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Part B Programming: Cultivating Positive Results

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:

  1. Disorganized charts and missing documentation
  2. Lack of significant change warranting consideration for therapy services
  3. Lack of functional outcomes being noted
  4. Lack of progress noted with justification of skilled need for care
  5. No discharge summary noted
  6. Missing and/or incorrect ICD-9 codes
  7. Incomplete/incorrect daily records of treatment
  8. No Physician signature
  9. Need for skilled service lacking in nursing notes 
In order to be successful in today's challenging operating environment, providers need to ensure that they are delivering quality care, optimizing reimbursement, and documenting services in a way that will stand up to audit scrutiny. Medicare Part B programs are an important part of clinical and financial outcomes, and require specific documentation practices and consistency in order to maintain compliance. For more information on how to cultivate a successful and profitable Medicare Part B program, contact our Sr. Vice President, Crista Stark at 410.667.7200 or via email at cstark@healthpro-rehab.com

Tags: nursing home operations, nursing home occupancy, medicare