Medicare Fundamentals Part 2: Medical Appropriateness Exception and Administrative Presumption of Care On-Demand Workshop

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Does the facility have a resident who is non-weight bearing on admission and will not need skilled therapy until the 30-day transfer rule has passed? Or perhaps there is a new admission coming in that the team is not quite sure will meet daily skilled clinical requirements. Can these cases be covered under Medicare Part A? During Medicare Fundamentals Part 2: Medical Appropriateness Exception and Administrative Presumption, you will take a deeper dive into two frequently misunderstood exceptions to the Medicare program requirements: the Medicare appropriateness exception, which allows skilled Medicare coverage to begin more than 30 days after the qualifying hospital stay; and the administrative presumption of coverage, which is the only guaranteed Medicare Part A coverage available in the SNF. This session will also help you understand when and how these exceptions can be used.

Jennifer LaBay RN, RAC-MT, RAC-MTA, CRC

Curriculum Development Specialist


Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, is a curriculum development specialist with AAPACN. She has been involved in the RAI process since 1997 and has been in the long-term care industry since 1991 serving in a variety of capacities including laundry aid, certified nursing assistant, charge nurse, nurse assessment coordinator, regional corporate clinical reimbursement specialist, and independent clinical reimbursement consultant. Jennifer has been a Master Teacher for AAPACN’s RAC-CT program since July 2011 and AAPACN's RAC-CTA advanced certification since 2019. She has been a Certified Risk Coder (CRC) through the American Academy of Professional Coders (AAPC) since 2020. Jennifer has considerable expertise in the MDS 3.0 and RAI process, the prospective payment system (PPS), and ICD-10 coding including the clinical and financial aspects. She has a knack for making her seminars an enjoyable learning experience and readily makes herself available to all attendees of her programs for any follow-up questions that may arise long after the seminar is complete.

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