Provision of therapy services in Skilled Nursing Facilities is under scrutiny from CMS and its Contractors, as well as being in the Office of Inspector General’s Work Book for 2011. The confusing start to the implementation of the MDS 3.0 and RUG IV, reminded those of us who were around in 1999 of “déjà vu” all over again. Therapists and nursing staff are struggling to understand the changes that were initiated in October 2010 and are still being updated.

This 2 day highly interactive program will provide participants with a thorough understanding of Medicare rules and regulations that influence the delivery of rehabilitation services within the skilled nursing facility for both Parts A and B.

MDS 3.0 introduced several new assessments along with changes in the way that therapy services are delivered and captured to create the RUG level. A thorough understanding of the makeup of the RUG IV system is essential to obtain the maximum legal reimbursement the facility is eligible for based on both therapy and nursing services. Significant changes have occurred over the last few years in the regulations concerning provision of Part B services and therapists still lack a thorough understanding of those changes.

This course includes such topics as; The new MDS 3.0 and RUGS IV regulations along with appropriate use of Restorative Nursing services; identifying the medical necessity of Medicare services; documenting both nursing and therapy services to assure reimbursement; what is “skilled” therapy and use of individual vs. concurrent vs. group care; utilization and supervision of non-therapist staff; differences in required documentation for Parts A and B; RACs, MACs, ZPICs and CERTs and Medical Review along with the top reasons for denials and the solutions to help fix the problems.

Case studies and documentation exercises will provide the participant with fuller understanding of the regulations and their impact on reimbursement. It sets straight many long standing misconceptions of “Medicare Rules”.