OIG Work Plan Update: What’s In. What’s Out.
Thursday, November 16
The good news: The OIG wants you to know what issues they’re looking at. The bad news: If during an investigation, they ask if you saw the plan and you say, “yes,” that signals you knew better. Say, “no,” and they’ll likely say you acted recklessly. It’s a Catch 22. Bottom line: You need to know what’s on their mind. And now you will, thanks to the upcoming OIG Work Plan Update webcast by healthcare attorney David Glaser.
Goodbye Total Knee Replacement. Hello Problems!
Thursday, December 7
If you're looking for total knee replacement on the inpatient-only list, forget it. Turn off your computer and call your auditing department. Total knee replacement is gone. But your troubles are just starting.
Case Management to Finance: We're Better Together
Former medical director of case management and medical necessity reviewer, Dr. Ronald Hirsch, has created an innovative teaching method to help you and others in case management understand the frustrations of your finance staff.
Turmoil: Joint Replacements Headed to Outpatient Facilities
The Centers for Medicare & Medicaid Services (CMS) have proposed removing total knee replacement from the inpatient-only list as of January 1, 2018. And CMS has also asked for comments on removing total and partial hip replacement from the inpatient-only list, allowing all three surgeries to be performed in ambulatory surgery centers as of January 1, 2019.
Auditors Obsessing with Observation
In what promises to be a game-changer for you and providers, Dr. Hirsch will go into detail on the use of observation in both medical and surgical patients. And, he will also review the proper billing methods for observation.
New Medicare Appeals Process Could Help Your Facility Prevail at the ALJ
This presentation will benefit participants by providing an in-depth look at the changes to the Medicare appeals process set forth in the recent CMS Final Rule and key OMHA initiatives taking place at the ALJ appeal level. These Final Rule provisions and OMHA initiatives will have a significant impact on how you approach your Medicare appeals.
Mastering Medicare Advantage, Part II: Understanding Risk Adjustment and HCCs
Medicare uses a complex risk-adjustment process when paying Medicare Advantage Organizations (MAOs) for services provided to Medicare beneficiaries who enroll in a Medicare Advantage plan. Of particular interest is the Risk Adjustment Data Valuation (RADV) and associated Hierarchical Condition Categories (HCCs) as you will discover during Part II of this crucially important webcast by author, educator, and consultant Duane Abbey.
How to Write a Proposed Decision to the ALJ and Get Paid Sooner Than Later
With the backlog at the Office of Medicare Hearings and Appeals, more than a few ALJs are asking appellants to submit proposed decisions. Will you be ready and able to give the ALJ something they can actually use? Now, thanks to this exclusive webcast and former ALJ and decision writer, Bob Soltis, you'll be able to write a proposed decision to include with your Request for Hearing.
Mastering Medicare Advantage, Part I: Improve Reimbursement, Claim Adjudication and Appeals
Medicare Advantage programs are becoming more and more popular. Understanding the differences between Medicare Advantage and traditional Medicare can translate into better reimbursement and less cost in filing and tracking claim adjudication and payment as you will discover during Part I of this crucially important webcast by author, educator, and consultant Duane Abbey.
Mastering Medicare Advantage: An Important 2-Part Webcast Series
Medicare Advantage is like sitting down and confronting a bowl of goulash—a steamy brew of meat, vegetables and broth. You really don't know what you're getting into until it's too late. Medicare Advantage is a brewing stew of compliance issues.
The MOON: Lessons Learned: An Important Case Study
The MOON is a new requirement that just went into effect on March 8, 2017. It is a requirement that many sites are struggling to deliver. This webcast, featuring lessons learned from Trinity Health, will help you identify what could work in your own organization. Sharing processes and policies means that you don't have to reinvent the wheel.
Warning: The RACs Are Back. New Contracts. New Rules.
The Recovery Audit Contracts—the RACs—are ready to start auditing your claims. While some processes will resemble previous audits, there are important changes to the new rules that warrant review, analysis, and understanding.
Implantable Device Credit Reporting: Intense Federal Audits Continue
The OIG has not slowed down in its apparent endeavor to access every facility, whether a hospital or an ASC, to audit each facility's claims history and current practices under implantable medical device credit requirements. High error rates make these targeted audits lucrative in terms of repayments and fines. It's not easy to master and implement these requirements, but you must know how. This webcast will show you how to report compliantly.
Learn New Rules to Win Your Appeals at the ALJ
Providers and suppliers appealing claims for Medicare, Medicare Advantage or Medicare Prescription Drug plans must understand the new rules of engagement in order to prevail through the appeals process. The benefit of this webcast is to help you understand the new rules in order to enhance successful outcomes throughout the appeals process, but specifically the ALJ level of appeal.
Mastering the Use of the JW Modifier
The ambiguity of the JW modifier continues to thwart effective planning by hospital pharmacy professionals. By attending this timely webcast, you will be made aware of the potential impact that the JW modifier can have on your organization and also know how critical documentation and medical necessity are to a successful transition.
Avoid a Collision with the MOON
Wednesday, March 8, 2017 could be doomsday. That's when the Medicare Outpatient Observation Notice (MOON) becomes effective. And getting observation right will be crucial because of the widespread publicity and public scrutiny of observation services. Now you will, thanks to this timely webcast by Ronald Hirsch, MD.
Debunking 5 Medicare Myths That Can Hinder and Hamper Your Judgment
Medicare rules are terribly complex. Yet as others seek to simplify these rules, misunderstandings become Medicare Myths — myths that can hinder and hamper your judgment when you come to the crossroads of doing what is right or following the law. During this timely webcast, you and your team will come to understand what one can do that is right, while doing what is legal.
Protect Your Facility from Cyberattacks: Learn from Real World Examples
Russian cyberattacks against U.S. institutions have ushered in a new reality for hospitals. The Dark web is teaming with criminals already attacking banks, universities and hospitals looting them for money, holding them for ransom. That's why cyberattacks are on the rise. If your facility hasn't been attacked it's probably just a matter of time. That is why this webcast is so vitally important. You and your team will come away equipped with the latest information on the cyber threat landscape and incidents in healthcare to help you keep patient data secured.
Don't Get Behind the Eight Ball: Eight New Therapy Stratified Codes up the Ante for Risk
Out with the old. In with the new. Old physical and occupational codes are gone December 31, 2016. In their place: Eight new therapy stratified codes that, if not billed correctly, could put your reimbursement at risk while putting therapy staff and coders behind the eight ball come January 1, 2017. Now's the time for coding and documentation lessons. So rack 'em up.
Provider-Based Clinics: In the Eye of the Storm
Provider-based clinics and associated operations have become very popular for hospitals because increased reimbursement results from filing both a facility and a professional claim. But all of that could change due to a potent storm that's gaining energy on the horizon. Once again, hospitals are at the storm's vortex.
DRG Clinical Validation: Necessary or Optional
The official 2017 Coding and Reporting Guidelines are creating one of the biggest frustrations for hospital audit and denial teams in recent memory. Ronald Hirsch, MD will provide valuable insight as a physician and as a nationally recognized physician advisor on how to arrive at a compliant solution for one of the most insidious attacks this year on DRG clinical validation.
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