Catalog Number : cra1944
Title : Conducting Inpatient and Outpatient Audits
Speaker : Duane Abbey

Webplay Recording Date : 7-13-2016
Webplay Price : $ 150 for two weeks viewing

Webinar Description:

How do we check to make certain we are coding and billing appropriately? What kind of outpatient audits should be conducted? How do inpatient and outpatient audits differ? To answer these questions and more please come join us in this upcoming Webinar.

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 appreciate the processes surrounding inpatient and outpatient audits
• To understand the audit process and techniques for selecting cases, 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 complexity of inpatient and outpatient reviews
• To appreciate the coding interface to the chargemaster for outpatient coding and billing
• To have knowledge of how to establish an ongoing CBR audit program along with special ad hoc audits
• To appreciate the RAC audits and the need to prepare with CBR audits

Target Audience: 

All personnel involved with coding, billing, and reimbursement activities. Compliance Officers, Compliance Analysts, Chargemaster Coordinators, Internal Auditors, other compliance personnel, financial analysts and other interested administrative personnel, coding staff, health information specialists, claims transaction personnel, .patient financial management personnel. Nurses and physicians are encouraged to attend.

A Few of the Topics that will be covered:

• 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
  • MAC Audits
  • The Chargemaster and Coding
• Payment Systems
  • Cost-Based Systems
  • Prospective Payment Systems
    • APCs
    • MS-DRGs
    • Other
  • Fee Schedule Payment Systems
    • MPFS and RBRVS
    • Other
  • Managed Care Contracts
    • Fee-for-Service
    • Special Provisions
  • Payment System Compliance
• Auditing Process
  • Systematic Approach
  • Problem/Opportunity Identification
  • Audit Design
  • Differences Between Inpatient and Outpatient Audits
  • 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
• Establishing a CBR Audit Program
  • Inpatient
  • Outpatient
  • Special
  • Medicare vs. Private Payers
• Sources for Additional Information
• Case Studies

Attendance Certificates:

All participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program.

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.