Skilled Nursing Facilities continue to face ongoing scrutiny of PDPM claims from both Medicare and Managed Care organizations. As audit activity continues, providers are seeing a wide range of denial reasons and documentation challenges that can impact whether PDPM coding withstands review.
Here’s another round of interactive PDPM case studies and together we will work through a new set of real-world scenarios based on actual denials and appeal outcomes. Throughout the session, participants will have the opportunity to review key information from the patient record, evaluate whether the documentation supports the coding, and consider whether the claim would withstand audit review.
We will then reveal the actual outcomes of these cases and discuss the documentation and clinical factors that influenced the final decision. Along the way, we will highlight lessons learned from recent audits and relevant RAI Manual updates that may impact how similar claims are supported in the future.
