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Prepare Your Agency for Government Audits

Product Code: YPADA102220A

Quick Overview

CMS has lifted the hold on home health claims reviews and resumed audit programs such as the Review Choice Demonstration. Learn how to minimize risks of review and avoid an unfavorable outcome.

Price: $249.00

Prepare Your Agency for Government Audits

Prepare Your Agency for Government Audits

Presented on: Thursday, October 22, 2020 | 1–2:00 p.m. Eastern

Presented by: Joe Osentoski, BAS, RN-BC

CMS just lifted the hold on home health claims reviews—such as Targeted Probe and Educate—and resumed audit programs such as the Review Choice Demonstration. As agencies transition from the review pause into a higher review risk, any audit triggered will add stress on operations and finances to address these administrative costs.

During this 60-minute webinar, expert speaker Joe Osentoski, BAS, RN-BC, will cover how to prepare your agency for the resumption to minimize risks of review, and how to avoid an unfavorable outcome if a review takes place.

This webinar will go over the CMS review contractors and the types of medical review each one performs. It will address waivers and relaxed documentation requirements that were available under the COVID-19 public health emergency (PHE). The program will cover triggers for reviews under the Patient-Driven Groupings Model (PDGM), looking at key prevention areas in which to focus ongoing quality improvement activity. Finally, Osentoski will provide an outline of how to respond to a review to maximize the chance of a successful outcome.

At the conclusion of this program, participants will be able to:

  • List the types of reviews conducted by CMS review contractors
  • Describe PHE waivers available to clinical documentation
  • Analyze patterns and billing practices that raise the risk of medical review
  • Describe steps to take in response to a review


Agenda

Take a look at the detailed agenda:

  1. CMS medical reviewers. This section will look at Medicare Administrative Contractors (MAC), Unified Program Integrity Contractors (UPIC), Supplemental Medical Review Contractors (SMRC), Recovery Audit Contractors (RAC), and Comprehensive Error Rate Testing (CERT) contractors. It will cover the types of reviews they issue, including Targeted Probe and Educate (TPE) and Review Choice Demonstration (RCD) by the MAC.

  2. PHE waivers available to clinical documentation. We’ll look at the post-PHE status of these waivers, including applicable dates of review and applicability of these waived items to dates of service.

  3. Patterns and billing practices that raise the risk of medical review. We’ll address two time points in a record’s lifespan that are vital for quality improvement action: admission and prior to final billing. Specific areas of high denial risk will be identified so agencies can implement timely preventive action. The admission review items also significantly support RCD success.

  4. Types of medical reviews (e.g., pre-payment, postpayment, audit, review, complex, automated). We’ll outline key response actions that will maximize an agency’s chance of a successful outcome. This includes timelines, method of response, items to review, and often-missed items.

Who Should Listen?

  • Home health administrators
  • Billers
  • Clinical managers
  • Compliance officers
  • Directors of nursing
  • Quality managers
  • Clinicians
  • Medical practices
  • Physicians

Meet the Speaker

Joe OsentoskiJoe Osentoski, BAS, RN-BC, ADR and appeals specialist with Gateway Home Health Coding & Consulting LLC, specializes in additional documentation request (ADR) responses and appeals. As a registered nurse for more than 25 years, his career has included clinical consulting in home health and hospice specializing in clinical quality assurance and regulatory compliance. He also has extensive experience with all types of Medicare audits and probes from the spectrum of Medicare contractors. He is a contributor to industry newsletters Home Health Line and Eli’s Home Care Week, and authored The ADRs and Appeals Handbook from DecisionHealth. Osentoski has completed over 5,000 ADRs in home care and hospice, filed thousands of appeals, and attended hundreds of Administrative Law Judge (ALJ) hearings on behalf of clients.

Continuing Education

Board of Medical Specialty Coding & Compliance (BMSC)
This program is preapproved by the Board of Medical Specialty Coding & Compliance (BMSC) for CEU(s).

Instructions

Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

CAN'T LISTEN LIVE? 
No problem. The On-Demand version is also available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $249 value! 

PLEASE NOTE 
Participation in the webinar is just $249 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 855-225-5341 or email customer@decisionhealth.com  if you have questions.