Common Audit Triggers

Why Should You Attend:

Do you know someone who has undergone a payer audit? If so, you already know that the experience is difficult and potentially expensive. This session will review common situations that may cause the provider to be scrutinized for erroneous billing, weak coding and ambiguous documentation that is lacking in expected details.

Payer audits are on the rise, including Medicare, Medicaid, and private payers. Regardless of whether violations are found, audits are time consuming, disruptive, and expensive. The session will also emphasize how the sophistication of claims processing edits, provider profiling, and questionable billing patterns all contribute to identification of unusual coding and billing. When documentation does not support the codes billed, providers are often liable for recovery of funds and possible penalties.

Regardless of whether there are findings of erroneous payments, the process is time consuming and disruptive. Although it is generally accepted that having a compliance plan and compliance officer in place, there may still be areas of weaknesses that need to be identified. Gain some insight about those areas that frequently surface during payer audits.

Areas Covered in the Webinar:

• Diagnosis and procedure triggers
• Documentation gaps
• Incorrect place of service and unlikely units
• Comparison of hospital, physician and sedation reporting
• Questionable evaluation and management levels

Who Will Benefit:

This webinar will provide valuable assistance to all personnel in:

• Coding
• Billing
• Revenue cycle
• Physicians
• Mid-level providers
• Nurses
• Claims follow-up
• Managers

Instructor Profile:

Dorothy D. Steed (CCS, CDIP, COC, CPCO, CPUM, CPUR, CPHM, CPMA, ACS-OP, CCS-P, RCC, RMC, CEMC, CPC-I, CFPC, PCS, FCS, CPAR) is an independent healthcare consultant and educator in Atlanta. She was a Medicare specialist for a large hospital system and a physician coding audit supervisor for another hospital system, with 39 years of experience in healthcare. Additionally, she is an instructor at a state technical college in Atlanta, provides auditing and training in both facility and physician services, and has been a speaker at several healthcare conferences.

Ms. Steed has written articles for several medical publishers and served as a contributing author for medical billing and coding training material. She writes online courses, and is an AHIMA certified ICD-10 trainer, both CM and PCS. Ms. Steed is credentialed in medical coding, clinical documentation improvement, medical billing, medical auditing, utilization management, healthcare management, healthcare compliance and patient accounts. She holds a Bachelor’s degree with a major in business and minors in both criminal justice and sociology.

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