Payment Suspensions, Recoveries and Other Issues: Government Audit and Enforcement Activity is Increasing, Be Prepared!

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Avoid Common Errors in Face-To-Face and Identify Issues Related To Physician Orders That May Lead to Audit Recoveries

Audit activity continues to trend upward. The MAC face-to-face audits are in full swing and identifying error rates approaching 90%. The Recovery Audit Contractor (RAC) program is back online and ZPIC activity is increasing. Auditors are not only seeking recoveries, but in some instances are imposing six month payment suspensions based on audit findings. In this environment, documentation compliance is more important than ever as payment suspensions, pre-payment reviews and recoveries can be fatal to a provider.

In this session, Robert W. Markette, Jr., CHC, a healthcare regulatory compliance expert, will review current problems identified in government audits. He will shed light on common errors in face-to-face as well as other matters including issues related to physician orders and other missing documentation that lead to recoveries by auditors. Robert will also review compliance steps to identify and prevent those problems before they occur.

Additionally, get strategies to address non-compliant physician documentation, why it is important that nurses sign and date the 485, and issues related to re-certifications and therapy goals.

Session Highlights:

  • Payment Suspensions – A little known government remedy that is becoming more common.
  • Face-to-Face MAC Audits – Where are we and where are we going?
  • How to leverage physician communication in order to support face-to-face documentation.
  • Face-to-Face isn't the only reason claims are denied,  other common denials from auditors, including recertification narratives, long term and short term goals, medical necessity and more.
  • Compliance Program Auditing and Monitoring – Why it is important to check yourself before the auditors arrive.
  • Responding to an ADR from the ZPIC – Why it might be important to be more proactive.
  • Responding to ADRs Generally – Common mistakes to avoid.

 Session Snapshot:

  • Audits, investigations and other government activity
    • MAC Face-to-Face Audits
    • ZPIC Activity
    • CERT Audits
    • MICs
    • Medicare and Medicaid RACs
  • RAC Recovery Trends
  • Appeal Filing Trends
  • DAB Delays
  • Suspension for Overpayment
  • Common Issues
  • F2F Compliance: Certification, Documentation, Clinical Note
  • CMS 485
  • Prevention
  • Education and Training

Who should attend

Administrators, Directors of Nursing, billing personnel, compliance personnel, ownership

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About Our Speaker

Robert W. Markette - Home Care Expert

For more than a decade, Robert W. Markette, Jr., CHC, has focused his practice on representing home health, hospice, private duty and DME providers in all aspects of their operations. With more than a decade of experience in working with these industries, Robert has developed a reputation for understanding the operational, compliance and legal/regulatory issues facing homecare providers.

In representing the homecare industry, Robert...   More Info
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