Fraud & Abuse Annual Compliance Training for Therapy Practices
An essential part of any compliance plan is an annual risk assessment, and an outshoot of that is annual education for all employees on fraud and abuse. Our fraud & abuse course follows the OIG recommended educational guidelines, and relates rehab case studies to draw in staff to a deeper understanding of how to detect, correct and prevent activities that have the potential to be considered fraud & abuse. Additionally we offer four mini-courses (15 minutes) each on high risk areas associated with documentation, coding and billing targeted to therapy staff and billers.
How to Survive A Medicare Audit
Is your documentation system effective? Do your forms facilitate and guide practice by prompting the therapist toward compliant documentation? Is there a “go to” person at your facility that understands the Medicare regulations and serves as a facility resource? Do you regularly assess risk and establish monitoring and auditing programs to ensure compliance with regulatory and internal policies? Are claims checked prior to submission to ensure documentation supports what was billed? In reviews of therapy services, CMS has consistently presented statistics that indicate non-compliance rates exceeding 90%. This seminar will assist outpatient rehab providers in all practice settings in understanding their potential ‘error’ rates should they come under focused medical review or a probe audit.
ABC’s of Medicare Documentation
Medicare overhauled the therapy documentation requirements in 2006 at the time that regulations for the therapy caps exception process were published. Some regulations were updated, some were clarified, and new regulations were added. Additionally there is an increasingly likelihood that rehab providers will be selected for claims review, either from a medical records process (review the chart) or a claims-based process (electronic review of edits, codes, and the therapy caps). This basic course reviews the current Medicare documentation requirements, including a step-by-step breakdown of these requirements. The basics of ICD-9 coding are reviewed, and a more detailed review of the CPT-4 procedures codes is undertaken. Full Course Details-
Medicare Compliance for the Private Practice
Does your clinic have a Code of Conduct? Do your employees know what to do if you are served a search warrant for medical and/or financial records? Do you regularly assess risk and establish monitoring and auditing programs to ensure compliance with regulatory and internal policies? The Office of the Inspector General of the Department of Health and Human Services (OIG) has issued “guidances” for effective corporate compliance, and suggests the use of the Compliance Guidance for Physicians for other small providers including rehab. The OIG has also published several rehab fraud cases involving outpatient providers over the past 10 years, with two cases having been published within the last year.
Functional Limitation Reporting to Meet Medicare Requirements
CMS has requiring functional limitation effective July 1, 2013. Since that time claims that are submitted without the required G-codes (signifying functional limitation category for current and goal status) and the identified impairment/severity modifiers will be rejected and not paid. This course is completed as a customized webinar for your practice and pricing includes additional consulting to address implementation and compliance issues. Up to date information and documentation requirements from Medicare will be reviewed, as well as sample case studies for both clinical evaluation and establishment of functional long term goals and assessment tools necessary for the establishment of current and project impairment ratings. Sample claims reporting scenarios for both CMS 1500 and the UB04 will be demonstrated.
Special circumstances for reporting will be covered including: reporting on more than one functional limitation; multiple disciplines reporting on functional limitation on the same claim, reporting functional limitation on evaluation only patients, reporting functional limitation when the patient has self discharged, and unique scenarios involving hospital outpatients including observation and Part B only patients. Call for scheduling and pricing – affordable as well as informational.