Current Status
Not Enrolled
From $25
Get Started
This course is currently closed

About the Course


Published: January 15, 2020


It has been found that almost 100% of the prior authorization levels given by the Medicare Advantage Plans do not match the PDPM score calculated by the facility MDS. In many cases the difference is $200-$500 per day in reimbursement. NaviHealth is the approved vendor who authorizes SNF stays for Humana and Security Health Plan. In this session we will discuss the request for recalculation process and the financial ramifications.

  • Identify the elements used by NaviHealth used to calculate a PDPM score.
  • Describe the request for recalculation process versus the request for admitting diagnosis change
  • List clinical documentation useful to the recalculation request.
  • Define “transition” as it relates to NaviHealth authorizations

Theresa Lang, RN, BSN, WCC

Theresa Lang, RN, BSN, WCC, is employed as the clinical reimbursement specialist for 9 SNFs in central and western WI. She has spent more than forty years working in long term care, consulting and training related to clinical reimbursement. She continues to have a consulting practice and train on ICD-10CM coding as an AHIMA approved ICD-10CM Trainer. Theresa is authoring a book on Diagnosis Coding and PDPM scheduled to be published in October 2019

Purchase the Course


Click here to register.

Registration will close at 11:59 PM April 11, 2020.




CEU: 1.0 – Data Structure, Content and Information Governance
Access to the Course

Access instructions to the recording will be provided within 2 business days following receipt of payment.

You will have 60 days to access the course after payment has been received.

Cancellation/Refund Policy

On demand webinars are non-refundable.

Access the Course