Phyllis, a speech pathologist with experience in rehab companies and appeals and audits, discussed the Medicare appeals process. She outlined the five levels of appeal: redetermination, reconsideration, administrative law judge hearing, Medicare Appeals Council, and judicial review in a Federal court. Phyllis emphasized the importance of going through all levels of appeal, even if it seems intimidating. She also provided guidance on how to file an appeal, including reviewing the Medicare summary notice, following instructions, providing supporting documentation, and submitting the appeal within the required timeframe. Phyllis stressed the importance of meeting deadlines and providing detailed explanations and evidence to build a strong case.

Phyllis discussed the importance of accurate and comprehensive documentation in healthcare, emphasizing the need for alignment with Medicare coverage guidelines. She highlighted the role of clinicians in gathering documentation and writing appeals, and the significance of utilizing advocacy groups and resources for support. Phyllis also stressed the importance of maintaining clear communication with providers and ensuring coordination between healthcare providers to avoid conflicting information. She concluded by encouraging regular review of documentation practices to identify areas for improvement.

Phyllis discussed the importance of establishing medical necessity and skilled services in healthcare practices. She emphasized the need for clear documentation, including the patient's prior level of function, and the use of standardized tests to show progression. Phyllis also highlighted the significance of discharge summaries, urging therapists to make them comprehensive and detailed. She stressed the importance of supporting services with evidence and regularly auditing records to prevent denials. Lastly, she touched on the Patient Driven Payment Model (PDPM) and its implications for skilled nursing facilities, emphasizing the need for interdisciplinary collaboration and accurate documentation.

Phyllis discussed the importance of utilizing supporting documentation, particularly for patients who had Covid, when appealing denials. She emphasized the need to understand the Covid waivers and their impact on Medicare denials. Phyllis also highlighted the significance of documenting a patient's cognitive function, using standardized assessments like the Phq-9 and Bim scoring, to demonstrate changes or needs for intervention. She stressed the importance of understanding the denial and gathering strong evidence to build a logical argument for fighting appeals. Lastly, she emphasized the need to know one's rights, document thoroughly, understand policies, incorporate cognitive assessments, and be persistent when submitting appeals.

Phyllis provided guidance on how to identify patient goals and the importance of standardized testing. She clarified that while goals are recommended, they are not always necessary. Phyllis also discussed the criteria for inpatient rehab facilities, stating that they have specific lists of diagnoses that qualify patients for these facilities. She emphasized that these criteria are not always aligned with the patient's medical diagnosis. 

In the meeting, Phyllis discussed the importance of thorough documentation for therapy sessions, emphasizing that it should be strong enough to stand up in a court of law. She also shared her experiences with denials, noting that they often occur with Medicare B patients, those who have exceeded their therapy cap, and dementia patients. Phyllis stressed the need for documentation and the importance of maintaining patient function. She also mentioned the role of auditors, suggesting that they should keep up with research and updates, but acknowledged that some may be more knowledgeable than others.