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Coders are taught very strict guidance and rules of code selection look-up, proper order of selection, and linking codes correctly, but the art of abstracting medical necessity from the documentation is often-times not taught until one reaches the world of auditing. This creates problems in that coders typically assign the codes prior to claim submission which may mean that medical necessity is not evaluated. During this session, we will explore this difference and how to ensure that medical necessity can be extrapolated through all areas of coding and auditing.<br><br>In this session, Our expert speaker Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT will define medical necessity, outline the fundamentals along with the myths and misconceptions of medical necessity, and provide attendees with take away steps of how to ensure proper development and implementation of these concepts within their own team.<br><br>Areas Covered In The Session:<br><br>Define the roles and duties of the coder according to noted resources<br>Define the roles and duties of the auditor according to noted resources<br>Define medical necessity –<br>(1) What is the role of medical necessity?<br>(2) How can a non-clinician auditor validate the clinician?<br>(3) Myths and misconceptions associated with medical necessity.<br>The fundamentals of medical necessity for coders –<br>(1) Why is this necessary?<br>(2) Why don’t they know?<br>Transferring medical necessity into the next phases in the ever-changing healthcare horizon
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SkillAcquire PERFORM REGULAR AUDITS You provide routine maintenance for your car- but what about your documentation? Live Webinar CODING vs AUDITING Does it all boil down to Medical Necessity? EDUCATE WISELY Be sure and discern the difference between someone’s opinion and the actual rules! SHANNON O. DeCONDA CPC, CPC-I, CPMA, CEMC, CMPM, CMSCS PRESIDENT OF NAMAS PARTNER IN DOCTORSMANAGEMENT 1
WE KNOW HOW TO HELP YOU DOCUMENTATION PITFALLS EMR costs so much money, and by your recent audit findings it appears your documentation is no better- how can that be? MEDICAL NECESSITY What are carriers looking for when it comes to medical necessity, and what concerns should you have over who is reviewing it? COMPLEXITY OF CARE IN YOUR DOCUMENTATION Small changes that can make a HUGE difference in your average everyday office notes CONSIDER THESE NEXT… Making changes to other areas of your documentation and billing practices may be necessary too. We will consider these topics and potential concerns 2
Defensive Coding Skills What exposed risk does your documentation have? Malpractice, misconduct, negligence, AND fraud & abuse $73.00 per encounter What is the risk? $2,336.00 per day Put all others aside and access fraud & abuse At 32 PPD: Risk? False Claims Act Triple the claim amount Penalties up to $11,000 per claim $25,000 penalty 5 years in jail $40,258.00 (plus potential jail) FCA Liability? 3
Why is Defensive Coding Needed? three variations of the documentation THE AUDITOR complexity of care documented THE CODER documentation content THE PHYSICIAN work involved Value is emphasized in the “work” involved with the patient encounter Value is emphasized on documentation content alone Assessment of the work and the documentation combined 4
Read more about the webinar Medicare even says the provider should “paint a portrait” of the patient through their documentation Complications with medical necessity arrive when providers insist that it should be “assumed” that a test “should have been ordered” Auditors are NOT allowed to assume or interpret. Provider of care Is tasked with connecting the dots between the documentation requirements and complexity of care to meet the medical necessity 5
