Medical Necessity for Emergency and Outpatient Services
Product Description:
Audio Conference on CD or Audio On-Demand
Sponsored by Medical Necessity Training Toolkit
presented on May 6, 2009
Manage medical necessity to improve reimbursement— focus on your outpatient departments.
Outpatient settings such as the emergency department (ED), same-day surgery (SDS), day treatment center (DTC), clinics and free-standing facilities generate the majority of medical necessity losses. Recent Recovery Audit Contractor (RAC) statistics indicate that denials related to medical necessity are the largest contributors to lost reimbursement. Inappropriate management of outpatient medical necessity is often the main reason. Learn how proper management can reduce loss enterprise wide.
The solution lies in an unlikely source: case management. Facilities that involve case management when patients reach your outpatient setting (ED, SDS, DTC, or clinic) are in a much better position to reduce denials, reduce compliance risk, and ensure proper financial reimbursement.
Listen to HCPro's audio conference Medical Necessity for Emergency and Outpatient Services: Understand the Regulations and Reduce Revenue Loss.. Speakers Barbara Aubry, RN, CPC, CHCQM, FAIHQ and Barbara Zellerino, RN, MHA, CPHQ show you how to adequately address medical necessity coding compliance in the ED and in outpatient services. You will learn the valuable role case management can play in an outpatient setting, as well as how to devise strategies to involve them in your processes. In addition, the speakers illustrate how the right software can make the difference between revenue you can keep and a reversed claim.
LEARNING OBJECTIVES
At the conclusion of this audio conference, you will be able to:
- List the steps to take to start recovering lost revenue in outpatient services related to medical necessity
- State the importance of initiating medical necessity checks in the ED and how it assists case managers when the patient is given a bed on the floor
- State the importance of doing medical necessity checks in outpatient settings
- Describe how to stay compliant with EMTALA regulations without losing revenue
- Describe what to look for to identify the need for outpatient case management at your facility
- Describe the functions of case management in the different outpatient settings
- Explain the value of improved documentation in the outpatient services
AGENDA:
- Compliance regulations
- EMTALA
- Medical Stabilizing Examination (MSE)
- Recovery Audit Contractor (RAC)
- Proper management of outpatient compliance
- ED
- Level A
- Level B
- Hospital ambulatory services
- Case management best practices in different outpatient settings
- Functions of case managers
- Expected outcomes
- How to get started
- Question and Answer session
BONUS TOOLS
In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and:
- Assessment tool to identify the need for case management in outpatient services
- List of potential Indicators for monitoring medical necessity and other case management activities in the ED and outpatient services
These materials are provided with PDF links.
MEET THE SPEAKERS
Barbara Aubry, RN, CPC, CHCQM, FAIHQ, is a regulatory analyst for 3M Health Information Systems. She is responsible for analyzing CMS and other payer rules and regulations and communicating that information to product development, continuous product improvement, marketing, and product development. Aubry is also in charge of creating and maintaining data for specific 3M software applications. Previously, she was utilization review manager at Holy Name Hospital, director of peer review and audit for a privately owned company, and manager of the department of utilization management for an East Coast HMO.
Barbara Zellerino, RN, HMA, CPHQ is a senior consultant with the consulting services business of 3M Health Information Systems. She has more than 20 years of quality and case management experience. In her current position, she consults with physician groups and hospital administration, HIM departments and Case Management/Utilization Review departments to implement effective documentation improvement programs, coding and data quality assurance, compliance audits, and performance management programs.
WHO SHOULD LISTEN?
Professionals employed by acute hospitals, ambulatory service centers, and level B/step down emergency facilities, including the following titles:
- VP of finance
- Compliance officer
- Director of case management
- Utilization review
- ED director
- Patient access director/manager
- PFS director/manager
- Revenue cycle/reimbursement professional
- ASC administrator
- Patient flow coordinator
- Quality director
AUDIO ON-DEMAND
In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase a CD or audio on-demand of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.
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