Detailing Documentation: Applying Documentation Strategies for Audit Success

_{Program description}

The shift from volume to value of skilled therapy services creates new opportunities for occupational therapy practitioners to directly impact function, independence, and quality of life, but it also places occupational therapy services under increased scrutiny as payment systems and structures change and payers look to balance costs. For most occupational therapy practitioners, it is not a matter of if their documentation will be selected for audit, but when. Understanding what auditors are looking for, and how to prepare for and respond to an audit, will help occupational therapy practitioners develop documentation skills that support audit success.

_{Learning Objectives}

• Implement qualitative documentation strategies that support occupational therapy services within multiple payer models for successful audit outcomes
• Apply 2 documentation review strategies that help ensure medical records are audit ready
• Effectively utilize audit and appeal processes to address audit requests and denials.

Earn 1.5 Contact Hour

Speakers

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.

Becky Finni, DHS, OTR/L, RAC-CT, FAOTA

Becky Finni has been an OT for more than 20 years within the long-term-care setting, with 10 years appealing SNF therapy claims and providing education nationwide related to Medicare documentation, coding, billing, and reimbursement. She served three terms on the Ohio OT/PT/AT Licensure Board and now serves as President of the Ohio OT Association. She is an Assistant Professor within the MOT Program at Muskingum University and works as a consultant performing SNF documentation and billing audits.

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.

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.

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.