Auditing for Commercial and Government Payers

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Auditing for Commercial and Government Payers

Product Code: YZHHA072418

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Auditing for Commercial and Government Payers

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Presented on:
Tuesday, July 24, 2018
12:00-3:00 p.m. Eastern

Presented by:
William L. Malm, ND, RN, CRCR, CMAS
Sharon Easterling, MHA, RHIA, CCS, CDIP, CRC, FAHIMA

Level of Program:

Are you ready for the next generation of payer audits? As both commercial and government payers switch to value-driven and risk-adjusted reimbursement models, the nature and scope of payer audits will be dramatically transformed. The stakes for correct coding and complete documentation have never been higher. Organizations need to take a hard look at their data and reboot their internal audit programs to protect appropriately earned revenue from payer audits and denials.

In this intensive three-hour program, expert speakers Sharon Easterling, MHA, RHIA, CCS, CDIP, CRC, FAHIMA, and William L. Malm, ND, RN, CRCR, CMAS, will walk participants through the different types of audits, the current audit landscape and goals for both internal and external audits, and the impact of coding and documentation on audit outcomes. Easterling and Malm will explain how to use your own data, from internal sources and external payer reports, to spot weak areas and potential audit targets in your organization; they’ll also share tips for turning these problem areas around.

Detailed case studies and in-depth examples will show how the concepts discussed apply to the real-world issues your organization faces. Participants will have the opportunity to pose questions to the speakers after each section of the program.

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

  • Describe the current audit environment for governmental and commercial payers
  • Identify top audit areas and tools to use in preparation
  • Describe the impact of EHR systems on documentation and audits
  • Explain the Quality Payment Programs and audit risk
  • Define risk adjustment and understand the audit implications related to Hierarchical Condition Categories (HCC)

Who Should Listen? 

  • Internal auditors
  • CDI managers/specialists
  • Revenue cycle managers/staff
  • HIM managers/directors
  • Revenue integrity managers and staff
  • Case managers
  • Utilization review staff
  • HIM staff
  • Patient financial services managers and staff
  • Compliance managers and staff


  • Part 1: Medicare and government audits
    • Current state of Medicare and government audits
    • Top audit objectives for Medicare and government audits
    • Implications for coding and the EHR
    • Case study/quiz
    • Q&A
    • Break
  • Part 2: Commercial/managed care audits
    • Current state of commercial/managed care audits
    • Top audit objectives for commercial/managed care audits
    • Implications for coding and the EHR
    • Case study/quiz
    • Q&A
    • Break
  • Part 3: Physician practice and Quality Payment Program audits
    • Current state of audits for physician practices
    • Top audit objectives for physician practices
    • Implications for coding and the EHR
    • Case study/quiz
    • Q&A

Continuing Education

(Live + On-Demand) - This program is approved by the Council for Certification of Medical Auditors, Inc for 3.0 continuing education contact hours.

Ability to claim credits for this webinar expire on: 7/23/19

Meet the Speaker

William L. Malm, ND, RN, CRCR, CMAS

William L. Malm, ND, RN, CRCR, CMAS, is a managing director at Health Revenue Integrity Services in Cleveland and Melbourne, Australia. He is a nationally recognized author and speaker on topics such as value-based care, healthcare compliance, chargemasters, and CMS recovery audits. He also brings a decade of experience with payer acute care audits. Malm has over 25 years of experience with a combination of clinical and financial healthcare knowledge that encompasses all aspects of revenue integrity. Previously, Malm played a key role in providing revenue integrity and data expertise for Craneware, PLC. He also serves as the president for the Certification Council of Medical Auditors. He has extensive experience with all prepayment and post payment audits, having worked as a systems compliance officer at a large for-profit healthcare system. Malm also co-hosts Appeal Academy’s “Finally Friday” discussions.

Sharon Easterling, MHA, RHIA, CCS, CDIP, CRC, FAHIMA

Sharon Easterling, MHA, RHIA, CCS, CDIP, CRC, FAHIMA, is the CEO of Recovery Analytics, LLC. Clinical documentation integrity and quality has been her career focus. Beginning her HIM journey over 20 years ago, Easterling’s experience is extensive: She has worked in a variety of HIM areas such as inpatient and outpatient coding, utilization review, CDI, and recovery audits, as well as managing HIM and coding departments. Easterling has worked in acute and ambulatory settings throughout her career, both strategically and operationally. She has served as corporate assistant vice president of a major integrated health system in the Southeast leading systemwide denial management, education, and defense, as well as senior director of ambulatory clinical documentation improvement at a large medical group.

Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
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. 

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 $399 value! 

Participation in the webinar is just $399 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email if you have questions.