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Moving Mountains: PDPM Triple Check Process and Billing Accuracy


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Moving Mountains: PDPM Triple Check Process and Billing Accuracy

Presentation Date: October 1, 2019 Live Webinar

Course Description:

This 1.25 hour webinar will review best practices to decrease potential billing errors and promote accurate reimbursement for PDPM claims through internal interdisciplinary auditing processes. Key roles of interdisciplinary team members in completion of a collaborative triple check process and key data collection, billing, and monitoring process pertinent to PDPM will be emphasized.

Learning Objectives
1. Review best practices for internal audit of PDPM claims prior to submission to decrease potential billing errors and promote accurate reimbursement
2. Identify key roles of the interdisciplinary team in completion of a collaborative triple check process of items/data elements impacting PDPM reimbursement
3. Review key data collection, billing and monitoring processes important to PDPM reimbursement accuracy including but not limited to understanding the updated HIPPS codes and validating UB-04 accuracy prior to submission.

Course Content
2:30 Updating internal billing accuracy processes to ensure validation of key PDPM reimbursement criteria

2:45 Roles and responsibilities of interdisciplinary team members in the triple check process
? Administrator, Business Office, Nursing, RAI Nurse Coordinator, Therapy, Medical Records

3:15 Understanding updated HIPPs codes
Key data validation, billing and monitoring processes
Compliance risks & using a QAPI framework to address them

3:30 Q&A
3:45 Closing Comments

Shelly Maffia, MSN, MBA, RN, LNHA, QCP, Director of Regulatory Services Shelly Maffia is a Registered Nurse and Nursing Home Administrator with over 15 years of experience serving in long term care leadership and consulting positions, including positions as Director of Nursing, Administrator, and Corporate Nurse Consultant and Training Positions. She earned the QAPI Certified Professional (QCP) credential from the American Association of Nurse Assessment Coordination (AANAC), which was established to promote the highest standards for QAPI program implementation in the long-term care profession.

Amie Martin, OTR/L, CHC, RAC-CT, Clinical Consultant
Amie Martin is an Occupational Therapist and Compliance Officer with over twenty years
of experience serving in long term care leadership positions and as a clinical program specialist. Amie is
certified in healthcare compliance. She has successfully partnered with providers to develop and implement
Compliance and Ethics Programs, achieve 5-star survey results, and ensure Medicare reimbursement accuracy as Founder and President of Proactive Medical Review Consulting.

Eleisha Wilkes, RN, RAC-CT
Eleisha Wilkes is a Registered Nurse and AANAC certified MDS consultant with over fifteen years of experience in long term care. She has served as a Director of Nursing, Case Manager and Resident Assessment Coordinator with extensive responsibility and success in driving QA in the areas of person centered assessment and care planning through effective systems, staff development, and interdisciplinary team collaboration. Eleisha specializes in Emergency Preparedness, MDS 3.0, reimbursement compliance, competency based staff education programs, SNF/NF survey readiness, and Phase 1-3 Requirements of Participation compliance.
Continuing Education Credit:

Administrators: can earn 1.25 hours of continuing education credit by the National Association of Boards of Examiners

Ohio Nurses: Nurses please note any continuing education that has been approved by NAB (or any other accredited body) can be accepted by the Ohio Board of Nursing in the State of Ohio. Nurses may use this continuing education to meet their licensure requirements. Please refer to OBN continuing education rules 4723-14-01 thru 4723-14-19.

Individual attendance will be monitored throughout the call.

Only those attending the entire call will be awarded continuing education credit. All participants regardless of need for CEUs, will receive a certificate of attendance. This course is considered a self-study course by Ohio BELTSS.

Administrators are reminded that BELTSS limits webinar credits to a total of ten (10.0) per renewal period.
How much does it cost?

Facilities will pay one low fee for an unlimited number of participants. However, the number and access code is valid only for one phone line/computer at the location registered with the Association. Any additional phone connections calling in will be billed the individual session registration fee.

Individual Session Fees: (prior to September 23)
Members: $55
Non Members: $130

Individual Session Fees: (September 23 and after)
Members: $75
Non Members: $175

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