Reprocessing vs. Self-Reporting
If claims are within the reprocessing window a simple reprocessing of the claims is acceptable, unless there is evidence of fraud. Medicare has timely filing and reopening limits which is up to 12 months from the date of service for any reason, or up to 4 years with good cause. However, if it is outside of the reprocessing window, the client needs to self-report. This video reviews these limits and what questions you need to ask your client.
Agenda
Faculty
Robert A. Wade, Esq.
Nelson Mullins Riley & Scarborough 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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