Join us on April 5 beginning at 1 p.m. for this 90-minute audio conference and learn how to take a data-driven approach to billing one-day and short stays. Our speakers will discuss how to set up a data dashboard so you can track high-risk cases. They will explain regulatory requirements, show how to use revised PEPPER reports, and provide case studies to demonstrate the right and wrong way to manage short stay billing.

Note: This is an intermediate-level program. Participants should have a general familiarity of the utilization review process and an understanding of the different payer populations, such as commercial, Medicare, and Medicaid.

Learning Objectives

• Identify the applicable regulations and guidance regarding medical necessity
• Create a utilization management data dashboard to track potential compliance risks and recoupment vulnerabilities
• Select high-risk one-day/short stays for audit

Describe an appropriate one-day inpatient admission and its components

Agenda

• Data metrics
  • Data dashboard setup
  • Internal data
  • External data: PEPPER
• Regulatory overview
  • CMS guidance on medical necessity
  • Criteria for appropriate use of observation services
• Case studies
  • Appropriate one-day stays
  • Chest pain
  • Cardiac procedure
• Processes when medical necessity isn’t met – condition code 44
• A live question and answer session will follow the presentation.

To see the complete agenda and to register, click here.

Speakers