Hospice Medical Review From a Medical Reviewer's Perspective
Presented by Annette Lee
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Hospice leadership and clinicians should have a thorough understanding of the Medicare medical review process to ensure compliant documentation. This course provides information that will encourage clinicians to document more completely and accurately and will help internal reviewers and leadership understand how to review and prepare records when they are requested by payers. This course is appropriate for nurses and administrators who provide hospice services.
Meet your instructor
Annette Lee
Annette is a registered nurse who has been practicing since 1990, with the majority of her nursing experience being in public health care. She has a master’s degree in health care administration. In 2000 she joined the home health intermediary Cahaba GBA, where she became an instructor, providing education to home health and…
Chapters & learning objectives
1. Who’s Calling, Please? How to Identify the CMS Contractors, and What They Expect
This chapter covers the variety of CMS contractors that may request access to hospice medical records and their methodology/triggers for audits. MACs, RACs, SMRCs, UPICs, OIG, and other contractors will be covered.
2. What Do They Want? What the Medical Reviewers Are Looking For
Chapter 2 describes the components for payment that are assembled as part of the documentation process for a Medical review, including Election, Certification, FTF, prognosis, POC updates, level of care, visit documentation, and medical history.
3. How to Succeed Upon Review
This chapter will cover how to clearly communicate the necessary components of payment in hospice to a reviewer. Strategies discussed in this chapter are how to order your documents, how to create a summary that assists in payment of the claim, and how to highlight documentation in the record while being compliant and not impacting the legibility of the documentation.
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