Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Overview

Develop a strategic risk-based audit to reduce denials and maximize revenue

Get expert guidance on how to structure a healthcare claims audit that supports an effective compliance program. The evolution of payer claims audits and healthcare regulations requires an effective and comprehensive claims audit to help prevent third-party audits and identify potential revenue opportunities. Organizations need to perform claims audits to meet regulatory requirements but also to protect their financial health. Developing and performing risk-based claims audits can potentially reduce payer audits and identify compliance gaps and revenue opportunities. Live Virtual Medicare Boot Camp®—Healthcare Claims Audit Version is your key to proven strategies for success and will answer your questions on designing a claims audit that is meaningful to your organization.

This Boot Camp teaches you about developing a claims audit process from beginning to end, incorporating official guidance and regulations required for an effective compliance program. You’ll leave the class armed with a thorough understanding of how to build a strategic risk-based audit and ready to put your new knowledge into action for tangible results.

You will leave this program knowing how to:

• Assess areas of risk
• Structure a risk-based audit
• Effectively select an audit sample
• Draft meaningful audit reports

You will leave this Boot Camp with an understanding of:

• The framework of conducting a claims audit
• The different types of audits and how you can prepare your organization for them
• The risk-based audit approach
• How to pull a relevant audit sample
• How to draft a comprehensive, meaningful, and actional audit report

Who should attend?
The course is fit for any member of your compliance, billing, revenue, or clinical team who wants to understand more about developing an effective claims audit and how to prepare for and navigate them.

• Revenue cycle directors and managers
• Revenue integrity directors, managers, and staff
• HIM directors, managers, and staff
• CDI directors, managers, and specialists
• Compliance directors, officers, and auditors
• Business office managers
• Case management directors and managers
• Case managers
• Utilization review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeal coordinators
• Patient financial services directors

See the HCPro difference for yourself!

• Focus on a practical claims audit approach: Learn how to create an effective claims audit encompassing the Office of Inspector General’s recommended auditing and monitoring method.
• Tools and skills to build a claims audit framework: Our instructors provide valuable tools and resources to help you build a comprehensive and effective claims audit structure that can be applied to any practice setting after the Boot Camp ends.

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

Looking to train your whole team? We can bring our expert instructors to you! Learn more here!

Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Outline/Agenda

Module 1: Audit Framework Overview and Resources

• Compliance plan
• Internal policies and procedures
• Scheduling
• Review and final sign-off
• Overall scope

Module 2: Sources of Authority

• Medicare & Medicaid manuals
• Provider manuals
• NCDs & LCDs
• Transmittals

Module 3: Assessing Areas of Risk

• OIG Work Plan
• CERT, RAC, TPE
• Comparative Billing Report
• Third-party audit requests
• Denial trends
• New services
• New and changed payment policies

Module 4: Risk-Based Audits

• Overall structure
• Benefits of risk-based audits
• Identifying unique risks to an organization
• PEPPER reports
• Targeting outliers

Module 5: Selecting an Audit Sample

• Identifying the purpose and objective
• Volume and dollar
• Payer type
• Identifying and determining what to omit
• Randomized versus statistical sample

Module 6: Managing Audit Details

• Organization
• Documentation
• Electronic versus paper files
• Understanding end deliverables
• Managing voluminous audits

Module 7: Drafting an Audit Report

• Executive summary
• Background
• Scope and objectives
• Sample methodology
• Error rate calculation
• Regulatory criteria
• Detailed findings

Module 8: Audit Findings and Follow-Up

• Meaningful audit findings
• Communication of findings
• Ownership and action plan
• Education and training
• Follow-up process and when follow-up is necessary

Module 9: Remittance and Payer Communication

• Understanding how to read a remittance/EOB
• Knowing the meaning of remittance/EOB terms
• Different payer communications
• Remittance Advice Remark Codes

Course agenda/outline is subject to change.

Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Learning Objectives

At the completion of this Boot Camp, participants will be able to:

• Identify the core elements of a properly designed claims audit
• Develop risk-based claim audit areas
• Develop a meaningful claims audit sample
• Analyze claims and publicly available data to build an audit structure

Continuing Education

If you are interested in offering this bootcamp to your employees and need to know what CE credits could be offered, please contact customer service at 800-650-6787 or email sales@hcpro.com.

Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Questions and Answers

Questions/Answers

What is the focus of the Live Virtual Medicare Boot Camp®—Healthcare Claims Audit Version?
The Live Virtual Medicare Boot Camp—Healthcare Claims Audit Version is an intensive course, held over two half-day sessions, on how to effectively structure a claims audit, from the planning phase to effective audit report drafting. The goal of the course is to provide participants with a sound understanding of the claims audit process with an approach to scope and develop a methodology that is effective regardless of the size of the organization.

What computer setup do I need to attend this class?
This class will be hosted on the GoToMeeting platform. Attendees should have access to a computer that has a microphone and speakers to participate; there is also an option to dial in over a phone line if you need to connect on your phone. You can read the full system requirements for GoToMeeting by visiting https://support.goto.com/meeting/help/system-requirements-for-attendees-g2m010003. You can also test your system by visiting https://support.logmeininc.com/gotomeeting/get-ready.

Does HCPro offer an on-site version of this Boot Camp?
In addition to our open registration and live virtual courses, we also offer this Boot Camp as an on-site program (with a substantial discount) for organizations that have a number of employees who need training. For more information on hosting an on-site Boot Camp, click on Host an On-Site Course.

What material does the course cover?
To view the course outline, click on "Course Outline" above.

Does the course require any previous experience or training?
Yes. Participants in this course should have three to five years of experience with healthcare claims and reimbursement methodologies.

What should I have available for each session?
For each class, participants should have their packet of materials and may wish to also have available a highlighter, a notebook for taking notes, and sticky notes/flags.

What if I have a question that didn’t get addressed in class?
There is ample opportunity during the course to ask questions. Questions should be related to the course and topics discussed throughout the course. Instructors are not able to address questions outside the scope of the course.

What if I need to cancel or transfer my registration?
To view our cancellation policy, click here.

Who typically attends the Medicare Boot Camp—Healthcare Claims Audit Version?

• Revenue cycle directors and managers
• Revenue integrity directors, managers, and staff
• HIM directors, managers, and staff
• CDI directors, managers, and specialists
• Compliance directors, officers, and auditors
• Business office managers
• Case management directors and managers
• Case managers
• Utilization review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeal coordinators
• Patient financial services directors

How is the course taught?
The course is taught using a combination of lecture and class discussion.

Does HCPro ever share contact information (e.g., name, address, phone number, email address, etc.) with other companies?
Historically, we have not shared contact information with anyone outside of our company. However, it is possible that at some point we might share contact information with other companies that offer products and services that we think would be of interest to our customers. If you would like us to keep your contact information confidential, please let us know so that we can flag your information in our customer database as "Do Not Share."

How do I get more information?
Contact us at 800-650-6787 or email sales@hcpro.com.

Live Virtual Medicare Boot Camp®—Healthcare Claims Audit

Things to Know Before Attending Class

What Is Included With Your Purchase

When you purchase a seat for our live virtual Boot Camps, you get online access for one participant to the live sessions, a hard copy of our printed workbook materials, and access to the recordings of the sessions. HCPro reserves the right to revoke your access if we find that you are sharing your login or any of the class information.

Course Materials

You will receive a hard copy of the class materials. These will be shipped to you via UPS. If ordering on our website, please be sure to enter the physical address of where these materials should be shipped to. If you order over the phone or if you are unsure of what address we have on file, please ask the person you are speaking with to verify your address information and update accordingly or call our customer service department. Materials should arrive approximately two business days prior to the start of class.

Virtual Boot Camp Platform

We use GoToMeeting to present our virtual Boot Camps. To ensure your system supports GoToMeeting, use this link: https://support.goto.com/meeting/system-check. We will send out access information for the class four business days prior to the class start and again one business day prior.

Session Recordings

You will have access to the recordings of each class session via a password-protected page on our website. You will be given the page location in your welcome email. Recordings will be added to the page within one business day following the live session. You will have access to this page for 60 days after the final live session.

Continuing Education Credits

To receive continuing education credits, you will be required to successfully complete a 40-question quiz that is based off of the content covered throughout the course. Successful completion is achieved by getting at least 80% of the multiple-choice questions correct.

What to Bring to Class

We suggest that you have the following available during the class: 

• Highlighter
• Note paper
• Sticky notes/flags
• Pen/pencil

Contact Information

For more information about our Boot Camps, contact us at 800-650-6787 or email sales@hcpro.com.

We Look Forward to Having You In Class!