Documentation: Understanding Medical Necessity
Legal & Financial Consequences of Inadequate Documentation
Presenter: Nick Merkin, JD, MBA, CHC, CHPC
Sponsored by Clear Recovery Center
In this presentation we will review the concept of “medical necessity,” including its definition. We will review some related laws to medical necessity, as well as its application in various cases. Additionally, we will cover the legal and financial consequences of inadequate documentation of medical necessity and how to avoid them. We will then present best practices in connection with medical necessity and its documentation.
Goals:
(1) Understand the definition of medical necessity;
(2) Assisting therapists to Identify risks involved with poor documentation of medical necessity;
(3) Encouraging therapists to think critically about documentation required by insurance companies;
(4) Informing therapists about recent legal developments affecting private practice;
(5) Educating therapists about best practices in documenting medical necessity.
Objectives:
(1) Articulate the definition of medical necessity;
(2) Apply the definition in various clinical contexts;
(3) Construct a framework for decision-making around adequacy of documentation;
(4) Identify the risks of poor clinical documentation;
(5) Understand best practices regarding documentation of medical necessity.
Level of Learning: Intermediate & Advanced
Presenter Bio:
Nick Merkin is the Chief Executive Officer of Compliagent, a national healthcare compliance consulting firm based in Los Angeles. As part of his consulting practice he frequently serves as a fractional or interim Chief Compliance Officer for organizations experiencing rapid growth, enforcement challenges, or are in the process of merger and acquisition.
Nick has a through knowledge of complex and rapidly changing state and federal laws and policies regarding organizational governance issues, board oversight and liability, compliance auditing, the Stark Law, the Anti-Kickback Statute, HIPPA Privacy, date security, and the False Claims Act.
Nick has particular expertise in the areas of alternate payment methodologies, and innovative provider structures for networks within the healthcare industry.
Nick earned his J.D. from Columbia Law School, where he was named a Harlan Fiske Stone Scholar and served as Managing Editor of the Columbia Journal of Law and Social Problems. Nick was also awarded an M.B.A. from Tel Aviv University’s Recanati School of Business and a B.A. from the University of Pennsylvania. A member of the California Bar, Nick is certified in Healthcare Compliance (CHC) and Healthcare Privacy Compliance(CHPC) by the Compliance Certification Board (CCB)
Meetings Are Now FREE For Members Who Pre-Register!
Participants Will Receive 2 CEUs Via Email
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8:30 A.M. Registration and Breakfast
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9:00 A.M. Announcements from President & Members
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9:15 A.M. Presentation Begins
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11:15 A.M. Presentation Ends & Informal Networking until 12 noon.
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12:00 P.M. Board Meeting Begins
Long Beach - South Bay CAMFT - APPROVAL NUMBER: 56159
LBSB CAMFT is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFT’s, LCSW’s, LEP’s & LPCC’s. LBSB CAMFT maintains responsibility for this program/course and its content.
Course meets the qualifications for two (2) hours of continuing education credit for LMFTs, LCSWs, LPCCs and/or LEPs, as required by the California Board of Behavioral Sciences.
Refund Policy: With a 24-hour written notice, a full refund will be provided. With less than 24 hours' notice, credit towards attendance at a future education program course will be provided. Target Audience: This educational program is planned for marriage and family therapists, marriage and family therapy associates, social workers, counselors and/or educations psychologist. Special Needs Accommodations: In the event that special needs accommodations are required, please contact Diane Bagatorian, Co-VP Programs diane@clearrecovercenter.com indicating your need at least 8 days prior to the educational program. Awarding Course Completion Certifications: LB-SB CAMFT monitors attendance with sign-in and sign-out sheets and final course evaluations. Once the participate have signed out and provided course evaluations, course completion certificates will be emailed to your with 14 days. . Grievances: The Program Administrator (PA) and Board of Directors (BOD) will handle complaints or grievances and conduct investigations to determine the appropriate resolutions. The BOD and PA will respond within 48 hours of receiving the complaint and will provide timely fall-up to the participant during the course of investigation and resolution.
