Recovery Auditor Update: Strategies and Focus Areas for 2016 - On-Demand
Tuesday, June 28, 2016
Elizabeth Lamkin, MHA, ACHE
Dr. Keith I. Stokes, MD
Medicare Compliance Watch
Level of Program:
Revenue loss due to auditor denials is increasingly common as hospitals struggle to emerge from audits unscathed. Lost reimbursement combined with compliance risks related to improper billing means denial prevention needs to be a top priority for hospitals and their systems.
During this program, expert speakers Elizabeth Lamkin, MHA, ACHE, and Dr. Keith I. Stokes, MD, provide an update on Recovery Auditor activity in 2016 and offer advice and strategies on approaching audits from both the revenue cycle and physician advisor perspectives. Additionally, they will discuss new focus areas such as SNFs, as well as the overall audit landscape, and will provide best practices for audit prevention related to recovery audits and other areas of concern, including managed Medicare plans.
At the conclusion of this program, participants will be able to:
- Identify various retrospective audit types
- Develop systems for denial prevention
- Demonstrate the importance of the denial prevention process to physicians, engaging them in the goal of compliance
Who Should Listen?
- RAC coordinators
- Case managers and directors
- Compliance officers
- CMOs, CFOs
- Physician advisors
- Billing/reimbursement staff members
- HIM managers and directors
- Revenue cycle managers and directors
- Utilization review committee staff members
- Auditing and denials management staff
- Quality Improvement Organizations (QIO)
- Current state Recovery Auditor program
- Other audit types such as MACs, CERT, and ZPICs
- False Claims Act and enforcement
- Compliance plans and requirement for monitoring and reasonable diligence
- How to stay informed on external audit risk
- External resources
- Websites: CMS as primary source
- PEPPER report
- Organizations (ACPA, AHA) that help interpret CMS rules
- CMS and auditor education
- How to assess your risk areas to develop systems that reduce denials and maintain margins
- Internal audits (outcome and process audits)
- Target outliers such as one-day inpatient stays and three-day observation
- Process audits such as percent of admissions screened for medical necessity
- Tools to track and trend internal audit denials
- How to work with clinical staff and physicians on documentation improvement
- Effective use of utilization management committee
- Effective physician advisor program
- How a physician advisor can lead utilization, care management, and CDI programs
- Physician advisor as physician educator
- Physician advisor as administrator and link to C-suite
- Live Q&A
AAPC (Live + On Demand)
This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. (CEH’s for this webcast expire on: 6/30/2017)
American Health Information Management Association (AHIMA)
This program has been approved for 1 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. (CEU’s for this webcast expire on: 6/27/2017)
Meet the Speakers
Elizabeth Lamkin, MHA, ACHE, is CEO of PACE Healthcare Consulting, LLC, in Hilton Head, South Carolina. She has 20 years of hospital CEO experience. Lamkin is a nationally known speaker and author on billing compliance, including CMS Recovery Auditors.
Dr. Keith I. Stokes, MD, is a board-certified physician with a diverse career that includes experience as a clinic medical director, hospital chief of staff, hospitalist, consultant, and physician advisor. He is COO of DocuComp, LLC, and a member of the steering committee for the Association for Integrity in Health Care Documentation. Dr. Stokes is also a member of the Society of Hospital Medicine and the American College of Physician Advisors. He has served as a consultant for numerous hospitals, primarily focused in the areas of utilization management and clinical documentation improvement.
Webinar system requirements and program materials:
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