Short Stays: A Data Driven Approach to Medical Necessity
Product Description:
AUDIO CONFERENCE ON CD OR ON-DEMAND
Sponsored by Revenue Cycle Institute
Presented on Tuesday, April 5, 2011
With short stays it’s easy to take a reactive approach and apply condition code 44 to troublesome records. It’s better to take a proactive approach to accurately reflect true patient care and ensure compliance.
Join us for this 90-minute audio conference and learn how to take a data-driven approach to billing one-day and short stays. Our speakers will discuss how to set up a data dashboard so you can track high-risk cases. They will explain regulatory requirements, show how to use revised PEPPER reports, and provide case studies to demonstrate the right and wrong way to manage short stay billing.
Note: This is an intermediate-level program. Listeners should have a general familiarity of the utilization review process and an understanding of the different payer populations, such as commercial, Medicare, and Medicaid.
LEARNING OBJECTIVES
At the end of the program, you will be able to:
- Identify the applicable regulations and guidance regarding medical necessity
- Create a utilization management data dashboard to track potential compliance risks and recoupment vulnerabilities
- Select high-risk one-day/short stays for audit
- Describe an appropriate one-day inpatient admission and its components
THE AGENDA
- Data metrics
- Data dashboard setup
- Internal data
- Commercial vs. Medicare ratios
- Observation rates – medical/surgical cases
- High-risk audit cases – RAC focus areas
- External data: PEPPER
- New and revised report
- The comparison criteria
- Regulatory overview
- CMS guidance on medical necessity
- Criteria for appropriate use of observation services
- Case studies
- Appropriate one-day stays
- Chest pain
- Cardiac procedure
- Processes when medical necessity isn’t met – condition code 44
- A live question and answer session follows the presentation.
MEET THE SPEAKERS
Deborah Hale, CCS, CCDS, is president of Administrative Consultant Service, LLC, in Shawnee, OK, and has more than 30 years of experience in health care management including administration, health information management, clinical documentation improvement, resource outcome management and utilization review. She is the author of Observation Services: A Guide to Compliant Level of Care Determinations from HCPro, with the third edition due in April.
Ralph Wuebker, MD, MBA, is executive director of audit, compliance and education for Executive Health Resources (EHR), Newtown Square, PA. He is a member of EHR’s physician education and audit team and visit client hospitals to provide medical executives and staff members with ongoing education on a variety of topics including Medicare and Medicaid compliance and regulations, medical necessity, recovery audit contractors, utilization review, denials management and length of stay.
WHO SHOULD LISTEN?
Revenue cycle managers/reimbursement directors, compliance officers, RAC coordinators, physicians/physician advisors, case managers/directors and staff, utilization review staff, HIM managers/directors, CDI professionals.
BONUS MATERIAL INCLUDED IN YOUR MATERIAL PACKET
In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials as well as a sample data dashboard and an overview of new PEPPER report.AUDIO ON-DEMAND
In addition to the regular participation options for HC Pro 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. It's also a perfect training tool for new staff or as a refresher for veteran staff.
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