Meeting Payer Document Requirements When Submitting Health Information

• Overview

Make sure your documents are compliant when submitting health information in order to ensure maximized quality of care for your patients.According to section 1862(a)(1)(A) of the Social Security Act, Medicare will not cover services that "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." Private payers and Medicare Advantage plans have their definitions of medical necessity. Not only do you want to make sure your documentation is compliant so that you are protected from false claims, you want to maximize revenue and improve the quality of care that your patients receive. This material will review how these go hand-in-hand and what your staff can do to help improve your practice as well.

Authors

Agenda

Clinical Documentation Improvement

• Compliance

• Revenue

• Quality of Care

Payer Guidelines

• NCD/LMRP

• NCCI Edits

• ABN and Private Pay Patients

Putting It in Practice

• Front Desk

• Ancillary Staff

• Providers