currently attending Lamar University to pursue a Masters degree in Nursing Administration. Corrinne has worked for National Government Services for fifteen years. She has two years experience as a Medical Review Analyst and thirteen years experience in Medicare education. She frequently speaks at National and State Association Conference to provide education to hospice providers on clinical documentation and hospice billing. She has twelve years experience in reviewing documentation for Medicare hospice claims and providing detailed education to hospice providers on medical review findings, coverage and nursing documentation. Corrinne provides in depth education on hospice billing via webinars, seminars and articles. Certified in 2009 as a Certified Professional Coder, 2010 as a Certified Ambulance Coder and 2014 as a Certified Ambulance Compliance Officer, 2019 Certified Ambulance Documentation Specialist.

Lauri Domingo
RN

Home Health Clinical Consultant
National Government Services


Lauri has 29 years of experience in healthcare to include billing, credentialing, provider relations, case management, and later nursing in the areas of General Medicine, Telemetry, Hemodialysis, and Addiction Medicine. She began her career in the Medicare Program in 2011 as a Nurse Reviewer for Appeals and Grievance at National Government Services. She then worked as a Senior Nurse Reviewer with the Mobile Medical Review Team where she provided on site auditing and education for inpatient hospitals and home health agencies in Jurisdiction K. She currently holds the position of Outreach and Education Consultant for Home Health in Jurisdictions 6 and K covering 24 states and territories providing education on Medicare regulations. Lauri was inducted into the Sigma Theta Tau International Nursing Honor Society in June 2009. She was selected for the Federal Government Services Leadership and Growth Development Program Class of 2019 to promote and support high potential leaders. She is a Registered Nurse and holds a Bachelors degree in Business Administration.


CANCELLATIONS

Cancellations are subject to 20% handling fee. There will be NO REFUNDS issued for cancellations received within 10 business days prior to program. Cancellations must be in writing. Refunds will not be made for no-shows. However, substitutions will be allowed. Should CAHSAH® cancel the program, a full registration fee refund will be issued.


CERTIFICATE OF COMPLETION
& CONTINUING EDUCATION UNITS (CEUs)

Provider approved by the California Board of Registered Nursing (Provider #CEP2463) for up to five and one half (5.5) contact hours of continuing education. You must be present for the entire workshop to earn Continuing Education Units. No partial credits can be given. Certificates are distributed at the close of the program.