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OnDemand Course

Medical Record Audits: The Must Know About Commercial and Government Provider Reviews and Repayments

Gain an understanding of what is needed to stay compliant with medical record audits.

Many physicians and other health care providers do not fully understand the implications and consequences of a payor audit, particularly when the payor is the federal government. Appropriate documentation is required to avoid recoupment and fines when payers audit medical records. What should you do when you discover a significant billing error or a coder complains about a provider's billing patterns? This topic helps health care organizations, providers, and billers understand the trends in payer audits on professional services, including the latest CMS probe and educate reviews. Learn what's important in the documentation and what to do to prevent an unfavorable audit and discover how to utilize your health care attorney and independent reviewers to strengthen your compliance program and deal with overpayment issues.

91 minutes
Certificate of Completion
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Why Lorman?

Over 35 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

What Causes the Initiation of a Billing Review (Internal vs. External)?

Should the Commencement of the Billing Review Be Under the Attorney-Client Privilege?

Utilizing Internal vs. External Reviewers to Perform the Billing Review

Conducting the Review Based Upon Operational Oversight vs. Attorney Oversight

Differences Between Medicare/Medicaid and Third-Party Payers

Repayment Based Upon Reprocessing of Claims vs. the Requirements for Self-Reporting to Applicable Payers

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Why Lorman?

Over 35 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Course

Applications have not yet been submitted for Delaware, Idaho, Kentucky, Maine, New Hampshire, Ohio, Oklahoma, South Carolina, and Wyoming CLE for this course. However, if you are interested in obtaining CLE for any of the listed states or have any additional credit questions please email us at [email protected] or call us at 866-352-9540.

This course was last revised on September 16, 2019.

Call 1-866-352-9540 for further credit information.

  • AK CLE 1.5
     
  • Alaska attorneys may receive 1.5 hours of continuing legal education for completing this program. Please contact the Alaska Bar Association or go to www.alaskabar.org for details regarding reciprocity with other states.
     
  • AL CLE 1.5
     
  • This course or a portion thereof has been approved by the Alabama State Mandatory Continuing Legal Education Commission for a maximum of 1.5 hours credit.
     
  • Arizona CLE 1.5
     
  • The Arizona State Bar does not pre-approve or pre-certify MCLE programs. However, records of this program and attendance will be maintained by Lorman Education Services for auditing purposes. This activity may qualify for up to 1.5 hours toward your annual CLE requirement for the State Bar of Arizona.
     
  • CA MCLE 1.5
     
  • Lorman Business Center, LLC. is a State Bar of California approved MCLE sponsor and this course qualifies for 1.5 CLE hours of participatory credit.
     
  • CT CLE 1.5
     
  • Neither the Connecticut Judicial Branch nor the Commission on Minimum Continuing Legal Education approve or accredit CLE providers or activities. This course has been approved for CLE credit in jurisdictions aside from CT and therefore it automatically meets the content and delivery requirements in Connecticut. Credit is based on a 60 minute credit hour and shall be awarded as follows: 1.5 CLE credit(s).
     
  • GA CLE 1.5
     
  • This program has been approved by the Georgia Commission on Continuing Lawyer Competency for 1.5 CLE hours.
     
  • MO CLE 1.8
     
  • This course qualifies for self-study CLE credit in Missouri.
     
  • MS CLE 1.5
     
  • This program has been approved by the Mississippi Commission on Continuing Legal Education for a maximum of 1.5 credit hours.
     
  • NJ CLE 1.8
     
  • This program has been approved by the Board on Continuing Legal Education of the Supreme Court of New Jersey for 1.8 hours of total CLE credit.
     
  • NM CLE 1.5
     
  • This program has been approved by the New Mexico Minimum Continuing Legal Education Board for 1.5 hours of credit.
     
  • PA CLE 1.5
     
  • This Distance Learning program has been approved by the Pennsylvania Continuing Legal Education Board for 1.5 hours of substantive law, practice and procedure CLE credit.
     
  • RI CLE 1.5
     
  • This program has been approved by the Rhode Island Mandatory Continuing Legal Education Commission for 1.5 hours of CLE credit.
     
  • VT CLE 1.5
     
  • This self-study program has been approved by the Mandatory Continuing Legal Education Board of Vermont for 1.5 hour(s) of CLE credit. Please note: Attorneys may only claim 12 credits per compliance period in this format. This course is considered "Non-Moderated Programming without Interactivity".
     
  • WA CLE 1.5
     
  • This program has been approved by the Washington State Board of Continuing Legal Education for 1.5 hours of A/V credit under the Law & Legal Procedure category.
     
  • WV MCLE 1.8
     
  • This program has been approved by the West Virginia State Bar MCLE Commission for 1.8 MCLE hours.
     

To earn each credit Lorman offers through the OnDemand learning platform, you need to watch 100% of the program. Also, for certain credits you will need to fulfill additional requirements which will be displayed on the "credits" tab when viewing the course.

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

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Why Lorman?

Over 35 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Carol Hoppe, CPC, CCS-P, CPC-I

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┬«
Robert A. Wade, Esq.

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]
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Why Lorman?

Over 35 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

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Pay once and get a full year of unlimited training in any format, any time!

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Questions? Call 877-296-2169 to speak with a real person.

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Product ID: 406182
Published 2019
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