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The Centers for Medicare & Medicaid Services (CMS) integrity contractors are rushing to catch up for lost revenue caused by the current pandemic. Among the types of audits— the Targeted Probe and Educate (TPE) audit. Yet the TPE is only one of many confronting your facility, although this one, established in 2017, is on hold. But for how long, nobody knows for certain. But what is known for certain it that your hospital will fare poorly if your claims are part of a TPE audit. So be prepared. And the best place to be prepared for TPE audits—and how to successfully appeal them—is during this RACmonitor webcast featuring regulatory and audit specialists Sean Weiss and Robert Liles, Esq.
You'll learn that often times, auditors have failed to adequately review the records or have applied improperly the coverage and payment rules. For example, TPE auditors are likely to cite, "Lack of Medical Necessity," or "Failure to Meet Applicable LCD/Medical Coverage Policies," or "Lack of Signature." But rather than exercise their appeal rights, some providers have simply agreed to repay any overpayments, hoping to avoid further scrutiny of their billing practices. But during this webcast, you'll learn about the possible consequences of this action plus how to avoid TPE audits! You'll learn the mistakes that auditors often make and how to benefit from their errors. And, in the process, you'll learn effective strategies for appealing adverse findings to the Medicare Administrative Contractor (MAC).
Why This is Relevant:
TPE audits are expected to be roaring back with a vengeance causing significant disruption to workflow, cashflow, while festering institutional dishonor.
Learning Objectives:
- Gain an understanding of the TPE audit process.
- Learn how to effectively respond to a TPE claims requests.
- Know the most common denial reasons cited in TPE audits.
- Clearly understand the possible impact of a poor showing in a TPE audit.
- Learn how to effectively appeal adverse findings to the MAC.
Who Should Attend:
Compliance Officers and professionals; Appeals and Denials specialist; Internal Auditors; Practice Managers; CFOs; CEOs; Coding professionals
Webcast Access Privileges: Only one login is allowed per webcast purchased. Discounted pricing for additional registrants is available. For more information about webcast pricing and requirements, click here.
About the Presenters
Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-P
Sean M. Weiss is an independent and objective third-party regulatory and compliance officer whose healthcare career spans more than 25 years. He is also a Partner and VP of Compliance with DoctorsManagement, LLC. He holds seven national certifications in auditing, coding, compliance and practice management, including certifications in coding and auditing from the American Academy of Professional Coders both on the physician and payer side (CPMA, CPC-P and CPC), and a compliance certification, Certified in Healthcare Compliance (CHC) from the Healthcare Compliance Association (HCCA). Sean is also a Certified Medical Compliance Officer (CMCO) through the Practice Management Institute and holds a Certified Medical Practice Executive (CMPE) credential from the Medical Group Management Association (MGMA).
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Robert W. Liles, Esq.
Robert Liles is managing partner at Liles Parker, a Washington DC-based healthcare law firm. He also holds an MS in Health Care Administration. Robert has worked on the provider side as a federal prosecutor and now defends healthcare providers in administrative audits, civil actions and criminal prosecutions. While at the U.S. Department of Justice (DOJ), he was selected to serve as the country's first National Health Care Fraud Coordinator. Robert has been rated "AV" by Martindale-Hubbell.
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