The key to audit preparedness is developing a daily process for complying with the Utilization Review (UR) Standards of Medicare’s Conditions of Participation. This session will provide you insight into key medical necessity rules and Medicare’s regulations that define inpatient vs. outpatient (with observation services) and tips for building a strong internal compliance process. It will examine how to create a UR process that proactively defends against Program Integrity Contractor medical necessity denials.
Following this session, participants should be able to:
• Discuss Medicare specific regulations defining hospital inpatient vs. hospital outpatient status. In addition, explain the compliance implications for the patient, physician and hospital.
• Better understand why it is so important to determine the appropriate admission status up front while the patient is still in the hospital.
• Discuss why observation status and one-day stays have become a major compliance issue and how hospitals lose significant revenue from overuse of observation, and expose the hospital to potential False Claims Act actions..
• Identify potential issues or gaps in their hospitals’ concurrent admission review process that may result in future denials by Program Integrity Contractors.
• Describe the keys to success for UR’s admission review screening process and physician documentation to support the admission determination.
Health Information Professionals, Coding Professionals for inpatient coding, CDI (Clinical Documentation Improvement) Professionals, Utilization Review Professionals, Case Managers, Medical Directors, Physicians, Revenue Cycle/Finance Professionals, and Hospital Leadership.
Continuing Education Units
This program has been approved for two continuing education
units for use in fulfilling the continuing education requirements of the
AHIMA's Commission on Certification of Health Informatics and Information
Management (CCHIIM). This program has prior approval
of the American Academy of Professional Coders (AAPC) for two continuing
education hours. Provider approved by the California Board of Registered
Nursing. Provider number is 05474 for two contact hours. Certificates of
attendance are provided for this webinar.
Clinical Documentation Management & External Forces.
Certificates of attendance are provided for this webinar, upon completion of
the event evaluation.
Event No. WEB033
Alternate Registration Form (PDF)