If you work with provider claims, then you have probably heard the phrase, “If it isn’t documented, it wasn’t done.” The importance of quality documentation in the medical record cannot be overstated. It protects patient safety, and coordination of care between providers and across the healthcare continuum.
Correctly coded claims will ensure appropriate payment and reduce denials of claims and protect the provider against accusation of fraud and abuse. It involves the inclusion of complete, accurate details of each encounter to support the integrity of the claim and proper reimbursement from federal and other third-party payers.
MHL, CMC, CMIS, CMOM, CMCO
Jan Hailey has more than 20 years of experience in healthcare with proficiency in administration, coding, and billing roles. She joined Saint Joseph Physician Network located in Mishawaka, IN as the Director of Quality in November 2015. In 2019, her role transitioned into Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. This transition allowed for her expertise to expand beyond the physician network to lead a comprehensive interdisciplinary team across the health system and work closely with providers, management, staff, community and payers to develop strategies on process improvement, gap closures and patient experience.
Jan also developed a documentation improvement program and is currently implementing an education program for Hierarchical Condition Category (HCC) coding in order to improve risk scores. She holds four professional certifications in office management, coding, and compliance. She is a member of WPS Medicare’s Provider Outreach and Advisory Group, Indiana Association for Healthcare Quality.
Jan has a passion for teaching and facilitates educational programs nationwide. Prior to joining Saint Joseph, Jan was the Director of Quality, Coding and Compliance for one of the largest health systems in Northern Indiana.
This training session will inform you of what you need to know about the importance of quality documentation in medical records.
The False Claims Act imposes liability on any person who submits a claim to the federal government that he or she knows (or should know) is false. Yet, incomplete/incorrect claims continue to be flagged in audits for everything from missing documentation to support medical necessity, missing order, inadequate documentation.
A Medicare Fee-for-Service Supplemental Improper payment Data report found 74.1% of the Part B improper payments were due to missing/inadequate documentation meaning something was incomplete or missing from the documentation submitted with a claim. Learn how to address and correct the top root causes identified for inadequate documentation:
Self-paced online program includes unlimited review of previously recorded instruction and the downloadable PowerPoint handout for 6 months.