Understand payor audit risks, key documentation tips, CMS Probe reviews, and how to strengthen compliance programs to avoid fines and recoupments.
Many physicians and other health care providers do not fully understand the implications and consequences of a payor audit, particularly when the payor is the federal government. Appropriate documentation is required to avoid recoupment and fines when payers audit medical records. What should you do when you discover a significant billing error or a coder complains about a provider’s billing patterns? This topic helps health care organizations, providers, and billers understand the trends in payer audits on professional services, including the latest CMS Probe and Educate reviews. Learn what’s important in the documentation and what to do to prevent an unfavorable audit and discover how to utilize your healthcare attorney and independent reviewers to strengthen your compliance program and deal with overpayment issues.
Learning Objectives
- You will be able to identify the triggers for billing reviews.
- You will be able to explain the difference between the roles and benefits of internal and external reviewers in conducting billing reviews.
- You will be able to recognize the advantages and limitations of each oversight mode.
- You will be able to discuss how to develop strategies for managing overpayment issues, including when to reprocess claims and when to self-report to applicable payers.
Agenda
- What Causes the Initiation of a Billing Review (Internal vs. External)?
- Should the Commencement of the Billing Review Be Under the Attorney-Client Privilege?
- Utilizing Internal vs. External Reviewers to Perform the Billing Review
- Conducting the Review Based Upon Operational Oversight vs. Attorney Oversight
- Differences Between Medicare/Medicaid and Third-Party Payers
- Repayment Based Upon Reprocessing of Claims vs. the Requirements for Self-Reporting to Applicable Payers
Speakers
Carol Hoppe, CPC, CCS-P, CPC-I,
MedLucid Solutions, LLC- President and CEO of MedLucid Solutions, LLC
- Provides clear solutions for medical practices
- Assists clients with all aspects of coding, billing, and A/R management for professional health care services, including chart reviews, education, and interim management support
- Conducts regular seminars and workshops on numerous topics, including E/M documentation guidelines, annual coding updates, and specialty specific coding sessions for clinicians and staff
- Written several publications related to billing and A/R management
- Certified Professional Coder (CPC) and a Certified Professional Coding Instructor (CPC-I), American Academy of Professional Coders (AAPC); Certified Coding Specialist Physician Based (CCS-P), American Health Information Management Association (AHIMA), AHIMA approved ICD-10-CM trainer
- Taught medical billing and coding as an adjunct instructor at Sanford Brown College, Indianapolis; online adjunct instructor at Ultimate Medical Academy
- Current member of the WPS Medicare Part B J8 Provider Outreach and Education Advisory Group (POE AG) and the AHIMA CCS-P Exam Development Committee
- Billing and coding representative for the Indiana State Medical Association
- B.S.M. degree, summa cum laude, Indiana Wesleyan University
- Can be contacted at 317-537-7553, carol@medlucidsolutions.com, www.medlucidsolutions.com or LinkedIn® and Facebook®
Robert A. Wade, Esq.,
Barnes & Thornburg LLP- Partner in the office of Barnes & Thornburg LLP
- Practice emphasizes all aspects of health care compliance, including developing, monitoring and documentation of an effective compliance program
- Currently serves as the compliance expert to the Board of Commissioners of Halifax Health advising the hospital on all aspects of their corporate integrity agreement
- Has experience in representing health care clients with respect to issues being investigated by the Department of Justice and the Office of Inspector General and negotiating and implementing Corporate Integrity Agreements
- Assists clients in documenting and defending financial arrangements between health care providers, including referring physicians, as being fair market value and commercially reasonable
- Has operationally practical experience having served as a general counsel and organizational integrity officer for a multihospital system for 6½ years
- Conducts regular seminars and workshops on numerous health care law which includes the False Claims Act, Stark Law, and the Anti-Kickback Statute
- Wrote several publications related to the areas of health care law
- Best Lawyers In America®, health care law, 2009-2014; Indiana Super Lawyers, 2009-2015
- J.D. degree, summa cum laude, Ohio State University, Moritz College of Law, Columbus, Ohio; B.A. degree, summa cum laude, Bowling Green State University
- Can be contacted at 574-237-1107 or Bob.Wade@btlaw.com
Who Should Attend
This live webinar is designed for medical records directors, health information directors, coders, business managers, office managers, nurses, hospital administrators, billing managers, social workers, counselors, release of records professionals, compliance managers, and attorneys.
