One hour Live Webinar: Billing Audits and Compliance
Damaris Medina, Attorney
Michelman & Robinson, LLP
The current economic climate has motivated an increase in attempts by government agencies and private payers to investigate coding and supporting documentation. The escalating pressure on both government and commercial payers to decrease costs has resulted in an increase in audit activity on payments to physicians and Urgent Care Centers to recoup costs. Based on its own statistics, in 2012 the government allocated at least $600 million towards recovering payments made to Medicare Fee For Service contractors.That same year,the government recovered more than $4 billionfrom a number of sources related to audits, investigations, and civil and criminal penalties. Based on the phenomenal return on investment, the trend of increased government audit activity is likely to continue.
While most government audits historically were limited to hospital payments, both government and commercial payers are beginning to turn their attention to Part B payments, specifically E/M services billed by urgent care. In September 2012, CMS announced that the recovery audit contractor (RAC) program would begin auditing claims that contain higher-level CPT codes for E/M services – specifically CPT codes99214and99215. As recent as a month ago, CMS announced another auditing program focusing on E/M CPT codes 99214 and 99215 called the Supplemental Medical Review Contractor (SMRC) program.
Commercial payers are following the government’s lead. Commercial payers commonly focus on particular code groups or particular issues. The identification of the higher levels of E/M services by the government as an issue area is expected to prompt commercial payers to increase their scrutiny of these codes. Many commercial payers reported an increase in post-payment audits by the end of 2012. The same trend is expected to be reported at the end of 2013.
At the conclusion of this session attendees will:
1. Know the current trends in commercial and government payer audit;
2. Understand the different auditing sources and what their target areas are;
3. Know what to do to prepare for audits from both commercial and government payers;
4. Understand compliance programs and how to implement them successfully;
5. Learn how to respond to different types of audits; and
6. Have concrete tips on how to prepare for and respond to an audit.
The Urgent Care Association of America designates this live activity for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The Urgent Care Association of America is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medication education for physicians.
Once you participate in this webinar and take the short quiz you can earn 1 credit in Legal & Regulatory towards your Urgent Care Management Certificate.