Detailing Documentation: Documenting for Payer Compliance

_{Program description}

Reimbursement is a constantly evolving system with new and changing policies impacting how occupational therapy services are delivered and paid. Compliant documentation practices help support the integrity and accurate reimbursement of occupational therapy services. Failure to understand and document in accordance with payer and regulatory requirements can increase the risk for compliance audits, payment denials, and even legal issues. In this highly regulated environment, occupational therapy practitioners need to have a thorough understanding of documentation requirements for skilled occupational therapy services to ensure documentation is compliant and supports reimbursement.

_{Learning objectives}

• Understand key technical components required for documentation compliance within multiple payer models
• Apply understanding of key documentation requirements to document skilled delivery of occupational therapy services
• Locate and use payer resources to improve documentation compliance for accurate reimbursement

Earn 1.5 Contact Hour

Sponsored by

Speakers

Christine Kroll, OTR/L

Christine Kroll is an Assistant Professor and the Doctoral Capstone Coordinator in the School of Occupational Therapy at the University of Indianapolis, starting a career in academia after many years in post-acute care settings and upper management in a therapy company in the mid-west. Christine has been active in the healthcare industry as a clinician, leader, manager, and Medicare consultant for over 20 years specializing in long-term care, Medicare consulting, billing and developing outpatient services. She has held elected and volunteer leadership positions with the state and national occupational therapy associations and presented regionally and nationally on Medicare policy and health care reform.

Kelsey Berg, OTR/L

Kelsey Berg is a Clinical Operations Manager at Magellan Health, providing direct supervision and coordination of utilization management staff. She plays an active role in quality improvement, clinical training, and enhancing the medical necessity review process. With her clinical review and habilitative background, she partners with health plans and providers to achieve positive results and outcomes for their clinics and members. Kelsey graduated from St. Catherine University in St. Paul, Minnesota and has extensive training in pediatric feeding therapy, sensory integration, and social-emotional development. She is dedicated to advancing the occupational therapy profession and educating practitioners on providing and documenting skilled evidenced based care.

Regina Braswell, OTR/L

Regina Braswell is a Senior Manager of Provider Relations at Magellan Health, partnering with health plans and assisting providers to ensure quality care and patient safety. She is committed to leveraging her clinical review and habilitative practice experiences in providing maximum guidance on how to document medical necessity appropriately. Regina has been instrumental in developing educational resources with an emphasis on common trends in documentation and tips on supporting the need for therapy. Shortly after graduating from the University of Central Arkansas, Regina conducted research on Child Care Strategies for Individuals Who Are Blind. She was invited to present her work at AOTA National Conference where she shared her findings. Regina is enthusiastic about fostering best practices and skilled care to enhance the occupational therapy profession and ultimately improve patient outcomes.

Kim Karr OTR/L, RAC-CT, CPHQ

Kim Karr is an occupational therapist and certified professional in healthcare quality with 22 years’ experience in a variety of acute and post-acute care settings as well as 11 years successfully addressing therapy claim audits and denials. Kim has extensive experience educating on a variety of therapy-related topics including therapy coding, regulatory requirements, payment policy, and documenting. She currently works for AOTA’s Regulatory Affairs department as the manager for coding and payment policy.

Julie Lenhardt

Julie Lenhardt is the Manager of Reimbursement and Regulatory Policy for the American Occupational Therapy Association. She monitors payment policy across the spectrum of payers including Medicare Part B, commercial insurance, Medicare Advantage, and Medicaid and writes comment letters on health care policy issues that affect access to and payment for occupational therapy services, with a focus on private practice settings. In addition, Ms. Lenhardt participates in meetings with federal agencies including the Centers for Medicare and Medicaid Services (CMS) and commercial insurance companies and answers member questions concerning payment policies and interpretation of those policies. Ms. Lenhardt has worked on health policy issues including coding, documentation, and utilization management at the national level for the past 15 years and spent 10 years in billing and administration at the clinic level. She holds a BA in Biology from Randolph-Macon College and is currently working on her certification as a Managed Healthcare Professional from AHIP.