Recovery Auditor Update: Strategies and Focus Areas for 2016 Presented on:
Tuesday, June 28, 2016
1:00–2:30 p.m. Eastern Presented by:
Elizabeth Lamkin, MHA, ACHE
Dr. Keith I. Stokes, MD Sponsored by:
Medicare Compliance Watch Level of Program:
Intermediate A recent AHA survey found that 37% of hospitals indicated, for automated denials, that outpatient billing errors had the largest financial impact.
Revenue loss due to auditor denials is increasingly common as hospitals struggle to emerge from audits unscathed. Lost reimbursement combined with compliance risks related to improper billing means denial prevention needs to be a top priority for hospitals and their systems.
During this program, expert speakers Elizabeth Lamkin, MHA, ACHE, and Dr. Keith I. Stokes, MD, provide an update on Recovery Auditor activity in 2016 and offer advice and strategies on approaching audits from both the revenue cycle and physician advisor perspectives. Additionally, they will discuss new focus areas such as SNFs, as well as the overall audit landscape, and will provide best practices for audit prevention related to recovery audits and other areas of concern, including managed Medicare plans. Agenda - Quality Improvement Organizations (QIO)
- Current state Recovery Auditor program
- Other audit types such as MACs, CERT, and ZPICs
- False Claims Act and enforcement
- Compliance plans and requirement for monitoring and reasonable diligence
- How to stay informed on external audit risk
- External resources
- Websites: CMS as primary source
- PEPPER report
- Organizations (ACPA, AHA) that help interpret CMS rules
- CMS and auditor education
- Publications
- How to assess your risk areas to develop systems that reduce denials and maintain margins
- Internal audits (outcome and process audits)
- Target outliers such as one-day inpatient stays and three-day observation
- Process audits such as percent of admissions screened for medical necessity
- Tools to track and trend internal audit denials
- How to work with clinical staff and physicians on documentation improvement
- Effective use of utilization management committee
- Effective physician advisor program
- How a physician advisor can lead utilization, care management, and CDI programs
- Physician advisor as physician educator
- Physician advisor as administrator and link to C-suite
- Live Q&A
Price: $259 |
