Medicare Boot Camp Audits, Appeals, and Denials Version

Transcription

1 Medicare Boot Camp Audits, Appeals, and Denials Version *** LIMITED TIME OFFER: FREE $100 AMAZON GIFT CARD! *** REGISTER TODAY! Course Overview Get expert guidance on preventing denials and focusing appeals efforts for success. The evolution of reimbursement models and uncertainty regarding healthcare laws mean that to keep the doors open, organizations can t afford write off appealable denials. Organizations need sound, practical information on overturning denials. Medicare Boot Camp Audits, Appeals, and Denials Version is your key to proven strategies for success and will answer all of your questions on denials management and appeals processes. This Boot Camp teaches you about the latest claim audit and appeal issues based on official guidance. You ll leave the class armed with a thorough understanding of the audit and appeal process and ready to put your new knowledge into action. You will leave this program knowing how to: Prepare for CMS audits Navigate the appeals process up to the Administrative Law Judge level Research denials and upcoming audit focus areas Implement policies to support efficient appeals and identify appropriate denials to appeal Who should attend? Revenue cycle directors and managers Revenue integrity directors, managers, and staff HIM directors, managers, and staff CDI directors, managers, and specialists Compliance directors, officers, and auditors Business office managers Case management directors and managers Case managers Utilizations review staff Utilization management staff Physician advisors Audit directors and coordinators Auditors Appeals coordinators Patient financial services directors See the HCPro Difference for Yourself Focus on the actual rules: Learn how to prepare for CMS audits and navigate the appeals process up to the Administrative Law Judge level. Tools and skills to navigate Medicare rules: Our instructors provide valuable tools and resources that will help you prioritize and research questions long after the Boot Camp ends. Hands-on learning: Attendees work a set of exercises/case studies after each module to ensure they understand the concepts and know how to apply them to real-world situations. Small class size: A low participant-to-teacher ratio is guaranteed.

2 Highly rated, well-established program: Participants consistently give the course an overall rating of 4.75 or higher (on a 5.0 scale). We currently conduct more than 30 Medicare Boot Camp courses each year. Learning Objectives At the conclusion of this educational activity, participants will be able to: Research the appeals process and related regulations Identify key steps in the appeals process up to the Administrative Law Judge level Explain common causes of Medicare denials Develop policies and practices to support compliance, reduce denials, and expedite appeals Analyze denied claims to select appropriate appeals AGENDA Outline/Agenda Module 1: Medicare Overview and Resources The Four Parts of Medicare Medicare Contractors Independent Government Agencies-Medicare Involvement Module 2: Medicare Research and Resources Web-Based Resources Key Sources of Authority Medicare Coverage Center, including LCDs NCDs, CED and Lab Coverage Manual Ways to Stay Current Module 3: Medicare Program Safeguards and Medicare Notices Medicare Policy Development, Financing, the Trust Funds, the need for Program Safeguards Improper Payments Program Safeguards Limitation on Liability provisions of the Social Security Act Notices of Non-Coverage Module 4: Prepayment Claim Reviews/Audits Prepayment Reviews Overview Automated Prepayment Reviews Prepayment Non-Medical Record Reviews Prepayment Medical Record Reviews Module 5: Postpayment Claim Reviews/Audits Establishment of Postpayment Claim Review/Audits Process Postpayment Claim Reviews/Audits Overview Postpayment Non-Medical Record Reviews Statistical Sampling and Extrapolations Postpayment Medical Record Reviews Module 6: Medicare FFS Claim Appeals Process (Part 1) Initial Determinations Reopenings and Overlap with Appeals Process Level 1 Appeal Process: Redetermination Level 2 Appeal Process: Reconsideration

3 Module 7: Medicare Appeals Process Overview (Part 2) Level 3 Appeal Process: Administrative Law Judge (ALJ) Hearing Level 4 Appeal Process: Medicare Appeals Council Level 5 Appeal Process: Judicial Review in U.S. District Court Module 8: Current Medicare Claim Audits and Appeals Issues Overview Two Midnight Expectation and QIO Review Expedited Judicial Review Medicare Overpayments Appeals Backlog Ways to Stay Current: Audit Topics Ways to Stay Current: ALJ Decisions, Appeals Council Decisions and Federal Court Decisions Course Agenda/Outline is subject to change. Please contact the event manager Marilyn (marilyn.b.turner@nyeventslist.com ) below for: - Multiple participant discounts - Price quotations or visa invitation letters - Payment by alternate channels (PayPal, check, Western Union, wire transfers etc) - Event sponsorships NO REFUNDS ALLOWED ON REGISTRATIONS Service fees included in this listing BUSINESS & LEGAL RESOURCES-BLR - New York Events List JOA190426CEV