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!


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. Erin Musumeci, RN 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):
  • 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.

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 Master's 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:
Erin Musumeci RN
National Government Services
Provider Outreach & Education
Home Health & Hospice Consultant

A dedicated and skilled RN with a broad range of healthcare experience including acute, post-acute, home health and hospice knowledge with excellent leadership and communication skills. Erin has spent more than a decade in nursing obtaining a significant understanding and background in research, case management, utilization review, medical record and claim review, state and federal healthcare regulations, patient, staff and provider education, as well as direct patient care including; infusion therapy, operating room, obstetrics, and an Advanced Achievement in Transplant Management Certification (AATMC). Erin also has experience as a Quality Improvement Analyst in the acute care setting and has previously been responsible for Continuum of Care, Transfusion Services, and Chemical Dependency Services councils. During her time as a Quality Analyst, Erin organized and led a Readmission Reduction Summit that involved multiple members of the healthcare community throughout Upstate NY establishing action plans to decrease 30-day readmission rates. Erin has worked in both the home health and hospice environments delivering holistic patient care and infusion services as a case manager in homes, facilities, and infusion suites. Her expertise with peripheral, central, PICC lines, and ports from infant to geriatric patients is second to none. Erin has professional experience as a Transitional Care Coordinator providing education to patients and family regarding pre-and post-discharge education for elective surgeries, as well as discharge planning for emergent/unplanned admissions. Her experiences with continuity of care, decreasing nosocomial infection rates, education regarding the patient plan of care, disease processes, collaboration with interdepartmental groups (IDG) and as a documentation specialist for infusion, home health and hospice services, offers unique insight into the current processes and need for education throughout the provider community. Erin has significant experience preparing and presenting data and educational material to small and large healthcare executive and clinical staff, as well as patient and public audiences.

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.