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NW - Medicare Documentation - Advance Beneficiary Notice Disease Management & Episodes of Care
This will be a live virtual event offered during NW 2022 Regional - Virtual Event
Medicare’s Advance Beneficiary Notice of Non-coverage (ABN) requires the chiropractic physician to know when a Medicare beneficiary’s treatments of spinal manipulations is no longer covered due to lack of Medical Necessity, as defined by Medicare. This class will revisit and review the Medicare criteria on Medical Necessity, required documentation and clinical judgements needed to determine and document the difference between Active and Maintenance care, based on a clear understanding of Episodes of Care.
Target Audience
Doctor of Chiropractic
Certified Chiropractic Physician's Assistant
Learning Objectives
- Differentiate the difference between Active and Maintenance Care as defined by Medicare.
- Recognize the characteristics of a new Episode of Care necessitating Initial Visit documentation.
- Recall and implement any necessary modifications in executing the ABN form when appropriate.
- Discuss the clinical applications of applying the Medicare model of active and maintenance care in the treatment of all patients, affecting better disease management.
Speaker:
Mollie Frawley, RN
Mollie Frawley currently works with the Florida Chiropractic Association as Insurance Liaison Coordinator providing FCA members information on regulatory, insurance and general business issues. A Registered Nurse and a legal nurse consultant, she is also a diplomate of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) and is a Certified Case manager (CCM). Ms. Frawley worked 9 years as a hospital clinical nurse, 16 years for the State of Florida in Medicaid, Corrections and Workers’ Compensation, 10 years as an independent consultant with her own business, and 3 years as a telephonic case manager handling litigated workers’ compensation cases. Her career has included thirty years of medical record review, health care monitoring and fraud and abuse investigations and 18 years of professional speaking including the development of nursing and medical continuing education programs. These experiences have included consulting, expert witnessing, developing administrative rules, assisting InterQual in developing the initial quality and utilization review program for Corrections, organizing and implementing a utilization and peer review program for the Division of Workers’ Compensation, identifying data queries to red-flag inappropriate billing practices and creating internal processes to identify, document, and track activity in order to monitor and analyze outcomes. As a volunteer, she has served on 2 fraud task forces assisting in creating a wallcard of “red flags” for identifying potential fraud, has participated on her certification board’s committee that prepared and reviewed test questions under the oversight of the National Board of Medical Examiners, has served as a Florida Supreme Court certified County Mediator in Leon and Gadsden Counties’ Small Claims Courts promoting alternative dispute resolutions and as a member of the Corrections Medical Authority’s Quality Management Committee. Her nonprofessional organizational interests include various fund raising activities for local nonprofit agencies as a local chapter leader with her religious fraternal organization, receiving the 2008 Volunteer Excellence Award within the Florida Region.
Available Credit
- 2.00 Doctor of Chiropractic (DC) CE
- 2.00 Documentation & Record Keeping (DOC) credit