Cross Recovery Recoupment for Physicians and Hospitals

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Learn How to Avoid Cross Recovery Situations and Comply with Regulations

Cross recovery is a sleeper issue in healthcare compliance, and can arise in a multitude of settings and circumstances. While it is currently not a high priority compliance area for federal and state auditors, the time is not far when it will be more aggressively addressed. As a physician or healthcare provider, you need to avoid noncompliance and prevent potential cross recovery situations by ensuring that your policies and procedures are properly in place.

Join this audio conference by industry veteran Duane Abbey, who will bring you up to speed with different types of cross recovery situations, about the federal entities out there, and what federal auditors will likely be looking for. You will learn what physicians should do if the hospital service is denied, the key compliance issues, as well as what kind of policies and procedures physicians, hospitals and other healthcare providers should have in place with regard to cross recovery.

After attending the webinar, you will be able to develop strategies to successfully address and/or prevent cross recovery situations, and stay compliant with the latest regulations.

Session Highlights

This session will bring you up to speed with:

  • Just what is cross recovery?
  • Federal auditing entities  
  • Are the federal auditors interested?
  • What should physicians do if the hospital service is denied?
  • Key compliance issues involving cross recovery
  • What kind of policies and procedures should physicians, hospitals and other healthcare providers have relative to cross recovery?
  • Can Medicare Secondary Payer (MSP) become involved in cross recovery?
  • Are there any challenges with observation versus inpatient admissions?
  • Do the Medicare Advantage programs become involved in these issues?

Session Objectives

Abbey will:

  • Review and discuss the different types of federal and state auditing entity including the RACs, OIG, ZPICs, etc.
  • Explain the statutory and regulatory authorities surrounding cross recovery
  • Briefly review the appeals process for contested claims
  • Explore the types of situations that lend themselves to cross recovery issues
  • Discuss different cross recovery scenarios
  • Teach you how to develop strategies for establishing written policies and procedures to address potential cross recovery issues
  • Bring you up to speed with the types of compliance issues that generate cross recovery situations
  • Discuss strategies for different healthcare providers working together to avoid cross recovery situations
  • Cover special situations such as MSP and MA Programs

Session Agenda

  • Introduction
    • Overview
    • Compliance issues
    • Pre-payment audits vs. post-payment audits
  • Auditing entities and appeals process
    • RACs – various types
    • OIG
    • ZPICs
    • MICs
    • CERT
    • Appeals process
  • Compliance issues
    • IP vs. OP – over two midnight rule
    • Site-of-service
    • Medical necessity – clinical vs. payment documentation
    • Over three-midnights rule
    • Medical secondary payer
    • Medicare advantage programs
  • Policy and procedure development
    • Physician and hospital issues
    • Hospitals and nursing facilities
    • Hospitals and home health
    • Physician professional versus hospital facility billing
    • Physicians – freestanding clinics vs. provider-based clinics
    • Payment documentation
  • Case studies

Who Should Attend

All personnel involved with compliance, coding, billing and reimbursement, financial analysts, health information management personnel, financial personnel, patient financial services personnel, chargemaster coordinators, provider-based clinic and/or clinical operations personnel, physicians and practitioners, and other interested personnel.

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-844-384-4744 Today

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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