MACtoberfest

Medical Review Updates

This session provides an overview of Palmetto GBA’s Medical Review program and discuss the Targeted Probe and Educate process, documentation expectations, responding to medical review calls for additional easily curable documentation, top denial reasons, and what Part A and Part B providers need to know when responding to an Additional Documentation Request (ADR).

On Demand

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Observation Care and Admission Decisions: Reducing Payer-Provider Friction

Presented by Dr. Rifkin and Debra Goodman

The clinical decision to admit a patient to inpatient care, or first try a stop in observation care, is one of the principal friction points between payers and providers; and is a central subject of audit reviews. This presentation describes the appropriate guidelines to follow to improve the structure and function of observation care. The most common diagnoses encountered in observation care are reviewed, with a few highlighted as being of particular importance in terms of payer-provider friction. Additionally, national database analyses are presented to support this discussion. Concrete next steps are described, for both payers and providers, that would decrease friction and ensure that patients are correctly evaluated for inpatient admission.

On Demand

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DME/HHH Guidance for Ordering Providers

When a physician makes a referral, it is important that medical necessity and other eligibility requirements are met. A proper referral is crucial to ensuring the appropriate beneficiary is referred to the appropriate service. This presentation will focus proper documentation when referring beneficiaries to Home health, hospice and DME services.

On Demand

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Hyperbaric Oxygen Therapy (HBO)

Presented by Sandra Booker

The Hyperbaric Oxygen Therapy (HBO) session is intended for Medicare Part A providers and will cover HBO requirements, documentation requirements, documentation errors, Wagner Grade requirements, medical necessity and more. Please join us for this informative educational session on HBO.

On Demand

Medical Review Updates

This session provides an overview of Palmetto GBA’s Medical Review program and discuss the Targeted Probe and Educate process, documentation expectations, responding to medical review calls for additional easily curable documentation, top denial reasons, and what Part A and Part B providers need to know when responding to an Additional Documentation Request (ADR).

On Demand

____________________

Observation Care and Admission Decisions: Reducing Payer-Provider Friction

Presented by Dr. Rifkin and Debra Goodman

The clinical decision to admit a patient to inpatient care, or first try a stop in observation care, is one of the principal friction points between payers and providers; and is a central subject of audit reviews. This presentation describes the appropriate guidelines to follow to improve the structure and function of observation care. The most common diagnoses encountered in observation care are reviewed, with a few highlighted as being of particular importance in terms of payer-provider friction. Additionally, national database analyses are presented to support this discussion. Concrete next steps are described, for both payers and providers, that would decrease friction and ensure that patients are correctly evaluated for inpatient admission.

On Demand

____________________

DME/HHH Guidance for Ordering Providers

When a physician makes a referral, it is important that medical necessity and other eligibility requirements are met. A proper referral is crucial to ensuring the appropriate beneficiary is referred to the appropriate service. This presentation will focus proper documentation when referring beneficiaries to home health, hospice and DME services.

On Demand

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Did You Know?

Everyone is busy and we understand that. Join us as we explore many of the tools available to reduce the time you spend on the phone or searching for things you need to submit and work your Medicare claims. During this session, Palmetto GBA will also share tips and reminders for accessing and using Palmetto GBA resources and staying up-to-date on Medicare rules and regulations.

This session will be of interest to coders, billers, office managers and supervisors, front desk staff and those working remittance advice after claims has been submitted. There will be a period for question at the end of this session. We encourage you to make a list of the tools you and your associates currently use in the hope that following this session, you will have identified new tools to add to your Medicare toolbox.  

On Demand

Quarterly Medicare Updates

Presented by Areka Freeman

This 45-minute webcast is designed to provide pertinent updates, changes and reminders to assist the provider community in staying compliant with Medicare rules and regulations and will include:

• Medicare Learning Network’s Medicare Quarterly Compliance Newsletter
• Medicare Learning Networks (MLN)
• Comprehensive Error Rate Testing (CERT)
• Claims Payment Issue Log (CPIL)

On Demand

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Let's Avoid Claim Overlaps

Presented by Charles Canaan and Areka Freeman

A claim overlap occurs when an incorrect claim submitted by the same or a different provider is processed which will causes problems with provider reimbursement. This webinar is for Inpatient Psychiatric Hospitals, Hospitals Outpatient Services, Skilled Nursing Facilities, Home Health Agencies, Hospice Agencies, Long Term Care Hospitals, Outpatient Rehabilitation Facilities, Inpatient Rehabilitation Facilities, and End Stage Renal Disease providers to teach providers and their billing staff how to avoid a claim overlap situation.

On Demand

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Jurisdictions J and M Appeals Overview

11:30 a.m. –12:30 p.m. ET

This session will provide a general overview of the appeal process, with helpful reminders to assist the provider community in understand the levels of appeals, to include the details of requesting a redetermination. This session will be of interest to Part A and B providers, facilities, compliance officers, billers, office managers, supervisors and their staff that review claim denials for the possible submission of a Medicare claim appeal. Providers that use outsource agencies to submit their appeals are encouraged to share the opportunity for those agencies to register and attend this session.

On Demand

Timely Topics

Join the Palmetto GBA Part B team as we review a variety of pertinent Medicare topics. This session will highlight the Ambulance Prior Authorization Program, the Outpatient Prior Authorization Program from a Part B perspective, Appropriate Use Criteria, Cognitive Assessment, Palmetto GBA’s Partnering for Prevention Initiative and more. 

On Demand

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Jurisdictions J and M Appeals Overview

This session will provide a general overview of the appeal process, with helpful reminders to assist the provider community in understand the levels of appeals, to include the details of requesting a redetermination. This session will be of interest to Part A and B providers, facilities, compliance officers, billers, office managers, supervisors and their staff that review claim denials for the possible submission of a Medicare claim appeal. Providers that use outsource agencies to submit their appeals are encouraged to share the opportunity for those agencies to register and attend this session

On Demand