How to Minimize the Risk of Negative Healthcare Audits

Duration: 60 Minutes
Healthcare audits can be a valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise. Attend this training to learn Specific examples of negative audits, as well as steps to prevent similar outcomes in your practice.
Healthcare Audits
Product ID: 501837
Objectives of the Presentation
  • The importance of medical necessity in billing and coding activities
  • The importance of documentation that supports medical necessity
  • The importance of understanding payer specific rules
  • The importance of internal monitoring in preventing negative audits
  • The importance of understanding rules related to evaluation and management coding
  • The importance of justifying medical necessity when prescribing high cost services
Why Should you Attend
This presentation will review steps healthcare practices can take to reduce the risk of negative audits. Payers have the right to reject or deny claims that are not compliant with their published requirements. In some cases CMS considers inaccurate reporting as fraudulent behavior that may lead to administrative of even criminal prosecution. There are numerous areas of focus on clinical practice coding/billing activities, including evaluation and management coding, resource utilization, ICD-10-CM, HCPCS and CPT coding. Each of these areas represent potential vulnerabilities that can be addressed by taking into consideration the medical necessity of each service and whether or not it is supported by adequate documentation.

Areas Covered
  • Medical necessity
  • Evaluation and management coding rules and audit vulnerabilities
  • Office procedure coding rules and audit vulnerabilities
  • Frequently targeted device prescribing behaviors
  • The impact of electronic health records on billing and coding activities and audit vulnerabilities
  • How documentation can prevent negative audits
Who will Benefit
  • Physicians
  • Nurse practitioners
  • Physician assistants
  • Office administrators
  • Billing and coding professionals
  • Office staff and auditors
$375
Recorded Session for one participant
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Live Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • The webinar joining link, username and password for joining the webinar will be updated on your OCP Account 24 hours prior to the webinar
  • Presentation handouts in Downloadable PDF format will be updated on your OCP Account 24 hours prior to the live session
  • Login to the audio conference on the scheduled date and time
  • Get answers to your queries through interactive Q&A sessions via chat at the end of the session
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account 24 hours after the completion of the session
  • Please let us know your thoughts and views at the end of the webinar, your valuable feedback will help us improve
Recorded Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • Upon purchase of the recorded session a link will be updated on your OCP Account within 24 hours
  • Please click on the link to access the Recorded Session
  • Presentation handouts in downloadable PDF format will be updated on your OCP Account within 24 hours of the purchase of the product
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account after 48 hours of the product Purchase
  • Please share your valuable Feedback at the end of the session
Instructor Profile:
Michael-Marron Stearns, CPC, CFPC, MD, is a physician informaticist, accomplished author, health information technology (HIT) and healthcare compliance consulting professional. He has 18 years of experience in the areas of electronic health records, quality reporting, health information exchange, clinical terminology development, standards, and billing and coding compliance. Dr. Marron-Stearns is the CEO and Founder of Apollo HIT, LLC, a company that provides HIT and compliance consulting services to the healthcare industry. He is a leading national authority on protecting the integrity of digital health information in electronic health records and health information exchange. He is also a certified professional coder (CPC), certified family practice coder (CFPC), neurologist (and former assistant professor of neurology and residency program coordinator), and accomplished author.

Dr. Marron-Stearns has provided leadership to informatics and terminology projects at the National Library of Medicine, the National Cancer Institute, and the College of American Pathologists. He served as the International Director of SNOMED International, where he played a central role in the design and development of SNOMED CT. He has provided direction and leadership to two leading EHR vendors, served as the founding board president for the Texas e-Health Alliance, and sits on numerous boards and committees including the National Patient Safety Board, the AHIMA Terminology and Classification Practice Council, the University of Texas at Austin HIT Certification Program Curriculum Committee, the Mentegram Advisory Board, the Mimir Health Advisory Board, and the University of Texas at Austin Health Information Exchange Laboratory Advisory Board.
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