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AUDIOCONFERENCE ON TAPE

presented on January 27, 2005

More than 80% of appeals result in additional reimbursement to the provider.

Follow the money and get the reimbursement you deserve!

Maximize your facility's reimbursement with a thorough understanding of denials and the appeals process. This 90-minute audio program will examine common reasons for denials, teach you how to recognize and react to a denial, and walk you step-by-step through the critical phases of the appeals process for both Medicare Part A and Part B.

Learn to anticipate and avoid denials

Nearly half of all rehab claims denials are due to improper documentation. Our expert speakers, Rick Gawenda, PT and Kate Wolske-Brewer, PT, GCS, MBA, will discuss common documentation errors and offer practical tips to help you avoid these pitfalls. They will also look at other frequently cited reasons for denials, including physician's orders, certification/recertification, reasonable and necessary criteria, and no documentation received. Your ability to identify the potential causes of denials is a major step toward avoiding them in the future.

Know how and when to appeal a claim

If your facility has already received a denial, communication between departments is vital. Many therapists do not initiate the appeals process because they may not even be aware their claim was denied. Our speakers will address this issue and discuss the importance of communication between therapists and billing staff.

The appeals process works-learn how to do it right

The statistics don't lie. Nearly 85% of appeals for Medicare Part A and Part B result in some level of reimbursement to the rehab provider. It is essential that you understand each step of the appeals process to ensure you receive the reimbursement you deserve.

Our speakers will address the various levels of the appeals process for both Part A and Part B, and will look ahead to anticipated changes in 2005. They will take you through the completion of critical appeal forms, including the Appointment of Representative (AOR) and Waiver of Payment (WOP). Mr. Gawenda and Ms. Wolske-Brewer will also provide helpful instruction on writing an appeal letter, as well as tips on preparing for a hearing before an Administrative Law Judge (ALJ).

Feel confident you are receiving every dollar you deserve for the important services you provide—Purchase today!

These helpful tools are included with this program:

• Sample appeal forms
• A checklist for the complete appeal process
• A tip sheet on preparing for an ALJ hearing
• Sample AOR and WOP forms

TAKE A LOOK AT THE AGENDA:

         1. Common reasons for denial

         2. Levels of appeal
                  a. Part A levels of appeal
                  b. Part B levels of appeal
                  c. Anticipated changes to the levels

         3. Managing the completion of critical forms
                  a. Appointment of Representative (AOR)
                  b. Waiver of Payment (WOP)

         4. Documentation to submit with an appeal

         5. How to write an appeal letter

         6. How to prepare for an Administrative Law Judge (ALJ) hearing

WHO SHOULD LISTEN:

Therapists across all healthcare settings, directors of rehab therapy, accounting staff, medical records staff, billing staff

MEET OUR EXPERTS:

Rick Gawenda, PT is currently Director of Physical Medicine and Rehabilitation at Detroit Receiving Hospital. He has worked in all areas of therapy within the hospital setting, and has worked in home health care for five years. Mr. Gawenda has provided valuable education and consulting to both hospitals and his peers in the areas of coding, billing, documentation, reimbursement, and the appeals process for denied Medicare claims. He is also the author of The How-To Manual for Rehab Documentation, recently published by HCPro.

Kate Wolske-Brewer, PT, GCS, MBA is the Director of Clinical Services and Program Development for Greenfield Rehabilitation Agency, Inc., which provides contract therapy services to skilled nursing facilities in and around Wisconsin. Mrs. Brewer has experience in a variety of practice settings including acute care, inpatient, outpatient, and skilled nursing facilities. Her areas of expertise include documentation, coding, billing and reimbursement for therapy services, denial management, administration and management, and clinical interventions for the geriatric client.

Victoria Groves (Moderator) is a managing editor at HCPro, Inc. She writes Briefings on Outpatient Rehab: Reimbursement and Regulations, a monthly newsletter for the outpatient rehab industry, as well as Rehab Regs, a free weekly ezine for inpatient and outpatient rehab facilities.

Program materials will be provided with PDF links.

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