Summary - The IRF Auditor’s Lens Webinar Series

What does your IRF look like through an auditor's lens? This three-part webinar series brings the auditor perspective to some of today's most challenging areas of IRF practice. Sessions will move beyond QI coding to explore lessons identified through audit findings, examine Medicare Advantage considerations within the IRF setting, and take a closer look at denials and appeals, including common denial rationales and strategies for responding. Participants will leave with practical insights they can use to strengthen documentation, compliance, and organizational preparedness.

Target Audience: IRF clinicians, PPS coordinators, coders, HIM professionals, quality and compliance staff, case managers, physicians, program leaders, revenue cycle professionals, and others involved in documentation, reimbursement, audit preparedness, and denial management.

Fees: Register for an individual session or unlock the full learning experience with discounted pricing for all three sessions.

$130 single webinar without recording
$160 single webinar with recording
$350 for all three sessions without recording
$380 for all three sessions with recording

Presenters:

Session 1: Heather Girard

Session 2: Stacy Johnson

Session 3: Marjorie Mantione

Gain insight into how Section GG and Section H coding are viewed and validated during documentation reviews and audits. One of UDSMR/McBee’s clinical experts will examine audit trends, documentation insights, and score validation issues identified through chart reviews, consultations, and industry observations. Participants will explore common risk areas, including activity-not-attempted coding, conflicting documentation, and insufficient support for reported scores, while learning practical approaches to strengthen documentation and coding defensibility.

Learning Outcomes:

Identify common Section GG and Section H documentation practices that may create audit risk
Recognize when “activity not attempted” coding is vulnerable to challenge by auditors or payers
Apply practical strategies to strengthen support for functional codes recorded on the IRF-PAI through consistent documentation in the medical record

Medicare Advantage changes are in the forefront of government relations topics impacting many venues of care. The IRF industry has been historically challenged in attaining access to IRF level of care for their MA patient populations. IRFs need to work together to ensure that these changes are monitored and enforced. Including, the importance of a comprehensive, individualized preadmission screening process that clearly communicates the patient's clinical condition, medical and functional needs, rehabilitation potential, and rationale for IRF-level care. Join us live as we share the positive impact these changes to MA plans will have on your practices.

Learning outcomes:

Identify the various MA resources including the Social Security Act Section 1852, The Code of Federal Regulations and the Medicare Managed care Manual
Interpret the recent MA changes in effect as of January 2024 resultant of the 2024 MA Final Rule and their impact on the IRF industry
Apply concepts to complete a comprehensive and individualized preadmission screening, perform peer-to-peer review, and process strategies to overcome MA challenges

IRF denials can extend far beyond an individual claim, affecting reimbursement, compliance risk, internal processes, and future audit activity. This session takes participants through the IRF review and denial landscape, examining the roles of Medicare review contractors, the ADR and review process, and the potential impact of audit findings on IRF providers. Participants will explore common denial rationales related to IRF documentation and medical necessity and examine practical approaches for responding to findings and developing effective appeals.

Learning outcomes:

List three Medicare IRF Contractors and their area of focus
Restate the purpose of the IRF Review Choice Demonstration project
Restate two common reasons for IRF denials
Describe strategies and resources to defend against Medicare denials

This webinar series will award the following CEUs upon completion.This webinar series will award the following CEUs upon completion.

McBee, a division of Netsmart Technologies, is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Each webinar in the series will award the following continuing education upon completion:
- The Documentation Behind Functional Coding; 1.5 Contact Hours for Nurses
- Medicare Advantage in the IRF Setting 1.5 Contact Hours for Nurses
- Denials and Appeals Impacts: 1.25 Contact Hours for Nurses
Uniform Data System (now part of Netsmart Technologies, Inc.) is an AOTA Approved Provider of professional development. This Distance Learning-Interactive Activity is offered at Introductory Level, Professional issues. The assignment of AOTA CEUs does not imply endorsement of specific course content, products, or clinical procedures by AOTA.
The Documentation Behind Functional Coding; 0.150 CEUs Course Approval ID# TBD
Medicare Advantage in the IRF Setting: 0.150CEUs | Course Approval ID# TBD
Denials and Appeals Impacts: 0.125 OT CEUs | Course Approval ID# 06341

The registration deadline is December 31, 2026.

Attendees who purchase webinar recordings will receive access to each recording for two weeks.

Separate registration and payment is required for each attendee. Full payment is required at registration. All fees paid are nonrefundable. Workshop materials/access will not be provided until payment is received. Cancellations will receive credit toward a future presentation of this topic.

If you are unable to attend the training, another person from your organization may attend in your place. You must notify IRFeducation@mcbeeassociates.com before the workshop if you will be making such a substitution.