Whether you want it or not, it’s coming. The dreaded letter stating that you owe money and they want it. Everyday thousands of providers are audited and then sent notice of overpayment demand letters. The first line of audit response is in the correspondence received by your practice. Simply accepting the terms laid out in demand letters, subpoenas and audit notifications could prove to be a huge mistake for your practice. You can reverse these investigations, audits and recoupment request with an effective response to these demand letters.
Compliance Expert J Paul Spencer, walks you through the different types of audit correspondence you may receive, the level of importance of each, and tips for successful response to the payer. It’s all in the response! Paul will help you successful response plan, but also he will tell the step-by-step process every practice must utilize to successfully respond to every type of demand letter you might receive.
Learning Objectives:
- Understand what types of demand letters a practice might receive
- Understand what the letters are actually requesting
- Know when the matter can be handled at the practice level
- Learn when it might be beneficial to get a 3rd party opinion
- Understand when legal counsel is useful or required
- Review and Dissection of Various Types of Audit and Investigation Letters and How to Approach Each
- Lean best practices for defending Overpayment Recoveries
- Understand medical necessity
- Understanding False Claim Act
Areas Covered in the Session:
- ADRs (Additional Documentation Request)
- The False Claims Act
- Medical Necessity
- Types of Audits
- SIU (Special Investigative Unit) Overpayment Demand
- Notice of Investigation vs Demand for Records
- Responding to Payer
- Appeal Documentation
- Reversing Payer Decision
Suggested Attendees:
- Billing Managers
- Practice Managers
- Providers
- C-Level Executives
- Office Staff and Billing Managers
- Medical Billing Companies
- Hospital Revenue Cycle Staff
- Physician
- Nurses
- Physician Assistants
- Nurse Practitioners
- Medical Assistants
- Practice Manager
- Office Managers
- Coders
- Auditors
- CDI Specialists
- Collection Staff
- Compliance Officers
- Telemedicine System Vendors
- Patient Accounts Personnel
- Medical Record Supervisors
- Health Information Management Administrators and Technicians
- Other Personnel Interested in Billing Privileges with the Medicare Program
Presenter Biography:
Paul has over 30 years of experience on the administrative side of healthcare, including six years with health insurance carriers. In his present role as a senior compliance consultant, Paul focuses on physician education, with an emphasis on documentation improvement for Evaluation & Management and surgical services.
Paul has assisted in creating compliance plans for a major diagnostic laboratory provider, as well as for multiple third-party billing companies. As the former director of coding and regulatory compliance for Providence Health Services in Washington, DC, he worked to solidify retrospective audit responses to commercial and governmental insurance carriers. He has extensive experience in a wide range of physician specialties, including anesthesia, emergency medicine, advanced wound care, orthopedic, general & neurosurgery, outpatient physical therapy, and pain management, among others.
Paul has served on the editorial board of RACMonitor and has been a frequent guest on that publication’s “Monitor Monday” broadcast, where he focuses on Medicaid audit and physician audit issues. He has carried the Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) credentials from the AAPC since 1998.
