Catalog Number : caa1233
Title : Conducting an APC Audit
Speaker : Duane Abbey

Webplay Recording Date : 4-19-2006
Webplay Price : $ 225 for two weeks viewing

Webinar Presenter: Duane C. Abbey, Ph.D., CFP

Webinar Title: Conducting APC Audits

Webinar Level: Intermediate to Advanced Level

Webinar Overview - General:

You may think you have solid APC coding and billing processes in place, but if you don't conduct periodic audits, your organization could be losing significant revenue and risking compliance.

It happens more often than you think: Hospitals unwittingly submit outpatient claims with errors-including non-compliance with Medicare initiatives and reporting requirements. That means hospitals frequently receive either too much or far less than their entitled reimbursement.

In order to avoid common compliance issues and identify where and how you can improve revenue, you must audit outpatient claims before they’re submitted for payment.

During an actual APC audit, one hospital discovered

• Discrepancies in HIM-assigned ICD-9-CM and CPT-4 codes in 30% of the charts reviewed
• Discrepancies in Charge Description Master (CDM) CPT-4 and HCPCS codes in 29% of the charts reviewed
• Incorrect or missing HCPCS C-codes to identify pass-through devices in 15% of the charts reviewed

This two-hour Webinar, Conducting an APC Audit, unravels the knotty process of auditing APC claims and provides proven methods for accurate APC billing and auditing.

Learning Objectives Include:

• To briefly review the main features of the APC payment system.
• To understand how the APC grouping logic determines payment for outpatient services.
• To discuss the critical aspects of compliance issues surrounding APCs and related encounter driven systems.
• To appreciate the extreme importance of correct coding and modifier utilization.
• To understand how to develop an overall APC Integrity Program.
• To delineate specific types of audits and reviews that are necessary to assure proper payment under APCs.

The following are only a few of the topics to be discussed:

I. Overview of APCs and Encounter-Driven Payment System
   a. Coding Systems
   b. Overall Grouping Process
   c. General Compliance Concerns
   d. Quantitative Measures
   e. Organizational Structuring - Provider-Based Rule
II. Key Definitions and Concepts for APCs
   a. CPT/HCPCS Coding
   b. Use of Modifiers
   c. Surgical Services
   d. Evaluation and Management Services
   e. Special Areas
     i. Observation
     ii. Emergency Department
     iii. Interventional Radiology
     iv. Injections and Infusions
     v. Others
III. Chargemaster Involvement In APCs
   a. Coding Interface
   b. Cost Report Interface
   c. Charge Development Concerns
IV. Policy and Procedure Development
   a. Coding
   b. Billing
   c. Chargemaster
V. Special APC Audit Areas
   a. Correct Coding & Modifier Utilization
   b. Emergency Department
   c. Provider-Based Clinics
   d. Technical Component E/M Levels
   e. Observation
VI. APC Audit Process
   a. Selection of Cases
   b. Stratification
   c. Review Process
   d. Reports and Recommendations

Prerequisites for Participating: General knowledge of outpatient services, CPT and HCPCS coding and the overall APC grouping process.

Suggested Attendees: Outpatient Coding Personnel, Coding, Billing and Claims Transaction Personnel, Internal Auditing Personnel, Financial and Compliance Personnel, Physicians and Other Interested Personnel

Attendance Certificate: Upon attending this course you will receive a 2 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.