Catalog Number : cra1067
Title : Coding, Billing & Reimbursement Compliance Audit
Speaker : Duane Abbey

Webplay Recording Date : 8-7-2014
Webplay Price : $ 125 for two weeks viewing

Webinar Objectives:

• To understand the broad spectrum of compliance areas to which hospitals, systems, physicians and clinics are subjected
• To understand the severity of current compliance issues, the auditing process and associated penalties
• To appreciate the importance of written policies and procedures for coding, billing and the chargemaster
• To understand the audit process and techniques for selecting charts, billing and remittance information for review
• To have knowledge of the statistical techniques for developing formal and informal audit processes
• To appreciate the role and use of computer technology in maintaining compliance and the process of auditing computer software and its utilization
• To understand the auditing process interface to various CBR Policies and Procedures and the CBR compliance program
• To understand the need to facilitate the auditing process with various hospital/clinic personnel so that the auditing process can be used effectively as an educational tool
• To appreciate the RAC audits and the need to prepare with CBR audits.

Webinar Outline/Agenda:

• Introduction
  • Healthcare Compliance Overview
  • Importance of Understanding and Meeting Rule/Regulations
  • Statutory versus Contractual Compliance
  • Systematic Approach to Maintaining Compliance
  • OIG Work Plans and Compliance Guidance
  • RAC Audits
• Payment Systems
  • Cost-Based Systems
  • Prospective Payment Systems
    • RBRVS
    • MS-DRGs
    • APCs
    • Other
  • Managed Care Contracts
    • Fee-for-Service
    • Special Provisions
  • Payment System Compliance
• Auditing Process
  • Systematic Approach
  • Problem/Opportunity Identification
  • Audit Design
  • Use of the OIG’s RAT-STATS Program
  • Reviewing Cases and Documenting Results
  • Report Development
  • Effecting Organizational Change
• Organizational Dynamics
  • Team Dynamics
  • Computer System Reports
  • Use of External Consultants/Legal Counsel
  • Coding, Billing & Reimbursement Policies and Procedures
• Sources for Additional Information
• Case Studies

Target Audience:

• Compliance Officers
• Compliance Analysts
• Chargemaster Coordinators
• Internal Auditors
• other compliance personnel
• financial analysts and other interested administrative personnel
• health information specialists
• claims transaction personnel
• patient financial management personnel
• Nurses and physicians are encouraged to attend

Attendance Certificate:

Upon attending this course you will receive a 1.5 Contact Hour Attendance Certificate or a 1.8 Nursing CEU. 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.