Who am I receiving an audit request from?
From the Office of the Inspector General to Medicare Administrative Contractors and recovery auditors, there are several different government agencies that you may receive Medicare and Medicaid audit requests from. You may also get audit requests from commercial payers, including Medicare Advantage Plans, which tend to focus on specific issues. This video reviews the difference between government and commercial payer audits; as well as discusses common causes of improper payments.
Robert A. Wade, Esq.
Barnes & Thornburg LLP
- Partner in the office of Barnes & Thornburg LLP
- Practice emphasizes all aspects of health care compliance, including developing, monitoring, and documentation of an effective compliance program
- Served as the compliance expert to the Board of Commissioners of Halifax Health, advising the hospital on all aspects of their corporate integrity agreement
- Has experience in representing health care clients with respect to issues being investigated by the Department of Justice and the Office of Inspector General and negotiating and implementing Corporate Integrity Agreements
- Assists clients in documenting and defending financial arrangements between health care providers, including referring physicians, as being fair market value and commercially reasonable
- Has operationally practical experience, having served as a general counsel and organizational integrity officer for a multihospital system for 6 1/2 years
- Host of Stark Integrity: The Stark Law and Compliance Podcast
- Conducts regular seminars and workshops on numerous health care laws, which includes the False Claims Act, Stark Law, and the Anti-Kickback Statute
- Wrote several publications related to the areas of health care law
- Best Lawyers In America®, health care law, 2009-2014; Indiana Super Lawyers, 2009-2015
- J.D. degree, summa cum laude, Ohio State University, Moritz College of Law, Columbus, Ohio; B.A. degree, summa cum laude, Bowling Green State University
- Can be contacted at 574-237-1107 or [email protected]
Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions, LLC
- President and CEO of MedLucid Solutions, LLC, providing clear solutions for medical practices
- Assists clients with all aspects of coding, billing, A/R and practice management for professional health care services, including chart reviews, education, practice assessments, practitioner shadowing, and interim management support
- Conducts regular seminars and workshops on numerous topics, including E/M documentation guidelines, annual coding updates, and specialty specific coding sessions for clinicians and staff
- Certified Professional Coder (CPC) and a Certified Professional Coding Instructor (CPC-I), American Academy of Professional Coders (AAPC); Certified Coding Specialist Physician Based (CCS-P), and American Health Information Management Association (AHIMA)
- Taught medical billing and coding as an adjunct instructor at Sanford Brown College, Indianapolis; online adjunct instructor at Ultimate Medical Academy
- Published author on articles related to billing, coding and A/R management
- Current member of the WPS Medicare Part B J8 Provider Outreach and Education Advisory Group (POE AG)
- Billing, coding and practice management representative for the Indiana State Medical Association
- B.S.M. degree, summa cum laude, Indiana Wesleyan University
- Can be contacted at 317-537-7553, [email protected], www.medlucidsolutions.com or on LinkedIn® and Facebook®
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