Learn how to effectively audit physician's notes and how to report the findings.
This topic will provide a resourceful overview of the monitoring and auditing process. Common questions such as: What is an audit? What do we do with the results? How can we mitigate compliance risks moving forward? You will walk away with a better understanding of the benefits and requirements of a monitoring and audit program within your organization. This information will also include when to seek advice from legal counsel, regulatory requirements and how to implement change for the road ahead.
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Role of Monitoring and Audit Programs
- A) Third Party Audits-How To Respond and What To Expect
- B) Internal and Quality Assurance Audits
- C) Monitoring vs. Auditing
- D) Challenges and Advantages of Coding Audits
- E) Coding Audits-What Do They Entail
- F) Creating An Effective Compliance Program/OIG Guidelines and Workplan
Findings and Results
- A) Documentation Issues Uncovered
- B) Potential Compliance Dangers
- C) Risk Areas
- D) Error Rates
- E) Seeking Legal Guidance Communicating Results and Potential Repayments
- F) Reporting Requirements/ Self Disclosure Protocols
- G) Future Monitoring/ Re-Audit Plan
- H) Implement Changes
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This course was last revised on October 31, 2019.
Call 1-866-352-9540 for further credit information.
This program does NOT qualify, nor meet the National Standard for NASBA accreditation.
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Murtha Cullina LLP
- Partner with Murtha Cullina LLP and serves as the co-chair of the firm’s Health Care Group
- Well known for his skills as a complex litigator, as a health care lawyer, and as an arbitrator
- Former clerk to Judge Leonard P. Moore of the United States Court of Appeals for the Second Circuit, he is a member of the Bar of the States of New York, Connecticut, Rhode Island, and Massachusetts
- As a health care lawyer, he has handled litigation, regulatory and transactional, including acquisitions, joint ventures, non-compete litigation, health care arbitration, HIPAA advice and claims, Stark and fraud and abuse, joint ventures, 501 (c ) (3) matters and issues, EMTALA, CONs, DONs, physician contracting, risk management, licensure and disciplinary, patient care, and medical staff matters, experience representing both payor and provider
- Experience with ACOs, IPAs, and the like; he serves as an arbitrator for both the AHLA and AAA. He is the original author of a treatise on HIPAA
- His approach to his practice is to seek to understand client goals, and to provide advice that will further those goals in a practical and appropriate manner; he is hard working and always looking for inventive ways to address client problems
- Past chair of the Health Law Section of the Connecticut Bar Association and past president of the Connecticut Health Lawyers Association
- Served on the Health Care Task force of the American Arbitration Association
- Listed in Chambers USA, Connecticut Super Lawyers, The Best Lawyers in America, and Who’s Who and achieved the highest rating in The Martindale-Hubbell Law Directory
- J.D. degree, Harvard Law School
Cheryl Krusch, LPN, CPC, CPMA, ICDCT-CM
- Director of auditing and clinical documentation improvement at VantagePoint, LLC where she manages a team of coding and auditing specialists
- Has been in the health care field for 30+ years, with extensive experience working in physician private practice, healthcare facilities and insurance carriers
- Her focus is clinical documentation auditing, training of coders and billers, and physician education on accurate coding and documentation
- Prior to joining VantagePoint, she was clinical coordinator for the Connecticut State Medical Society-IPA
- Began her career as a nurse with experience in hospital, nursing home and private physician office settings and prior to joining the Medical Society team, she worked for two national health plans
Susan Prior, CHC
- President and Chief Operating Officer of VantagePoint, LLC
- As a partner at VantagePoint for the past fifteen years, she has full management and strategic responsibility for oversight of VantagePoint’s daily operations and business development
- Diverse background and experience allows her to assist clients with strategic planning, revenue cycle management, contract negotiation, business analytics, provider compensation design and operational re-design She works with a variety of clients including hospitals, private practices, integrated health care delivery systems, ASCs, and investors
- She is intently focused on the challenges faced by hospital-based medical groups from operational, reimbursement, and regulatory perspectives, helping develop strategies for their long-term success
- Certified in health care compliance through the Health Care Compliance Association (HCCA), she also works with clients to develop risk mitigation strategies and with attorneys to provide consultative assistance on a variety of fraud and abuse matters
- Completed several projects involving work with Medicare, Medicaid, private payers, the OIG and the FBI
- Was also the driving force behind VantagePoint achieving certification with the National Committee on Quality Assurance (NCQA) as a Credential Verification Organization (CVO) for its line of enrollment and primary source verification service
- Has served as the president of the Health Financial Management Association (Connecticut chapter), on the National Advisory Committee for HFMA National, former Treasurer of Women Executives in HealthCare and is currently on the Board of the American College of Healthcare Executives and Chair of the Women’s Forum
- Graduate, University of Connecticut
- Can be contacted at 203-288-6860 or [email protected]
Melissa Walsh, CPC, ACS-AN
- Coding auditor and trainer at VantagePoint, LLC where she audits Evaluation and Management (E&M) services, medical office and surgical procedures for physician practices
- Brings to Vantagepoint 20+ years of experience in health care working in physician private practice; her background includes coding, compliance, auditing, revenue cycle and credentialing
- Completed the Professional Medical Coding Curriculum in 2013 and is a Certified Professional Coder (CPC) through the American Association of Professional Coders (AAPC); additionally, she is Certified in Anesthesia and Pain Management Coding (ACS-AN) through the Board of Medical Specialty Coding
- In addition to auditing work, she also educates providers on proper coding and documentation and analyzes coding trends by specialty for physicians and midlevel providers
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