Recovery Audit Contractor Defense: Manage Medical Necessity
Product Description:
Join industry experts, Robert R. Corrato, MD, MBA, Patricia Blaisdell, and Tanja Twist, MBA/HCM to discover how the demonstration program looked at many areas involving medical necessity. The faculty will show you from all sides of the revenue cycle how mastering medical necessity is a must in order to be truly RAC ready.
Session Overview:
During the demonstration project, RACs focused heavily on medical necessity issues. During this session our speakers provide:
- Ways to integrate case management or install an admitting case manager
- Tips to review physician orders for medical necessity
- Ways to set up criteria in the emergency department
- Steps to ensure criteria are met for one-day stays and observation
- Strategies to properly use the Medicare Secondary Payer Questionnaire
- Ways to identify data mining opportunities to determine risk areas
- Components of rehab medical necessity
- Frequent errors/vulnerabilities in documenting medical necessity for rehab
- Implications of RAC for rehab services admissions and documentation
- Tips to optimize the role of case management and physician advisors
Bonus Resources Include:
- Two EHR client bulletins on Kyphoplasty investigations
RAC Ready & Compliant
HCPro, Inc. has determined this program meets one or more of the following criteria:- The main topic contains substantive information about a RAC-identified error
- The program will help you in your appeals preparation
- The program will help you operationalize your RAC strategy/process
About the faculty:
PATRICIA BLAISDELL is vice president for postacute care services with the California Hospital Association. She provides membership support and advocacy for hospital-based medical rehabilitation and skilled nursing facilities, including policy analysis and interpretation, communication with regulatory bodies and third-party payers, and planning and implementation of educational programs.
ROBERT R. CORRATO, MD, MBA, as founder of EHR in 1997, he has president and chief executive officer. Prior to founding EHR, he held the post of deputy director of the office of health policy and clinical outcomes at Thomas Jefferson University, Philadelphia, Pa. An internist with extensive outpatient, inpatient, academic and community-based clinical practice experience, he is one of only six physicians in the U.S. to have completed medical fellowship training in managed care/administrative medicine. He often serves as a featured speaker at healthcare industry events, has been published in leading healthcare journals, including the Journal of the American Medical Association, sits on the editorial boards of numerous healthcare publications, and has served as a peer reviewer for the Annals of Internal Medicine.
TANJA TWIST, MBA/HCM, is director of patient financial services at Methodist Hospital of Southern California in Arcadia. In her current position she is responsible for oversight of the admitting and business offices at Methodist Hospital, a 460-bed, not-for-profit hospital serving the central San Gabriel Valley in California. She has been in healthcare management for more than 20 years and is the current national finance chairperson for the American Association of Healthcare Administrative Management (AAHAM), the government relations chairperson for the Southern California chapter of AAHAM, and a current member of the Healthcare Financial Management Association (HFMA). She also sits on the advisory board of HCPro, Inc.’s The RAC Report.
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