Clinician Episodes

(Although they may interest non-clinicians as well)

Outpatient Directed Episodes:

Radiology Orders

Emphasizes differences between hospital and non-hospital order requirements, safe harbors of test design and using protocols with radiology techs.

Therapy Certification

Discusses differences between orders and certifications and requirements for reviewing the plan of care.

ABN

Targeted at encouraging greater use of the ABN.  Why ABNs are necessary, what to do with screening tests, role of automated ABN software and when the physician’s office should obtain the ABN.

Non-Physician Supervision

Addresses the key points of the Medicare incident to rules driving home need to provide direct supervision and be involved when the patient has new issues.

Inpatient Directed Episodes:

Short Stays

Addresses documentation required for observation stays, how to record observation and how to document the necessity of inpatient admissions given admission screening criteria.

Investigational Devices

The different categories of devices are addressed as well as basics of coverage for the device and related items and services.

Physician-Provider Relationships

Overview of fraud and abuse basics, how to work better together by avoiding misunderstandings and the need for timesheets and patience in physician-provider arrangements.

 

Non-Clinician Episodes

Bad Debts

Basics of claiming Medicare bad debt including collection requirements, changes in bad debt policy and when to write off debt.

Government Exclusions

Why exclusions occur and how to work with compliance and legal quickly and efficiently to address billing and overpayment concerns.

Documentation

Provides some insight for educating physicians on improving documentation to reduce reimbursement risk but also improve quality.

Provider Based Rules

Explains the basic requirements for obtaining provider based status to bill Medicare for another site/program as part of the hospital.

Board Fraud and Abuse

Basics for board members on fraud and abuse rules and billing investigations and how to act prudently when working through tough issues.