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, CMCO, CMIS, CMOM
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.
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.