Course Code: REL-PAC-0-DPFA
Type: Online Course
Content Expiration Date: 11/30/2024
Discuss current fraud and abuse statistics affecting the Medicare system.
Explain the difference between fraud and abuse.
List the 5 areas that must be present to substantiate medical necessity.
Identify at least 4 processes the MDS can impact.
Identify at least 3 ways documentation should support MDS coding.
Section 1: Introduction
About This Course
Section 2: Fraud and Abuse in the Medicare System
Cost of Fraud and Abuse
Fraud and Abuse – So What’s The Difference?
Section 3: Documentation Guidelines
Establishment of Medical Necessity
Physician Certification and Recertification
Documenting the Plan of Care
Signatures Are Vital!
Boilerplating is a No-No!
Document With Reviewers in Mind
Documentation is a Team Effort
Section 4: MDS Documentation Best Practices
The MDS Impact
MDS Documentation Best Practices
Sections C and D: BIMS and Mood Scoring
Section G: Activities of Daily Living (ADLs)
Section GG: Functional Abilities and Goals
Section I: Active Diagnosis
Section K: Weight Loss
Percent Intake by Artificial Route
Section M: Skin Conditions
Section 5: Conclusion
Exam and BrainSparks
Ron Orth RN, CHC, CMAC, AHIMA-Approved ICD-10-CM Trainer
Ronald Orth, RN, CMAC, CHC obtained a nursing degree from Milwaukee Area Technical College in 1985 and a B. A. in Health Care Administration from Concordia University in 1996. Mr. Orth possesses over 30 years of nursing experience with over 20 of those in the Skilled Nursing industry. Mr. Orth has extensive experience in teaching Medicare regulations to healthcare providers both in the US and internationally. Mr. Orth is currently the Post-acute Care Curriculum Designer and is certified in Healthcare Compliance through the Compliance Certification Board (CCB). Ron has also successfully completed the Infection Control Officer training through the AHCA and is an AHIMA approved ICD-10-CM trainer.
Disclosure: Ron Orth RN, CHC, CMAC, AHIMA-Approved ICD-10-CM Trainer has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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