Additional Document Requests (ADRs) Hospice


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.

HOSPICE BREAKOUT OVERVIEW

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's 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. Madeleine Collins has 10 years' 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 Topics (objectives):
  • Review 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.

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.



HOSPICE SPEAKER:
Madeleine Collins

RN CPHM
National Government Services
Provider Outreach & Education
Home Health & Hospice Consultant

Madeleine "Mandy" Collins is a Registered Nurse with over 27 years of experience with an advanced knowledge base to include both clinical and Medicare practices. Mandy is a member of the NGS Provider Outreach and Education Team with a focus on Hospice services. She previously served as the lead of the Mobile Medical Review Team (MMR) where she assisted in development and delivery of Medicare instruction for live audiences in the acute care and home health settings with 1:1 provider education. Additionally, Mandy carries a wide range of medical record review and appeals experience for Medicare/Medicaid/Commercial contracts. Mandy possesses a strong fundamental understanding of Medicare policy, compliance and interpretation which has been vital in her previous role as a subject matter expert in Administrative Law (ALJ) hearings for both the CMS Qualified Independent Contractor (QIC) and CMS Recovery Audit Contractor (RA). Mandy's clinical career highlights include recent Hospice experience as a case manager/admission nurse, extensive experience in acute care specializing in critical care, long term care management and numerous outpatient environments. Mandy proudly served as an enlisted member of the US Army Reserve Nurse Corps.

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.