CDI and Compliance: Reducing Denials and Protecting Against Fraud and Abuse -
Presented on: September 10, 2015
Presented by: Sarah C. Mendiola, Esq., LPN, CPC
In this 90-minute webcast, associate attorney Sarah C. Mendiola, Esq., LPN, CPC, whose work focuses on appeal of denied claims by CMS contractors, provides actual examples of costly denials that could have been prevented with CDIS intervention. These include 2-midnight rule denials, medical necessity for major joint replacement (as outlined by CMS), and justification of MCCs that are difficult to support clinically while maintaining compliance guidelines. Ms. Mendiola also explains the impact a Corporate Integrity Agreement has on the CDIS and on the organization.
At the end of the program, participants will be able to:
- Identify denial intervention steps
- Describe the role of accurate documentation in prevention of denials related to the False Claims Act
- Define principal parts of a Corporate Integrity Agreement and its potential impact
- Preventable denial targets
- Major joint replacement (and other surgeries)
- CDI review goals
- False Claims Act
- Fraud versus abuse
- Government action
- Financial and legal impact
- Corporate Integrity Agreement
- General requirement
- CDI involvement
- Reviews and assessments
- Q/A (not live)
Who Should Listen?
Denials management coordinators, clinical documentation improvement specialists, CDI Managers, HIM directors/managers, compliance officers, inpatient coders
- Benchmarking data
- legislation samples
The live versio of this program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification, offered as a service of the Association of Clinical Documentation Improvement Specialists (ACDIS).
Disclosure Information: The planners, presenters, and contributors of this CNE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity.
Meet the Speaker
Sarah C. Mendiola, Esq., LPN, CPC, is an associate attorney at the law firm of Fotheringill & Wade, LLC, and the denial defense company of Washington & West, LLC. Ms. Mendiola is also a licensed nurse in the state of Maryland and a Certified Professional Coder (CPC). Her work focuses on the appeal of claim denials by the Centers for Medicare and Medicaid (CMS) contractors, commercial insurers, and the Maryland Medical Assistance Program. Mendiola has experience with both traditional Medicare denials and Medicare Advantage denials. She represents clients at Administrative Law Judge hearings and has obtained favorable results for claim denials from Zone Program Integrity Contractor (ZPIC) audits.
Webinar system requirements and program materials:
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:
Internet: 56K or faster Internet connection (high-speed connection recommended)
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices
Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location.
COULDN'T LISTEN LIVE?
No problem. The On-Demand version is also available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $199 value!
Participation in this webinar is just $199 per site. All materials must be retrieved from the Internet.
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