Defending your rights under the published rules and regulations, ensuring a level playing field, and, most importantly, receiving due process are things you should expect and, more importantly, demand!
Audits are a tremendous tool in the arsenal of payers and their contractors. Often times, auditors hide behind nuanced terms such as “Reopening for Good-Cause,” or “Medical Necessity” or “LCDs/Medical Coverage.” And that makes responding effectively to an audit challenging for healthcare professionals engaged in claims denial responses and those charged with the responsibility of responding to audits with overpayment demands. Acerbating an already difficult situation is the fact that payers, and especially their contractors, have become more aggressive in their approach and often-times deploy heavy-handed tactics, which has drawn the ire of many in Congress and the healthcare community at large.
This RACmonitor webcast will focus on the U.S. Department of Justice Criminal Division “Evaluation of Corporate Compliance Programs,” with a specific focus on “Creating a Culture of Compliance,” which lends itself to helping you and your facility establish best practices regarding policies and procedures as they relate to payer requirements attached to billing, coding and documentation of services provided and billed. As you’ll learn in this webcast, with the creation of a well-maintained compliance program, you and your facility can create strong defense strategies to combat the non-specific denials or lack of clinical judgment deployed on most audits performed where over-payment demands are made or when escalation to Office of Inspector General and the Department of Justice OIG/DOJ are threatened.
CMS has authorized the resumption of medical record auditing. CMS, regardless of the status of the public health emergency, will conduct pre and post-payment reviews, SMRC and RAC Audits. The DOJ, OIG and HHS recently announced more than $4.5 billion in alleged false and fraudulent claims since 2016, and $850 million since April.
Compliance officers, internal auditors, practice managers, CFO, CEO, coders.