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