Medicare Fundamentals Part 10: Medical Review and Appeals On-Demand Workshop
- Registration Closed
The SNF Medicare claims processing system is based largely on the honor system. A claim is submitted to the Medicare Administrative Contractor and is paid without the SNF first being asked for evidence that items on the bill occurred or met Medicare requirements for billing. Medical review is the process of reviewing a portion of claims to determine whether services provided were medically reasonable and necessary, as well as to follow up on the effectiveness of previous corrective actions. Following Medicare Fundamentals Part 10: Medical Review and Appeals, you will be able to describe the medical review process including what to do when a request for medical records comes in and how to proceed if the decision is not in the facility’s favor.
0.5 contact hour will be awarded for this continuing nursing education activity. Learners must view at least 80% of the entire video and complete the associated evaluation to receive the contact hours. No partial credit will be awarded. Contact hours will be awarded for this activity until February 3, 2026.
Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC
Curriculum Development Specialist
Jennifer is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the post-acute care arena since 1991 serving in a variety of capacities including CNA, charge nurse, MDS coordinator, and regional corporate clinical reimbursement specialist. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10, including the clinical and financial aspects.