Documentation that Prevents Fraud and Abuse

Documentation that Prevents Fraud and Abuse 

The purpose of this course is to provide you with key information that will help you identify the critical role documentation plays in the care of the resident and the financial well-being of your agency. This documentation includes provision of services and fulfilling Medicare requirements, including the MDS 3.0 assessments. This course will also cover fraud and abuse in the Medicare system and how proper documentation can protect you and your agency from fraud and abuse claims.


Hours: 0.50


Certificates provided by accrediting body (0 Match)

Course Details

Course Code: REL-PAC-0-DPFA
Hours: 0.5
Type: Online Course
Content Expiration Date: 11/30/2024
Learning Objectives:
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

Learning Objectives

Section 2: Fraud and Abuse in the Medicare System

Cost of Fraud and Abuse

Governmental Agencies

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

Nutritional Approaches

Percent Intake by Artificial Route

Section M: Skin Conditions

MDS Corrections



Section 5: Conclusion


Course Contributor




Exam and BrainSparks

Instructor: 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.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.