Provision of therapy services in SNF continues to be under intense scrutiny from CMS, its Contractors and the Office of Inspector General (OIG). The confusing start to the implementation of the MDS 3.0 and RUG IV in 2010 has continued over into 2012.

The change in practice patterns in the 2011 fiscal year prompted a warning from the OIG and more changes by CMS to ensure that therapy services were being provided, not just appropriately based on the needs of the patient, but also being paid at the rate of actual treatment provided and not at the projected amount generated by the existing PPS assessment schedule.

Staff are struggling to understand the modification that were introduced with the MDS 3.0, not only in the Final Rule in July 2011 but ongoing in the training sessions provided after it was published contradicting some of the published regulations. These more recent changes are included in the updated RAI Manual effective April 1st 2012.

This course includes such topics as; MDS 3.0 Assessments; RUGS IV payments, Case Mix Index and Index Maximization; what CMS determines is “skilled” therapy along with different treatment modes; how to clearly support the medical necessity of therapy services through both nursing and therapy documentation, assuring proper reimbursement, and the appropriate use of Restorative Nursing services.

Case studies and exercises will provide the participant with a fuller understanding of the regulations and their impact on reimbursement. With this knowledge the licensed professional is empowered to make decisions to assure Medicare compliance, quality of care and maximize legal reimbursement.

Program Highlights

1. MDS 3.0 ASSESSMENTS; COT, SOT, & EOT OMRAs and the rest, what the manual really says!

2. FACT vs. FICTION: Just how much do you REALLY KNOW about Medicare Part A?

3. RUGs IV: Determining appropriate RUG categories along with Index Maximization

4. DOCUMENTATION REQUIREMENTS: What you really need to make the reviewer happy.

5. DOCUMENTATION DIVIDE: How to get Nursing and Therapy on the same page

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