Observation Services v. Inpatient Admission
Product Description:
AUDIO ON CD OR ON-DEMAND
Sponsored by Observation Status, Second Edition
With conflicting information about admission necessity and observation services, and Medicare Administrative Contractors (MACs) and RACs poised to audit on medical necessity grounds, hospitals need a solid process to determine the appropriate level of care and defend their determinations.
During this two-hour audio conference, you will learn strategies to prevent medical necessity denials, including how to develop a strong utilization management process with a focus on the role of the physician advisor. Speakers Deborah Hale and Dr. Gregory Palega will discuss the utilization review committee, explain proper use of condition code 44, and provide tips to get the most out of your physician advisor.
At the end of the program, you will be able to:
- Recognize key elements of a compliant utilization management process
- Describe the current RAC medical necessity initiatives
- Explain key elements of the physician advisor review responsibilities
- Develop an action plan to determine correct level of care
- Identify 2011 proposed changes to observation regulations and reimbursement
TAKE A LOOK AT THE AGENDA
- RAC and MAC challenges
- Requirements for physician orders
- Inpatient medical necessity targets
- Hospital initiatives to address challenges and the truth about
- Condition Code 44
- The case management protocol
- Provider liable claims (bill type 12X)
- Inpatient-only surgery list
- Utilization review committee
- Role of the physician advisor
- Case studies
- Making a clinical judgement
- Tips to communicate with the provider of record
- Documenting the review and notifying the patient
A question and answer session follows the presentation.
MEET THE SPEAKERS
Deborah K. Hale, CCS, CCDS, is president of Administrative Consultant Service, LLC (ACS), in Shawnee, OK. She has more than 30 years of experience in health care management including administration, health information management, clinical documentation improvement, case management and utilization review.
Gregory Palega, MD, JD, practices medicine in North Carolina and serves as a physician advisor for MedManagement in Birmingham, AL. He has expertise in corporate compliance and health law regulations.
YOUR MATERIALS PACKET
In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and tools. These materials are provided with PDF links.
WHO SHOULD LISTEN?
Case managers and directors, utilization review nurses, revenue cycle managers, HIM managers and directors, physicians, physician advisors, medical staff leadership, and compliance officers.AUDIO ON-DEMAND
In addition to the regular participation options for HCPro audio conferences—live, CD, or combination packages—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.
PROGRAM MATERIALS
Program materials are provided with PDF links. the conference.Product Types : Departments :
