Boot Camps

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 payor 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 for financial health. Developing and performing risk-based claims audits can potentially reduce payor audits and identify compliance gaps and revenue opportunities. Medicare Boot Camp®—Healthcare Claims Audit is your key to proven strategies for success and will answer your questions on designing a claims audit that is meaningful to an 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

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 you 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 is hoping 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
• Utilizations review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeals 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 audits 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 that will help you build a comprehensive architect of an 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 615-724-7200 or email PD-IS@SimplifyCompliance.com.

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

Medicare Boot Camp®—Healthcare Claims Audit

Course Locations & Dates

Below is the current course schedule for Medicare Boot Camp®—Healthcare Claims Audit. We update this schedule on a regular basis.

Registrations are processed in the order received. Class size is limited and classes often sell out. We recommend against making travel arrangements until after we have confirmed your course registration.

To register for a class, click the "Register" button.
If you would like to register multiple attendees (large groups), call 800-650-6787 for assistance.

To view our cancellation policy, click here.

August 2023

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Medicare Boot Camp®—Healthcare Claims Audit

Outline/Agenda

Overall Learning Outcome:

• Understand the overall framework of conducting a claims audit
• Learn various unique steps needed based on different the type of claim audit
• Understand how to examine and determine risk areas
• Learn how to pull a relevant audit sample and different methods
• Learn how to draft a comprehensive, meaningful, and actional audit report

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
• NCD & LCD
• 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 organization
• PEPPER Reports
• Targeting Outliers

Module 5: Selecting Audit Sample

• Identifying the purpose and objective
• Volume and Dollar
• Payor type
• Identify and determine what to omit
• Randomized versus Statistical Sample

Module 6: Managing Audit Details

• Organizations
• Documentations
• Electronic versus paper files
• Understanding end deliverables
• Managing voluminous audits

Module 7: Drafting 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
• Communications of findings
• Ownership and action plan
• Education and training
• Follow-up process and when necessary

Module 9: Remittance and Payer Communication

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

Course Agenda/Outline is subject to change.

Medicare Boot Camp®—Healthcare Claims Audit

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 claim audit areas
• Develop a meaningful claims audit sample
• Analyze claims and publicly available data to build an audit structure

Continuing Education

Coming Soon!

Medicare Boot Camp®—Healthcare Claims Audit

Questions and Answers

What is the focus of the Medicare Boot Camp®—Healthcare Claims Audit?
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 through 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 effectively 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?

• 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
• Utilizations review staff
• Utilization management staff
• Physician advisors
• Audit directors and coordinators
• Auditors
• Appeals 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 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Medicare Boot Camp®—Healthcare Claims Audit

COVID Safety

Simplify Compliance and HCPro place the highest priority on the safety of our guests. Simplify Compliance and HCPro will continue to monitor the COVID-19 environment and the recommended guidelines and will communicate adjustments to any onsite policies and procedures outlined in the Getting Ready for Class document that will be emailed to attendees one week and one business day prior to the class.