Understand payor audit risks, key documentation tips, CMS Probe reviews, and how to strengthen compliance programs to avoid fines and recoupments.
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.
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Why Lorman?
Over 38 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 38 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
This course was last revised on February 6, 2025.
Call 1-866-352-9540 for further credit information.
- AHIMA 1.5 including Data Structure, Content, and Information Governance 1.5
- This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
- 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.
- AR CLE 1.5
- This course has been approved for 1.5 hours of CLE by the Arkansas CLE Board.
- 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 Education Services 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.
- HI CLE 1.5
- This program was approved by the Hawaii State Board of Continuing Legal Education for 1.5 CLE credit hours.
- IL CLE 1.5
- This course was approved for a total of 1.5 hours of MCLE Credit by the Illinois MCLE Board.
- IN CLE 1.5
- This program has been approved by the Indiana Commission on Continuing Legal Education. Participating attorneys are eligible to receive up to 1.5 hours of Distance Education credit.
- MO CLE 1.8
- This course qualifies for self-study CLE credit in Missouri.
- ND CLE 1.0
- North Dakota CLE policy does not allow for pre-approval of any self-study courses. This course may qualify for up to 1.0 hours of CLE credit.
- NH MCLE 1.5
- NH MCLE does not approve or accredit CLE activities for the NH Minimum CLE requirement. Lorman Education Services believes this Ondemand course meets the requirement of NH Supreme Court Rule 53 and may qualify for CLE credit(s). Program Length: 89 Minutes.
- 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.
- NV CLE 1.5
- This program has been approved by the Nevada Board of Continuing Legal Education for 1.5 CLE hours.
- NY CLE 1.5 including Areas of Professional Practice 1.5
- This course has been approved in accordance with the requirements of the New York Continuing Legal Education Board for up to a maximum of 1.5 credit hours in the area(s) of Areas of Professional Practice for 1.50 hours. Each hour may be counted only as satisfying one category of credit. Duplicate credit for the same hour of instruction is not permitted. This course qualifies for both established and newly admitted attorneys. Lorman Education- Noggin Guru, Inc. has a financial hardship guideline. Please contact customer service at 1.866.352.9539 for instructions on how to apply.
- 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.
- TN CLE 1.5
- This program has been approved as a distance learning format by the Tennessee Commission on Continuing Legal Education for a maximum of 1.5 hours of credit.
- VT CLE 1.5
- WI CLE 1.5
- This program qualifies for 1.5 hour(s) of ondemand CLE through the WI Board of Bar Examiners.
- 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.
MP3 Download
- AK CLE 1.5
- Arizona CLE 1.5
- CA MCLE 1.5
- CT CLE 1.5
- HI CLE 1.5
- MO CLE 1.8
- NJ CLE 1.8
- NM CLE 1.5
- VT CLE 1.5
- WV MCLE 1.8
This program does NOT qualify, nor meet the National Standard for NASBA accreditation.
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Why Lorman?
Over 38 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
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 of 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)
- Former 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®
Robert A. Wade, Esq.
Nelson Mullins Riley & Scarborough LLP
- Partner in the office of Nelson Mullins Riley & Scarborough LLP in Nashville, TN
- Concentrates his practice in representing health care clients, including large health systems, hospitals, ambulatory surgical centers, physician groups, physicians and other medical providers
- Expertise includes representing clients with respect to the Stark Act, Anti-Kickback Statute, False Claims Act, Emergency Medical Treatment and Active Labor Act, and Providing Fair Market Value and Commercial Reasonableness Defensibility Analysis for Physician Compensation Arrangements
- Is nationally recognized in 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
- 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
- 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 615-664-5326 or [email protected]
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Why Lorman?
Over 38 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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