Observation Services: Assign Proper Level of Care to Prevent Denials
Product Description:
AUDIO CONFERENCE ON CD OR ON-DEMAND
Sponsored by: Observation Services: A Guide to Compliant Level of Care Determinations, Third Edition
Presented on Wednesday, July 13, 2011
“Observation Service – I still don’t get it!”
CERTs, RACs, MACs and MICs are more active than ever in auditing the necessity of inpatient admission. Use this opportunity to analyze your organization’s processes and build a strong defense against risk.
During this two-hour audio conference, our expert speaker reviews level of care regulations, addresses medical necessity requirements, and discusses key elements of an effective appeals process. You'll walk away with proven strategies to use observation services appropriately, prevent denials, and reduce your audit risk.
This is a basic to intermediate level program.
At the end of the program you will be able to:
• Recognize key elements of CMS guidelines for determining level of care
• Describe the current CERT, RAC and MAC medical necessity initiatives
• Explain key elements of an effective Utilization Review process
• Develop an action plan to determine correct level of care
• Describe the key elements of an effective appeals process for admission necessity.
TAKE A LOOK AT THE AGENDA:
- Government audit initiatives for patient status
- OIG
- CERT
- RAC
- MAC
- MIC
- Requirements for physician orders
- Admission order wording
- Backdating
- Case management protocol
- Inpatient-only surgery list
- Inpatient medical necessity targets
- Necessity of admission
- Necessity of procedure
- Strategies for improvement and hospital compliance
- Tips/skills for effective Case Management communication
- UR committee and the Role of the Physician Advisor
- Condition code 44
- Provider Liable Claims
- The five levels of the appeals process
- A question and answer session follows the presentation.
CONTINUING EDUCATION
AAPC: This program has prior approval of the American Academy of Professional Coders for 2.0 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor.
AHIMA: This program has been approved for 2.0 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
MEET THE SPEAKER:
Deborah K. 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 Status: A Complete Guide to Compliant Level of Care Determinations,” from HCPro.
MATERIALS
In addition to the expertise and advice presented during this audio conference, you'll receive a slide presentation of the program materials and valuable takeaways, which you can use at your facility, including:
- Pocket cards for distinguishing between inpatient and outpatient level of care for both medical and surgical cases
- Sample observation newsletter
- UR form to document the process of physician advisor review
WHO SHOULD LISTEN?
Case management directors, case managers, UR nurses, revenue cycle managers, physicians, compliance officers, patient access staff, clinical documentation improvement specialists.
AUDIO ON-DEMAND
Purchase a CD or an audio on-demand of the audio conference 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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