Medicare Audit Defend Tactics to Prevent Recoupment and Overpayment
Course Description:
A significant area of government scrutiny includes claims reviews by the Centers for Medicare & Medicaid Services (CMS) and its audit contractors to ensure CMS accomplishes it stated mission for program integrity to “prevent, detect and combat fraud, waste and abuse in the Medicare and Medicaid Programs”. Receipt of Medicare dollars obligates providers to comply with a host of regulatory requirements, leaving practices open to the always looming possibility of being audited, either by CMS and its audit contractors directly or by health plans that have been delegated the responsibility to provide Medicare coverage. Being audit ready is a necessity and helps practices avoid enforcement actions including recoupments and exclusions from participation in government healthcare programs. Even if you are fairly confident that your Practice is doing everything “correct” regarding Medicare, this webinar will provide an overview of the types of audits your practice may be subject to, audit triggers, and best practice tips to get and stay audit ready.
CMS will continue its robust auditing of Providers in receipt of government healthcare program dollars. Audits faced by providers who accept Medicare dollars include: Targeted Probe & Educate (TPE) Program audits, Unified Program Integrity Contractor (UPIC) audits, Supplemental Medical Review Contractor (SMRC) audits, and Comprehensive Error Rate Testing (CERT) audits to name a few. Understanding the requirements of these audits and how to appropriately prepare for when (not if) the audit occurs is critical to protect your provider business. Preparation can decrease the administrative burden and costs on providers when inevitably faced with an audit.
When adverse results occur, CMS and its contractors have powerful tools to recoup overpayments and address program integrity concerns in connection with adverse audit results. Thus, an understanding of Medicare audit defense strategies have the potential to significantly lower damages amounts. This webinar will provide an overview of provider appeal requirements in addition to the current audit landscape, audit risks, and best practices related to CMS audits.
The myriad of Medicare requirements makes it nearly impossible for practices to be 100% compliant with regulation. Attendees will learn what are the key Medicare audits and enforcement actions. This webinar will provide attendees with best practices to protect their provider businesses.
Learning Objectives:
- Comply with CMS Medicare and Medicaid Regulations and Programs
- Know how to integrate audit-readiness into your business operations
- Understand the RADV, RAC, CERT, TPE, UPIC and what do these audits test for
- Prevent you from becoming the next poster child for HHS- OIG most wanted
- Understand the current audit landscape
- Understand the requirements for the most common types of Medicare related audits
- Learn audit triggers and best practices to mitigate those triggers
- Understand how to integrate audit readiness in business operations to decrease administrative burden and costs related to responding to audits
- Learn best practices for how to respond to an audit
- Learn best practice for shaping a Medicare audit defense strategy
- Protect you and your practices from legal issues and avoid huge penalties
Areas Covered in the Session:
- CMS Medicare and Medicaid Regulation
- HHS-OIG Audits and Enforcement Guidelines
- Medicare audit triggers and how to avoid them
- Dig into what auditors want you to produce before they arrive
- Strategies after an Audit Notice
- Medicare audit defense strategy with time-tested tips
- Audits Types
- RADV
- RAC
- CERT
- TPE
- UPIC
- Other audit types
- Vocabulary and Language you should use in your responses and what to avoid
- Time-tested audit preparation response program to reduce recoupment demands
- Identify red flags in your auditor’s language to evaluate what they’re really looking for
- Response strategies to each audit type request for the highest odds of a positive outcome
- When you need to call an attorney and when you can go it alone
- Live Q&A Session
Suggested Attendees:
- Healthcare Executives and Administrators
- Compliance Officers & Lawyers
- Physicians and NPPs
- Reimbursement and Rev Cycle Personnel
- Compliance Officers
- Special Investigation Unit (SIU)
- In-House legal Counsel
- Provider Relations/Provider Education Personnel
- Medical Practice Managers
- Practice Manager
- Financial Officers
- Department Managers
- Clinical Staff
- Front Desk Team
- Every Member of the Practice/ System
About the Presenter:
Osato F. Chitou, ESQ., MPH, is the Founder and Principal Consultant of NMOC Healthcare Compliance Consulting, LLC, doing business as Compli by Osato which provides legal and compliance advisory services to Payors and Providers in receipt of Government Healthcare Funds. Ms. Chitou has a deep understanding of Government Healthcare Programs and focuses her services on Medicare and Medicaid Conditions of Participation, Private Equity backed Physician Groups, Payor Contracting, and Effective Compliance Programs.
She is a subject matter expert in Medicare DSNP, CSNP, ISNP, MMP, and PACE regulatory requirements. She presents nationally on issues related to Medicare Advantage risk adjustment, compliance requirements, and best practices related to operationalizing compliance. Ms. Chitou received her BA in Biological Anthropology from Boston University, her MPH from the University of North Carolina – Greensboro and her JD from Rutgers School of Law. Ms. Chitou is admitted to practice Law in New York, New Jersey, and the Supreme Court of the United States.
Additional Information:
After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.
System Requirement:
- Internet Speed: Preferably above 1 MBPS
- Headset: Any decent headset and microphone which can be used to talk and hear clearly
Can’t Listen Live?
No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com
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