Defend CMS Audits and Penalties: 2024 Medicare RADV & RAC Audits Rules

Course Description:

The goal of the presentation is to provide techniques and practical strategies for healthcare professionals, administrators, and organizations for inevitable RAC (Recovery Audit Contractor) and RADV (Risk Adjustment Data Validation) audits. By focusing on proactive preparation, strategic planning, and bolstering resilience, this presentation will effectively equip healthcare systems with the tools and knowledge necessary to navigate the challenges. Attendees will receive a deeper understanding of audit processes, potential vulnerabilities, and practical strategies to fortify their systems, ensuring compliance and mitigating risks. Ultimately, the goal is to empower healthcare professionals to proactively address audit challenges, optimize operational efficiency, and safeguard the financial integrity of their organizations.  

Learning Objectives:

• Understand the complexity of audit processes
• Implement actionable strategies and best practices to lessen denials
• Ensure compliance with regulatory requirements and standards related to RAC and RADV audits
• Improve operational efficiency and responsiveness to audits
• Identify potential vulnerabilities

Areas Covered in the Session:

• Introduction of RADV and RAC Audit
  • RAC (Recovery Audit Contractor) Audit
  • RADV (Risk Adjustment Data Validation) Audit
• What is the Regulatory Framework
• Difference Between RAC & RADV
• Understanding The Navigation of Audits
  • Audit Selection Criteria
  • Data Analysis Methods
  • Medical Record Review Process
  • Coding and Billing Practices
  • Financial Impact
  • Continuous Monitoring and Improvement
  • Appeal Process
  • Operational Challenges
• Audit Stages and Challenges
• The Process for RAC Audit
• The Process for RADV Audits
• Regulatory and Standard Requirements
• Reasons for Appeal Denials
• Appeals and Dispute Resolution
  • Procedures for appealing RAC and RADV audit findings
  • Common reasons for appeal denials and successful appeal strategies
  • Legal considerations in the appeals process
• Strategies to Reduce Denials
• Compliance for RAC Audits
• Compliance for RADV Audits
• Improving Operational Efficiency
• Identifying Potential Vulnerabilities
• Future Trends and Challenges

Suggested Attendees:

• Healthcare Executives
• Medical Providers
• Medical Coders
• Medical Billers
• Medical Auditors
• Clinical Documentation Integrity Professionals
• Denials Management Team
• Population Health Professionals
• Revenue Cycle Management Professionals
• Healthcare Administrators
• Compliance Officers 

About the Presenter:

Sandra Love, MSN, RN, CCDS, CCDS-O, CPC, is the director of solutions for Norwood in Austin, TX. She has more than 17 years of nursing experience and 11 years in CDI. Previously, Love served as a manager of outpatient clinical documentation excellence at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina, where she helped implement two pediatric CDI programs and an outpatient CDI program. A past president of North Carolina ACDIS, Love has spoken at ACDIS chapter meetings and past national ACDIS conferences. She is also a former member of the ACDIS Events Committee and ACDIS Leadership Council.  

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 hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

Snippet From Our Previous Session:

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Testimonials:

"This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course"

Melissa Preston, Health Information Management Staff

"David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN" 

Sandie Fowler, Out of Network Billing Staff

"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer