ASHI Webinar Documentation and Risk Management - From Medical Necessity to Clinical Appropriateness

Course overview

Hour One: Documentation and Compliance Overview, Rules and Regulations Recognize and avoid or correct behavior that is contrary to the rule of "no opt-out for chiropractors". Apply compliance rules set forth by governmental agencies that apply to providers of service to Federally insured patients. Demonstrate day-to-day application of guidance on Federal Program and state requirements for coding, billing, and finances. Differentiate between active and maintenance care, according to the official Medicare definitions and other third-party guidelines. Interpret the four types of risk the Office of Inspector General (HHS) expects providers to focus on with Policy and Procedure, per the OIG Guidance for Small Practices. Recognize the limitations of experimental, investigational, and unproven technologies. Hour Two: Documentation of Initial Visits-New Patients, New Episodes, and New Conditions Identify and apply concepts that differentiate types of initial visits, from new patients to updated episodes. Produce documentation of initial visits that comply with board requirements for chiropractors. Summarize documentation requirements as they apply to the new initial Evaluation and Management guidelines set forth January 1, 2021. Establish medical necessity for your care and know with surety that initial visit documentation is complete. Rank complicating factors and contraindications according to priority and include with initial assessment. Populate a required treatment plan for care, whether for short- or longer-term care. Hour Three: Documentation and Case Management for Routine Visits, Preventive Maintenance, and Wellness Care Differentiate between requirements for medically necessary services vs. maintenance which is self-pay. Apply primary subluxation vs secondary compensation logic to mitigate risk for the full-spine adjustment. Reproduce the key elements of routine chiropractic visits in documentation as set forth by third-party, State and Federal guidelines. Interpret functional data to determine stages and levels of care. Demonstrate the ability to implement therapeutic withdrawal and to document its results. Recognize maximum therapeutic benefit (MTB) and properly document discharge from active treatment. Hour Four: The Risks Associated Billing and Financial Compliance Regulations Give examples of billing and financial compliance that cross the line of False Claims Act and Anti-Kickback Statute violations. Apply billing and financial compliance regulations to the day-to-day operations of the practice, including payment and prepayment plans. Execute random auditing of charges and collections to meet OIG compliance guidelines. Recognize and apply the rules of offering financial hardship discounts. Produce advertising that falls within the guidelines of board and federal rules.