Medicare Boot Camp®—Healthcare Claims Audit Version

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. 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 detailed information about HCPro's 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!

Medicare Boot Camp®—Healthcare Claims Audit Version

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

Medicare Boot Camp®—Healthcare Claims Audit Version

Learning Objectives

At the conclusion of this educational activity, participants will be able to:

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

Continuing Education

AAPC
This program has been approved by the AAPC for 8 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

ACDIS
This program has been approved for 8 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 Integrity Specialists (ACDIS).

AHIMA
This program has been approved for 8 continuing education unit(s) (CEUs) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting of Approved CEUs from AHIMA does not constitute endorsement of the program content or its program provider.

ANCC
HCPro is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is available for 8 nursing contact hours.

CCB
The Compliance Certification Board (CCB) has approved this event for up to 9.6 CCB CEUs. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB of this program content or of the program sponsor.

CCMC
This program has been pre-approved by The Commission for Case Manager Certification to provide 8 hours of continuing education credit to CCM board certified case managers.

NAHRI
This program has been approved for 8 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

Disclosure Statement:
HCPro has confirmed that none of the faculty/presenters, planners, or contributors have any relevant financial relationships to disclose related to the content of this educational activity.

Medicare Boot Camp®—Healthcare Claims Audit Version

Questions and Answers

What is the focus of the Medicare Boot Camp®—Healthcare Claims Audit Version?
The Medicare Boot Camp—Healthcare Claims Audit Version is an intensive, one-day course 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.

Where is the course offered?
Open registration sessions are offered at various locations around the country, typically at mid-priced business hotels such as HYATT Place or Hilton Garden Inn. For a current schedule of upcoming open registration courses, click on "Locations/Dates" above.

Does HCPro offer an on-site version of this Boot Camp?
In addition to our open registration 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 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

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. Generally, participants have three to five years experience with healthcare claims and reimbursement methodologies.

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

What do I need to bring to class?
When you arrive at class, you will receive a spiral bound book of course materials. In addition, please bring the following to all classes:

• A highlighter
• A notebook for taking notes
• Sticky notes/flags
• A pen/pencil

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.

Medicare Boot Camp®—Healthcare Claims Audit Version

Things to Know Before Attending Class

Directions and Hotel Information

The hotel address, phone number, URL, room rate, and room rate cut-off date are posted on our website at https://hcmarketplace.com/product-type/boot-camps/medicare. The hotel websites give detailed directions to the hotel as well as information about the location. Please call the hotel directly to make a room reservation. Be sure to identify yourself as an HCPro Boot Camp participant. Please be sure to make your reservation before the cut-off date. After the cut-off date, contact the hotel to determine room availability and rates.

Course Materials

When you arrive at class, you will receive extensive workbooks containing the class materials utilized throughout the Boot Camp. The workbooks will be yours to keep, so plan accordingly in allowing enough room in your luggage on the return trip home. Workbooks may also be shipped from the hotel at your own expense.

Classroom Time

Other than breaks and a half hour for lunch, we will be in class from 8:00 a.m. to 5:00 p.m. If the class gets behind, class may run later than 5:00 p.m.

Lunch

Although our in-person Boot Camps typically provide coffee in the morning and drinks and snacks in the afternoon, everyone is on their own for lunch. Note that many hotels do not have restaurants on-site. If you are flying to the course, we generally recommend renting a car.

What to Bring to Class

We recommend you bring the following to class:

• Highlighter and pen/pencil
• A notebook for making your own notes
• Sticky notes/flags

Use of Laptop Computers or Electronic Devices

Our instructors demonstrate where to find many resources on the CMS website. If you have access to a laptop or tablet, you may bring it to class to follow along, but you may wish to consider the power and wireless needs of your device. Many conference rooms do not have plugins situated conveniently to the tables, so you may wish to ensure you have sufficient battery power. HCPro does not purchase group wireless access for the conference rooms, but many hotels provide free wireless access. You may wish to confirm your connectivity options prior to arriving at the hotel. Please be courteous in your use of electronic devices. Use of electronic devices should not disrupt the class or disturb other participants. HCPro is not responsible for lost, stolen, or damaged devices. Maintaining the security and safety of your device is your responsibility. Cell phone use during class is strictly prohibited.

Dress

Business attire is not necessary. Please dress comfortably. Also, we find that the classrooms are sometimes on the cool side, even during the warmer months. You may be more comfortable if you bring a sweater or sweatshirt in case you get cold. 

Copyright Protection of Course Materials

You will receive a complete copy of our course materials at the beginning of class. The materials used were custom designed by our company specifically for use in connection with this course. We have invested a tremendous amount of time, money, and effort in developing, refining, and maintaining these materials, and they are protected by copyright laws. Course materials may not be duplicated. You may use the materials  in direct connection with the course or (ii) as a personal reference in your day-to-day work. No claim is asserted to any U.S. Government, American Medical Association, or American Hospital Association works included in the course materials workbook.  

Cancellation and Transfer Policy

For our cancellation and transfer policy, visit our website: http://hcmarketplace.com/cancellations

Contact Information

If you have any question about the Boot Camp program, please contact:

Customer Service
(800) 650-6787 phone 
(800) 785-9212 fax
http://hcmarketplace.com/product-type/boot-camps

We Look Forward to Having You In Class!