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Hospice Medical Review From a Medical Reviewer's Perspective

presented by Annette Lee, RN, MS, HCS-D, COS-C

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Target Audience:

Disclosure Statement:

Financial: Annette Lee receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Nonfinancial: Annette Lee has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

Accreditation Check:
Video Runtime: 46 Minutes; Learning Assessment Time: 29 Minutes

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, RN, MS, HCS-D, COS-C

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 hospice providers…

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Chapters & Learning Objectives

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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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