Description
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 providers 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 whats important in the documentation and what to do to prevent an unfavorable audit and discover how to utilize your health care attorney and independent reviewers to strengthen your compliance program and deal with overpayment issues.
Date: 2025-02-06 Start Time: 1:00 PM ET End Time: 2:30 PM ET
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 selfreport to applicable payers.