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Government Audits from A to Z

The government fraud fighters are many, and at times their roles and processes can be confusing to providers. Join these two popular Monitor Monday Panelists to define the roles of the various CMS Program Integrity agencies and initiatives currently underway. This session will cover Medicare and Medicaid and provide actual case studies from the field, as well as OIG reports relating to the activities of the auditors.

Nancy BeckleySpeakers

 Nancy J. Beckley, MS, MBA, CHC
Nancy Beckley & Associates LLC

John Paul Spencer
John Paul Spencer, CPC, CPC-H
Compliance Officer
FiMed Management


Inpatient Versus Outpatient Procedures and the Use of Observation: Learn to Avoid Pitfalls and Remain Compliant

When should a procedure be performed as an outpatient and when is inpatient admission warranted? When can your hospital provide observation services for patients having outpatient surgery? Despite the fact that errors can result in large financial losses, hospitals have struggled to get level of care and observation right. The reasons: Rules surrounding observation are vague and sometimes counterintuitive. Admission is mandatory for some procedures but allowed for others only under certain limited circumstances. Admitting inappropriately and misusing observation can adversely impact your hospital’s financial performance, create compliance risk, confuse patients, and expose them to additional out-of-pocket expenses. Learn tactics to get level of care right every time and build a bulletproof observation protocol.

Steven Meyerson, MD

Steven J. Meyerson, M.D.
Vice President of Regulations and Education
Accretive Physician Advisory Services (PAS®)



Best Practices for RAC Appeals

Hospitals cannot afford to handle RAC appeals haphazardly.  It is imperative that hospitals adopt an integrated and strategic methodology for their RAC appeals.  This includes a  multi-faceted approach to appeals including practical matters such as carefully monitoring claims through the appeals process, evaluating supporting documentation, satisfying the early presentation of evidence requirement at reconsideration, assessing expert witness testimony, requesting the audit file and communicating with the ALJ’s office.  Hospitals should also be attuned to developing successful legal arguments to advance in both a written submission and at an ALJ hearing.

Andrew Wachler

Andrew B. Wachler
Managing Partner
Wachler & Associates, P.C.



Hot Audit Topic: Outpatient Infusion Services: Learn the Proactive Approach to Avoid Infusion-related RAC, MIC and MAC Audits

The RAC program is stepping up its scrutiny of infusion services, particularly related to documentation for services charged and billed.  Learn how Auditors — MICs ZPICs and RACs along with CERT reports — have identified specific issues relative to the coding and documentation to support the code assignment and understand the top compliance issues facing you including documentation related to time, route, site and flushes, single versus mixed solutions, concurrent versus sequential treatment, local and national coverage determinations, medical necessity, hierarchy and chemotherapy.

Robin Zweifel

Robin Zweifel, BS, MT(ASCP)
Vice President, Clinical Consulting Services
Panacea Healthcare Solutions, Inc.



Care Management: Lessons Learned from the Field to Achieve Compliance and Efficiency

Examine real life situations illustrating the potential breakdown of hospital Utilization Management and Care Management and the consequences including loss of revenue, compliance issues, uncoordinated care and a break down in physician relations.  Learn the effective systems for Utilization and Care Management that give a framework for compliance and efficiency, including tips on how to successfully work with medical staff in your facility.

Elizabeth Lamkin

Elizabeth Lamkin, MHA
PACE Healthcare Commons Hospitals, LLC



Hot RAC Topic- Never Heard Before Legal Arguments to Challenge RAC Denials

This session will focus on arguments that you may not have heard before — arguments that you can use to challenge denials for insufficient documentation, short stays, missing signatures, violations of Conditions of Participation (CoPs) and other similar denials. You will learn practical risk-management tips, including how a three-sentence training session may improve your short stay documentation.

David M. Glaser

David M. Glaser
Fredrikson & Byron’s Health Law Group


Sandry Routhier
Sandra Routhier
Senior Healthcare Consultant
Panacea Healthcare Solutions, Inc.


The OIG Work Plan: Top Audit Targets for 2013

The Office of Inspector General (OIG) will release its 2013 Work Plan by October 1, giving providers an advance look at areas the OIG will focus on in the New Year.   Learn important insights into OIG audit priorities that provider and suppliers should incorporate into their audit and compliance programs.

Brian D. Annulis, JD


Brian D. Annulis, JDP
Meade & Roach, LLP



Case Study: Lawrence Memorial Hospital Best Practices to Reduce Denials and Win Appeals   

Find out how Lawrence Memorial Hospital has created a culture for Medicare compliance by empowering staff to build a strong process surrounding patient status election, submitting accurate claims and managing denials and appeals. 

Taryn Schraad, RHIT


Taryn Schraad, RHIT
Audit & Appeals Specialist
Lawrence Memorial Hospital (Lawrence, KS)



Learn How to Get Physicians to Improve Clinical Documentation to Safeguard Compliance

Today, as never before, physician documentation is THE critical component for dodging the barrage of audits being directed at your facility and even determining your success or failure in surviving healthcare reform. Appropriate documentation by physicians remains one of the most prevalent causes for denial of inpatient reimbursement today.

Robert Gold, MD

Robert S. Gold, MD
Cofounder and CEO
DCBA, Inc.



Bridging the Gap – Revenue Cycle and Case Management: The Strategy to Prevent RAC Takebacks

The time has come for case management to talk to revenue cycle leaders and revenue cycle leaders to talk to case management. The RACs are targeting a vulnerability called “Medical Necessity” and the longer the silos are allowed to exist, the more hospitals are at financial risk for recoupment.

Steven Meyerson, MD

Steven J. Meyerson, M.D.
Vice President of Regulations and Education
Accretive Physician Advisory Services (PAS®)


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