Documentation that Prevents Fraud and Abuse

Course Code: REL-PAC-0-DPFA

Hours: 0.5

Type: Online Course

Content Expiration Date: 12/31/2024

Learning Objectives:
Discuss current fraud and abuse statistics affecting the Medicare system.
Explain the difference between fraud and abuse.
List the 5 areas that must be present to substantiate medical necessity.
Identify at least 4 processes the MDS can impact.
Identify at least 3 ways documentation should support MDS coding.

Outline:
Section 1: Introduction

About This Course

Learning Objectives

Section 2: Fraud and Abuse in the Medicare System

Cost of Fraud and Abuse

Governmental Agencies

Fraud and Abuse – So What’s The Difference?

Review

Summary

Section 3: Documentation Guidelines

Establishment of Medical Necessity

Physician Certification and Recertification

Documenting the Plan of Care

Signatures Are Vital!

Boilerplating is a No-No!

Document With Reviewers in Mind

Documentation is a Team Effort

Review

Summary

Section 4: MDS Documentation Best Practices

The MDS Impact

MDS Documentation Best Practices

Sections C and D: BIMS and Mood Scoring

Section G: Activities of Daily Living (ADLs)

Section GG: Functional Abilities and Goals

Section I: Active Diagnosis

Section K: Weight Loss

Nutritional Approaches

Percent Intake by Artificial Route

Section M: Skin Conditions

MDS Corrections

Review

Summary

Section 5: Conclusion

Summary

Course Contributor

Resources

References

Congratulations!

Exam and BrainSparks

Instructor: Ron Orth RN, CHC, CMAC

Ron Orth obtained a nursing degree from Milwaukee Area Technical College in 1985 and a B. A. in Health Care Administration from Concordia University in 1996. Mr. Orth possesses over 30 years of nursing experience with over 20 of those in the Skilled Nursing industry. Mr. Orth has extensive experience in teaching Medicare regulations to healthcare providers both in the US and internationally. Mr. Orth is currently the Director of Curriculum Design for Post-acute Care at Relias. Ron is certified in Healthcare Compliance through the Compliance Certification Board (CCB). Ron has also successfully completed the Infection Control Officer training through the AHCA.

Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.

Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.

Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.