Catalog Number : cca1628
Title : The RACs, OIG & Statistical Extrapolation
Speaker : Duane Abbey

Webplay Recording Date : 3-6-2014
Webplay Price : $ 125 for two weeks viewing

Webinar Overview:

Exactly how is statistical extrapolation conducted? What issues from the RAC audits can involve statistical extrapolation? Can statistical extrapolation be used by hospitals and clinics internally? To answer these questions and more come join us for this Webinar.

Webinar Objectives:

• Review Current RAC and OIG Activities for Healthcare Providers
• Review Current and Future Issues than May Involve Statistical Extrapolation
• Appreciate E/M Coding for the ED
• Understand How the "-25" Modifier Can Be Misused
• Explore the Overall Process of Statistical Extrapolation
• Understand the Sampling Process to Determine Error Rate
• Appreciate the Final Sampling Size and Audit Process
• Understand the Way in Which Repayment Demands Are Calculated
• Understand the Use of OIG' RAT-STATS Program For Statistical Extrapolation
• Appreciate Healthcare Providers' Use of Statistical Extrapolation Internally
• Understand the OIG's Use of Compliance Integrity Agreements Relative to Extrapolation

Target Audience:

Chief Compliance Officers, CBR Compliance Officers, Healthcare Auditors, Healthcare Compliance Personnel, Chargemaster Coordinators, Billing and Claims Generation Personnel, Patient Financial Management Personnel, Cost Accounting Personnel, Cost Report Personnel, Financial Analysts, Managed Care Contract Personnel, Revenue Enhancement Personnel, Chief Financial Officers, Chief Compliance Officers, Financial Planners, Hospital Legal Counsel, and Hospital Personnel Interested in Compliance

A few of the Topics that will be covered:

• CMS Federal Auditing Programs
  • Recovery Audit Contractors (RACs)
  • OIG Audits
  • CERTs
  • MAC
  • Other
• Issues Amenable for Statistical Extrapolation
  • Repetitive Errors in Coding, Billing and Reimbursement
  • "-25" Modifier on E/M Levels
  • "-59" Modifiers for Distinct Services
  • E/M Levels
  • Other
• The Process for Statistical Extrapolation
  • Identified Problem Areas
  • Identification of the Universe of Claims for Consideration
  • Probe Audit to Determine Error Rate
  • Calculation of Statistically Valid Sample Size
  • Selection of Cases from the Universe on a Random Basis
  • Conduct of the Audit on the Selected Sample
  • Calculation of the Overpayment Recoupment
• OIG RAT-STATS Program
  • Program Used By Federal Auditors
  • Freely Available
  • Features Use for Healthcare Extrapolation
  • Other Statistical Software
• Case Studies
  • "-25" Modifier
  • ER E/M Levels
  • Physician Visit E/M Levels
  • Hospital Internal Use to Calculate Overpayment Refunds
  • Improper Extrapolation by Auditors
• Associated Issues
  • Use of Statistical Consultants
  • Use of Legal Counsel
  • Understanding Audit Guidelines
  • OIG Compliance Integrity Agreements (CIAs)
• Sources for Further Information

Contact Hours:

Upon attending this course you will receive  a 1.5 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.