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Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of the medical review is to determine whether the services provided are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. This presentation discusses recent national trends in Medical Review, Reasons for increased review and the various Medical Review programs. The presentation highlights specific denial trends associated with claims following hospitalization for a psychiatric diagnosis. The presentation will culminate in a review of the keys to responding to a medical record request and appeal tips and strategies.
1. Learn to summarize goals of Medicare Medical Review.
2. Learn identify and articulate examples of the Medicare Medical Review Process.
3. Learn to identify strategies for interdisciplinary management of Medicare documentation requests and appeals.