Successful Medical Claim Resolution: A PDPM Review and Denial Trend Analysis

Course overview

Skilled Nursing Facilities (SNF) have entered the fifth year since the implementation of the Patient Driven Payment Model (PDPM). Within the last five years the healthcare system has also faced an unprecedented public health emergency (PHE) which sent regulatory waves through the post-acute industry including a pause in the claims review process and allowing for the use of waivers for qualifying stay determinations for Medicare A beneficiaries. As normality has returned to the industry, the Centers for Medicare and Medicaid (CMS) claims review process is fully in swing requiring all SNFs in the nation to receive, at minimum, a five-claim probe, and other review entities have implemented separate reviews. Based on trend analysis this course details best practice system processes and response methodology to improve medical review outcomes and promote technical and clinical accuracy in submitted claims.