Skilled Rehab Services: Avoiding Denied Claims

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Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing recent national trends in Medical Review, Reasons for increased review and the various Medical Review programs. The speaker will present specific denial trends with examples of denial statements. The presentation will culminate in a review of the keys to responding to a medical record request and appeal tips and strategies.

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Skilled Rehab Services: Avoiding Denied Claims

  1. 1. Skilled Rehabilitation Services:Avoiding Denied ClaimsHARMONY UNIVERSITYThe Provider Unit ofHarmony Healthcare International, Inc. (HHI)Presented by:Keri Hart, MS CCC SLP, RAC-CTDirector of CHHRP Program Development
  2. 2. Speaker BioNearly 25 Years Experience in Long-term CareCorporate Director of ClinicalReimbursement ServicesMDSCorporate Rehab DirectorRehab DirectorSLPCognition (Dementia and Head Injury)Head and Neck (Dysphagia and Voice)Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 2
  3. 3. Increase in Medicare DocumentationReviewsUnderstanding why an increase inMedicare Part A and Part B hasoccurred will allow providers toidentify their risk areasUnderstanding trends in denials forMedicare Part A and Part B hasoccurred will allow providers toidentify their risk areCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 3
  4. 4. DocumentationEnsure rehabilitation documentationsupports:Part A coverage criteriaPart B coverage criteriaDocumentation of deficitsRequires the skills of a therapistEvidence of ProgressCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 4
  5. 5. Increase in Medicare DocumentationReviewsSignificant increase in the number of medical reviewrequests from Medicare Administrative Contractors(MACs)Medicare Part A and BBilling inconsistenciesICD-9 Coding triggersSimilar pattern to Medical Record Reviews withinthe nursing facility setting in the early 90sNumber of "Help Letters“ was astoundingly highInvestigations into potential fraudulent billingpractices increasedCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 5
  6. 6. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 6Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 6Zone Program Integrity Contractor(ZPIC)Goal is to identify FraudCMS launched another major initiative totarget providers other than the hospitalsetting as the RAC auditors have beenfocusing on hospital auditsSoutheast, South Central, Midwest,Northeast and West Coast regions of theU.S. are seeing the most ZPIC audits atthis time
  7. 7. ZPICZone Program Integrity Contractors (ZPICs) Medicare fraud and abuse prevention and detectionResult of these audits may be prepayment reviewfor up to a yearVery CostlyUnannounced on site visitsPre-Payment review after submission of ADRZPICs can take as long as they want to review andmake a determination on a given claim.Notice is lacking, and SNF providers are oftentaken by surpriseCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 7
  8. 8. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 8Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 8Zone Program Integrity Contractor(ZPIC)ZPICsSafeGuard ServicesAdvanceMedHealth integrityIntegriguardSurprise on-site visitsTargeted data analysis100 DaysReturn AdmissionsLong Term Residents
  9. 9. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 9Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 9On-site Medical RecordReview AuditsInterviews of Rehab Staff and MDS QuestionsSample therapy staff interview questions:1. Do you feel pressure to meet your RUG levels?2. Who has the say on discharge from therapy?Sample MDS staff interview questions:1. Who decides the ARD?2. Do they provide group and concurrenttreatments?
  10. 10. OIG Report November 2012In fiscal year (FY) 2012, Medicare paid $32.2 billionfor SNF servicesSubmission of inaccurate, medically unnecessary,and fraudulent claimsMedicare Payment Advisory Commission has raisedconcerns about SNFs’ improperly billing for therapyto obtain additional Medicare paymentsIncrease and expand reviews of SNF claimsUse CMS fraud prevention system to identify SNFsbilling higher paying RUGsMonitor compliance with therapy assessments (COT)Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 10
  11. 11. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 11Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 11OIG FindingsFrom 2006 to 2008, SNFs increasingly billed forhigher paying RUGs, even though beneficiarycharacteristics remained largely unchangedPercentage of RUGs for ultra high therapy increasedfrom 17 to 28 percentPercentage of RUGs with high ADL scores increasedfrom 30 percent in 2006 to 34 percent in 2008Even though SNFs significantly increased theirbilling for these higher paying RUGs, beneficiaries’ages and diagnoses at admission were largelyunchanged from 2006 to 2008
  12. 12. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 12Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 12OIG FindingsFor-profit SNFs were far more likely thannonprofit or government SNFs to bill forhigher paying RUGs32 percent of RUGs from for-profit SNFswere for ultra high therapy, compared to 18percent from nonprofit SNFs and 13 percentfrom government SNFs. In addition, for-profit SNFs had a higher use of RUGs withhigh ADL scores than both for profit andgovernment SNFs. For-profit SNFs also hadlonger lengths of stay, on average, comparedto those of the other types of SNFs.
  13. 13. OIG Report November 2012OIG recommendations (CMS concurred):1) Increase and expand reviews of SNF claims2) Use CMS fraud prevention system to identifySNFs billing higher paying RUGs3) Monitor compliance with therapy assessments(COT)4) Change the current method for determining howmuch therapy is needed to ensure appropriatepayments5) Improve the accuracy of MDS itemsCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 13
  14. 14. CMS ResultsProviders have received feedbackresults for 2012 Medicare Part A fromtheir MACSummarizes initial medical recorddeterminations onlyDoes not include appeal results foroverturns and decision reversalsSimilar trends across MACsCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 14
  15. 15. CMS ResultsNHIC 2012 Example:24.32 % did not respond toAdditional Documentation Request(ADR)43.44 % Denial RateCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 15
  16. 16. CMS ResultsNHIC 2012 Example (continued):Denial Trends:86.7 % Medical information provideddid not support the need for SNF Care5.7% Missing IncompleteDocumentation of records received1.27% No 3 Day Qualifying HospitalStayCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 16
  17. 17. Medicare Part B ReviewsSignificant increase in the number ofmedical review requests from MedicareAdministrative Contractors (MACs)Exception ProcessJanuary 2012 initiation of clinicaloutcomes directly on the Medicare PartB billOIG ReportCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 17
  18. 18. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 18Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 18OIG ReportPart BOIG report regarding Questionable Billingfor Medicare Outpatient Therapy Services(Medicare Part B)Medicare expenditures for outpatienttherapy increased 133 percent between2000 and 2009, from $2.1 billion to $4.9billion, while the number of Medicarebeneficiaries receiving outpatient therapyincreased only 26 percent from 3.6 millionto 4.5 million
  19. 19. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 19Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 19OIG ReportPart BIdentified 20 counties that had in 2009:The highest average Medicare payment perbeneficiaryMore than $1 million in total Medicare paymentsfor outpatient therapy (i.e., high utilizationcounties)Analyzed Miami-Dade County, Florida, separatelybecause it had the highest average Medicarepayments per beneficiary among the highutilization counties and the highest total Medicarepayments for outpatient therapy in 2009
  20. 20. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 20Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 20OIG ReportPart BSix questionable billing characteristicsthat may indicate fraud:(1) Services for which providers indicatedthat an annual cap would be exceeded(2) Beneficiaries whose providers indicatedthat an annual therapy cap would beexceeded on the beneficiaries first date ofservice(3) Payments for beneficiaries whoreceived outpatient therapy from multipleproviders
  21. 21. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 21Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 21OIG ReportPart B(4) Payments for therapy services providedthroughout the year(5) Payments for services that exceeded anannual cap(6) Providers who were paid for more than8 hours of outpatient therapy provided in asingle day
  22. 22. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 22Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 22FindingsMedicare per-beneficiary spending onoutpatient therapy services in Miami-DadeCounty was three times the national average in2009Medicare paid an average of $3,459 per Miami-Dade beneficiary for outpatient therapy,compared to an average of $1,078 nationallyEach therapy beneficiary in Miami-Dade Countyreceived an average of 158 services during 2009,while the national average was 49 services perbeneficiary
  23. 23. Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 23Copyright © 2012 All Rights Reserved Harmony Healthcare International, Inc. 23OIG RecommendationsTarget outpatient therapy claims in highutilization areas for further reviewTarget outpatient therapy claims withquestionable billing characteristics for furtherreviewReview geographic areas and providers withquestionable billing and take appropriateaction based on resultsRevise the current therapy cap exceptionprocess
  24. 24. Manual Medical Review forMedicare Part B-April 2013January 1st2013 extended through December31st2013Financial Limitation for Outpatient TherapyServices – Section 3005 of the Middle ClassTax Relief and Job Creation Act of 2012Any providers billing therapy servicesthrough Medicare Part B will be consideredoutpatient therapy services24Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  25. 25. Manual Medical Review forMedicare Part B-April 2013Outpatient services includes:Skilled Nursing FacilitiesLong-term care facilitiesOutpatient clinicsHOPDs (hospital-based outpatient clinics)previously exempt from the therapy capsPrivate practicesHome health agencies25Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  26. 26. Manual Medical Review forMedicare Part B-April 2013Similar to the therapy cap, there is athreshold of $3,700 for PT and SLPservices combined and anotherthreshold of $3,700 for OT services.Such requests for exceptions will bemanually medically reviewed.26Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  27. 27. Manual Medicare Reviews forMedicare Part B-April 2013April 2013: Providers will no longer berequired to submit requests for exceptions tothe threshold advance of furnishing therapyservices above the $3700Recovery Auditors (RAC) will now conductprepayment review for all claims processed on orafter April 1, 2013. The specific process forManual Medical reviews is based on what stateservices are provided.27Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  28. 28. Manual Medicare Reviews forMedicare Part B-April 2013The contractors will use the coverageand payment policy requirements inSection 220 of the Medicare BenefitPolicy manual and any applicable localcoverage decision policies whenmaking determinations for approvingtherapy services above the threshold Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 28
  29. 29. Manual Medicare Reviews forMedicare Part B-April 2013Pre-Payment Review: Claimssubmitted in the Recovery AuditPrepayment Review Demonstrationstates will be reviewed on aprepayment basis.These states are Florida, California,Michigan, Texas, New York, Louisiana,Illinois, Pennsylvania, Ohio, NorthCarolina and Missouri.Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 29
  30. 30. Manual Medicare Reviews forMedicare Part B-April 2013Prepayment Review (Cont)The Recovery Auditor will conductprepayment review within 10 businessdays of receiving the additionaldocumentation requested and willnotify the MAC of the paymentdecision. The facility’s MAC will thennotify the therapy provider of theoutcome of the decision.Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 30
  31. 31. Manual Medicare Reviews forMedicare Part B-April 2013Post-payment Review: In theremaining states, the Recovery Auditorswill conduct “immediate post-paymentreview”. The MAC will flag the claimsthat meet the criteria, request additionaldocumentation and pay the claim.Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 31
  32. 32. Manual Medicare Reviews forMedicare Part B-April 2013Post-payment Review (continued)The MAC will send an ADR to the providerrequesting the additional documentation be sentto the Recovery Auditor.The Recovery Auditor will conduct postpayment review and will notify the MAC of thepayment decision. The facility’s MAC will thennotify the therapy provider of the outcome ofthe decision.Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 32
  33. 33. Medicare Part B ReviewsMost MACs have updated their Local CoverageDeterminations (LCDs) for inclusion of the G CodesrequirementsSome have taken the opportunity to add additionalrequirementsNational Government Services: PT/OT January 2013:“Where therapy exceeds an established cap, progressreports will be required at least every 5 treatment days.Writing progress notes more frequently than theminimum is encouraged to support the medicalnecessity of treatment.”Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 33
  34. 34. Denial ReasonsTechnicalThe provider did not meet a regulatory conditionsfor paymentDifficult to win on appealProvider did not send the needed documentationClinicalDocumentation does not justify the clinical needfor the service(s) providedCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 34
  35. 35. Technical Denial ReasonsDocumentation not received within requested timeframeResponse to Additional Documentation Request(ADR) did contain documentation requestedPhysician Certification not signed or missingTherapy Billing logs do not support billingPart A – MDS Assessment does not supportPart B - 8 Minute RuleIllegible documentationHospital documentation was not submittedCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 35
  36. 36. Clinical Denial ReasonsDocumentation did not support medicalnecessityDocumentation does not support dailyskilled intervention by a qualified therapistDocumentation in the medical records didnot support continued progressThe amount, frequency and duration ofservices were not reasonable, given thepatient’s current statusCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 36
  37. 37. Clinical Denial ReasonsDocumentation demonstrates that thetherapist worked long enough with thebeneficiary to develop a restorativeprogramPracticing of previously taughtexercises does not require the skills of atherapistCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 37
  38. 38. Denial ReasonsSkills of A TherapistST minutes were reduced based on clinical judgmentbecause documentation did not support the billedminutes were reasonable and necessary. Thebeneficiary could not participate in self feedingduring this period and required the speech therapistto assist with 100% of the feeding.Documentation did not support medical necessityand need for continued skilled therapy. Patient needsassistance and supervision.Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 38
  39. 39. Denial ReasonsDeconditioningSkills of a therapist are not required to maintainfunction or improve strength and enduranceServices related to activities for the general good andwelfare of patients (e.g., general exercises topromote overall fitness and flexibility, and activitiesto provide diversion or general motivation), do notconstitute physical therapy services for MedicarepurposesPracticing of previously taught exercises does notrequire the skills of a therapistCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 39
  40. 40. Denial ReasonsRestorative Level of CareSkilled therapy was provided whennon-skilled maintenance serviceswould have been more appropriateRestorative level of care providedDocumentation supports thatrestorative nursing couldve helpedthe beneficiary progress versus skilledrehabilitation services40Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  41. 41. Denial ReasonsCustodial Level of CareSkilled rehabilitation and nursing serviceswere custodial in nature and could have beenmet with restorative nursing, family member,or nursing provision of intermittent skilledrehabilitation and nursing services and thatneeds were custodial in nature and couldhave been met with restorative nursing,family member, or nursing assistant41Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  42. 42. Denial ReasonsPrior Level of FunctionThe therapist ignored the patient’s prior level offunction and set unrealistic goalsPrior level of function was illegible. Prior level offunction was blank.Patients functional level had not changed whencompared to his prior level of functioningdocumented in the medical recordWeekly nursing progress notes demonstrate that thebeneficiary required the same amount of assistance(extensive assistance) prior to and after the hospitalstayCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 42
  43. 43. Denial ReasonsRehab PotentialThe medical record did not support thatthe condition of the patient wouldimprove materially in a reasonable andgenerally predictable period of timePoor rehab potentialCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 43
  44. 44. Denial ReasonsGoalsGoals are not functional (i.e., patientwill perform 10 repetitions of upperextremity exercises with the yellowtheraband)Duplication of services betweendisciplinesCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 44
  45. 45. Denial ReasonsLack of Functional ProgressGains were not significant and there was noindication of carryover of the functional taskLack of documentation relating to the patienthaving the potential to show significantprogressNo significant improvement with functionalabilityThe outcome of therapy treatment was notdocumentedFailure to document a complete treatment planas outlined in Documentation Required sectionCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 45
  46. 46. Denial ReasonsModalitiesElectrical Stimulation used to treat motor functiondisorders, such as multiple sclerosis, is consideredinvestigational and therefore, non-coveredElectrical Stimulation used in the treatment offacial nerve paralysis, commonly known as Bell’sPalsy, is considered investigational and therefore,non-coveredDiathermy and Ultrasound heat treatments for thetreatment of asthma, bronchitis, or any otherpulmonary condition are considered notreasonable and necessary, and therefore, non-covered46Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  47. 47. Denial ReasonsCognitive TherapyThe record documented a diagnosis ofAlzheimer’s disease. SLP documentationdoes not support further significantpractical improvement could be expected.Medical justification for ST services is notestablishedSpeech treatment cognition for dementiaPoor progress with cognitionCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 47
  48. 48. Denial ReasonsInpatient Level of CareDocumentation did not support theneed for inpatient level of careNo daily skilled care requiring a stay inthe SNFSupervised level of care48Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  49. 49. Denial ReasonsMedical Record ConflictsNursing notes mostly dependentADLs/functional tasks throughout the SNFstay. Nursing note indicated there was noimprovement and fluctuation of progresswith self-care tasks.MDS assessments indicate that thebeneficiarys ability to perform functionaltasks/ADLs did not improve from the 5-dayto the 90-day assessment49Harmony Healthcare International, Inc.Copyright © 2013 All Rights Reserved
  50. 50. Denial ReasonsServices provided were likely clinicallyappropriate but the documentation didnot support:Technical requirementsNeed to receive an inpatient level of careThe skills of a therapist were requiredMedical necessityFunctional outcomeCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 50
  51. 51. ADR ResponseCommon practice to receive communicationsfrom Medicare review agencies requestingproof of skilled servicesCMS online billingMailUnderstand the process to manage theinquiry in a timely and detailed manner inorder to minimize lost revenueHarmony Healthcare International, Inc. 51Copyright © 2013 All Rights Reserved
  52. 52. ADR ResponseRaise facility awarenessFunction as a TEAMCommunicationOrganizationHarmony Healthcare International, Inc. 52Copyright © 2013 All Rights Reserved
  53. 53. ADR ResponseThe process starts with an AdditionalDevelopment Request (ADR)These can be triggered by items specificto the patient, such as:RUG scoreICD-9 Codes on BillWide spread probeHarmony Healthcare International, Inc. 53Copyright © 2013 All Rights Reserved
  54. 54. The AppealThe following team members are beneficial in thisprocess:Rehabilitation DirectorTherapists who provided careMedical RecordsMDS CoordinatorDirector of NursingRestorative Nursing Program ManagerSocial ServicesDietaryAdditional team members who participated in careHarmony Healthcare International, Inc. 54Copyright © 2013 All Rights Reserved
  55. 55. ADR ResponseAssign a team leader to oversee thepreparation of the response packageCarefully read the request for recordsDue DateDocuments requestedReview MAC specific requirementsWhere to sendCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 55
  56. 56. ADR ResponsePREP(Proper Reimbursement Explanation Paper)Include a statement of position letter withthe medical record documentation to thereviewing agency explaining the servicesprovided to the patientIdentify potential risk areasSummarize skilled care providedAdd additional documents to support theclaimCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 56
  57. 57. ADR ResponseEach team member should review thepackage as a wholeThe team leader should have a finallook prior to submitting the appealAlways keep a copy of the packet sentto the reviewing agencyHarmony Healthcare International, Inc. 57Copyright © 2013 All Rights Reserved
  58. 58. Tracking ResultsInternal tracking system to monitorWhen ADR or denial was receivedWhen package was sent outFinal results of the reviewKeep a copy of records sentCommunicate results with the TeamHarmony Healthcare International, Inc. 58Copyright © 2013 All Rights Reserved
  59. 59. Denial ProcessIt is not uncommon for an ADR to result inthe denial of part or all of a claimOnce an initial claim determination ismade providers have the right to appealAll appeal requests must be made inwritingHarmony Healthcare International, Inc. 59Copyright © 2013 All Rights Reserved
  60. 60. Denial ProcessAppeal RightsMedicare offers five levels in the Part Aand Part B Appeals Process:1. Redetermination by a MAC2. Reconsideration by a QIC3. Hearing by an Administrative Law Judge(ALJ)4. Review by the Medicare Appeals Council,within the Department Appeals Board5. Judicial review in U.S. District CourtHarmony Healthcare International, Inc. 60Copyright © 2013 All Rights Reserved
  61. 61. Keys to SuccessProvide clinically appropriate careUnderstand the requirements for MedicarePart A and B for your specific MACLocal coverage determinations (LCDs)Document care providedWhy were the skilled hands of a therapistneeded?Medical necessityDeficitsOutcomesCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 61
  62. 62. Keys to SuccessUtilize a checklist to ensure alldocuments are includedWas a copy of the original signedcertification sent or a copy of the unsignedcopy?Respond to ADRs timelyCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 62
  63. 63. What is a CHHRP-LTC?A Certified Harmony HealthcareRehabilitation Professional (CHHRP-LTC) is an InterdisciplinaryProfessional who has SuccessfullyCompleted an Intensive and Clinically-Founded Training Geared Specificallyto Patients in a Skilled Nursing Facility(SNF) Setting.Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 63
  64. 64. What is a CHHRP-LTC?3 Day Certification Includes:CEUsMedicare Therapy Documentation in aSNF Medicare Coverage CriteriaRehabilitation Program DevelopmentMDS Coding for the Therapy ProfessionalCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 64
  65. 65. What is a CHHRP-LTC?Hot Topics Discussed:Office of Inspector General (OIG) ReportFunctional Reporting of G-CodesThe Jimmo Settlement AgreementUpdated 2013 Process for Manual MedicalReview of Part B  Therapy2013 Multiple Procedure PaymentReduction (MPPR)Medicare Part A an B Denial TrendsCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 65
  66. 66. What is a CHHRP-LTC?info.harmony-healthcare.com/chhrpSee Upcoming CHHRP-LTCCertification ProgramsHost a CHHRP-LTC CertificationPrograms and earn free attendeesCopyright © 2013 All Rights Reserved Harmony Healthcare International, Inc. 66
  67. 67. Questions/AnswersHarmony Healthcare International1 (800) 530 – 4413www.Harmony-Healthcare.comFollow Me & HHI on Twitter@ChhrpHart@Harmonyhlthcare67Copyright © 2013 All Rights Reserved Harmony Healthcare International, Inc.

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