Primer For Therapists: Establishing Medical Necessity In Clinical Documentation

Children suspected of having an ASD often benefit from outpatient therapy services. To obtain reimbursement for services, clear documentation submitted by licensed clinicians in physical therapy, occupational therapy and speech and language pathology is necessary. Establishing medical necessity in documentation when a deficit is present requires a systematic approach. Understanding the components of medical necessity and how they vary from state to state is essential. This program will provide a strategy from which to begin. Case studies included. Established Need:

Children suspected of having an ASD often benefit from outpatient therapy services. To obtain reimbursement for services, clear documentation submitted by licensed clinicians in physical therapy, occupational therapy and speech and language pathology is necessary.

Frequently, prior to the beginning of therapy, documentation must be submitted by licensed clinicians identifying the deficits and the plan of care. As a result, it is incumbent upon the clinician seeking to provide effective clinical services, to be well versed in specific aspects of clinical documentation that are needed to establish medical necessity.

Establishing medical necessity in documentation, when a deficit is present, requires a systematic approach. Understanding the components of medical necessity and how they vary from state to state is essential. In addition, understanding the need for metrics in describing deficits, goals and outcomes will be covered as well as how best to include evidence based practice (EBP) into the clinical documentation strategy. Without a clear strategy for clinical documentation, medically necessary therapy services may not be approved or may be cut short.

This program will provide a strategy from which to begin. Case studies will be included in demonstrating best practice in clinical documentation as well as to discuss common errors made. Audience participation will be encouraged during the analysis of case studies.

Audience:

This program is appropriate for physical therapists, occupational therapists and speech and language pathologists as well as the directors that manage services of this type and case managers. In addition, the program will assist families and caregivers in how best to participate.

Learning objectives:

Upon completion of the course the attendee will be able to:

1. Analyze the definition of medical necessity in several states
2. Describe necessary components of documentation to establish medical necessity
3. Select correct measurements to describe deficits, goals and outcomes
4. Discuss the role of the parent in establishing medical necessity
5. Apply the concepts of medical necessity and clinical documentation in the clinical setting
6. Applying evidence based practice into clinical documentation

Program outline:

Program outline:

1. Orientation
2. Definition of medical necessity
   1. Components
   2. Comparison
3. Documentation
   1. Components
   2. Frequently made errors
4. Measurement
   1. Components
   2. Frequently made errors
5. Role of parents
   1. Parent data collection
   2. Teaching parents the role of metrics
6. Case studies
1. 2 case studies
2. Correct documentation
3. Incorrect documentation
7. Applying EBP
   1. Understanding types of evidence
   2. Incorporating EBP into documentation
8. Closing remarks
   1. Next steps
   2. Question and Answers