The development of a strong Part B program can not only benefit the functional abilities of patients, but is also a critical component of optimizing reimbursement and creating downstream revenue opportunities. A focused Part B program impacts a patient's ability to maintain the highest functional level, while also assisting to decrease medical complications. This cultivates positive clinical outcomes, which can also translate into a positive impact to your bottom line.
Benefits of Part B & Outpatient Programming:
*Coordination of care throughout the disease management process promotes optimal functional independence, measurable progress, enhanced quality of life, and helps individuals age in place.
* Coordination with home care and other community resources promotes continuity of care and helps to stabilize occupancy.
Compliance & Part B Reimbursement:
Medical Necessity" is "THE" hot topic as a result of the increase in pre-payment and post-payment audits being conducted by Medicare and third party payers. Given that Medicare Part B documentation requirements are more stringent that other payers, qualifying residents for this care and appropriately documenting progress that includes medical necessity is critical.
Below is a list of the top reasons for denials which stem from inadequate documentation of medical necessity:
- Disorganized charts and missing documentation
- Lack of significant change warranting consideration for therapy services
- Lack of functional outcomes being noted
- Lack of progress noted with justification of skilled need for care
- No discharge summary noted
- Missing and/or incorrect ICD-9 codes
- Incomplete/incorrect daily records of treatment
- No Physician signature
- Need for skilled service lacking in nursing notes