Additional Document Requests (ADRs) Home Health


GENERAL SESSION OVERVIEW

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, SMRCs and RACs. Attendees will gain a better understanding of the medical review process, Medicare's Additional Development Request, and documentation processes. Additionally, Ms. Lee will discuss the appeals process and a 30k view of documentation that would support the medical necessity for both home health and hospice. The breakout sessions will provide the additional details!

Program Topics:
  • Gain an understanding of the targeted probe and educate (TPE) process.
  • Identify top denial reasons for medically reviewed claims.
  • Gain an understanding of the documentation requirements to support services billed.
  • Identify top denial reasons for claims.
  • Review up to date references and resources for 2022 regulations.

HOME HEALTH BREAKOUT OVERVIEW

This Home Health breakout session features NGS Home Health Clinical Consultant, Shelly Dailey MSN, BSN, RN, CPHM, who will be reviewing tips on responding to a home health Targeted Probe & Educate (TPE) Additional Documentation Request (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 homebound status, the need for skilled service in the home, the plan of care, oversight of services and the face-to-face encounter.

Home Health Topics (objectives):
  • Identify top denial reasons for Home Health Medicare claims.
  • Develop an understanding of how medical record documentation supports patient eligibility for utilization of the Medicare Home Health benefit.
  • Overview of all five eligibility requirements.
  • Up to Date references and resources for federal Medicare home health regulations.
  • Provide a thorough understanding of the TPE Medical Review process.

FACULTY

GENERAL SESSION SPEAKER:
Annette Lee
RN, MS, COS-C, HCS-D
CEO of Provider Insights, Inc.


Annette is a passionate home health/hospice and patient advocate, who provides support and empowers her clients to create a culture of compliance, while providing quality, efficient patient centered care. A registered nurse, with a Masters in Health Care Administration, Annette has practiced 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 has provided 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.



HOME HEALTH SPEAKER:

Shelly R. Dailey
MSN, BSN, RN, CPHM
National Government Services
Provider Outreach & Education
Home Health & Hospice Consultant

A passionate patient and provider advocate with a Master’s Degree in Nursing, Shelly has 30 years of experience in health care; including an Associate Degree and certification in Healthcare Administration.  Shelly became an integral member of the NGS Mobile Medical Review Team in 2011 and joined Provider Outreach & Education at NGS in 2014.  She has a significant background in state and federal Medicare regulations, nursing education, home health, hospice, adult medicine, psychiatry, skilled nursing facility, ambulance, and inpatient and outpatient hospitalization.  Shelly has worked as an adjunct nursing professor at Roberts Wesleyan College in Rochester, NY and is currently a matriculated nursing Ph.D. student at The Catholic University of America in Washington, DC developing research specific to American military combat veterans. She has worked closely with the Department of Justice (DOJ), the Department of Health & Human Services, the Office of the Inspector General (HHS OIG) and the FBI on multiple Medicare fraud trials, and has received two prestigious NGS awards, Continuous Improvement and Values in Action, for her hard work and dedication to provider collaboration and education. She is a Member of the CNY Medical Reserve Corp, the American Nurses Association, the New York State Nurses Association, the Sigma Theta Tau International Honor Society of Nursing and the International Nurses Association (INA), who recognized Shelly as a World-Wide Leader in Healthcare in 2017. Her most valued personal and professional experiences include work with the federal government and American Red Cross during the aftermath of Hurricane Katrina in Louisiana, Mississippi and Alabama, as well as missionary work in Guatemala in 2018 & 2019.

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 #CEP17394) for 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.