Physician Provider Audits (Audio Conference)

AUDIOCONFERENCE ON CD OR AUDIO ARCHIVE

Sponsored by Hospital Auditing and Monitoring, 2nd edition

presented on March 5, 2008

Physicians rarely list coding and documentation among their top priorities. Many believe that such compliance concerns take time away from clinical care and have nothing to do with caring for patients. This is one of your toughest challenges as your facility tackles physician provider audits.

Listen to HCPro's audioconference “Physician Provider Audits: The latest tools to analyze risk and benchmark compliance.” Experts Andrei M. Costantino, MHA, CHC, CPC-H. CPC and Margaret Nusbaum BA, CPC, both of Trinity Healthcare in Farmington Hills, MI, will share their facility’s strategy for auditing and monitoring both large physician practices and multiple physician networks.

Most internal audit and compliance departments have limited resources to perform auditing and monitoring reviews of their physician networks/practices to determine whether they are in compliance with third-party payer or government billing and coding guidelines. But with the 2008 OIG Work Plan highlighting a number of risk areas, you need to handle this hot-button issue.

Our speakers tell you how to use data mining, dashboards, and scorecards, how to implement an effective physician auditing and monitoring process, and even how to make the case for additional resources using benchmarking data tools.

At the end of this audioconference, you and your staff will be able to:

• Analyze data to develop risk and audit strategies
• Use benchmark data to establish goals/targets and make your case for additional resources
• Use external (CMS) and internal (provider) data to develop physician compliance tools
• Construct and implement an effective auditing and monitoring strategy for large physician practices or multiple physician networks
• Develop individual physician scorecards

AGENDA

• Overview
• Current regulatory environment
• Limited auditing resources
• How to use your resources efficiently
• How to Use Data
• External (CMS and payer) data
• Internal facility data
• To perform a baseline risk assessment  
• Development of a physician scorecard
• How Trinity uses its physician scorecard
• Scorecard Evaluation Categories
• Net reimbursement error rate
• Bell curve analysis
• Documentation errors
• How to report physician auditing and monitoring data
• Case study examples
• Audit rating/follow-up
• Physician benchmarks
• A question and answer session will follow the presentation

BONUS TOOLS

In addition to the expertise and advice presented during this audioconference, you'll also receive a slide presentation of the program materials and:

• Sample physician scorecard

These materials are provided with PDF links.

MEET THE SPEAKERS

Andrei M. Costantino, MHA, CHC, CPC-H. CPC Director, Organizational Integrity, Trinity Health. Mr. Constantino possesses 17 years of comprehensive experience specializing in third party reimbursement, regulatory compliance issues, financial feasibility studies, Medicare and Medicaid fraud defense work, and reimbursement coding and compliance education and training.  He has also participated in group discussions with the U.S. Department of Justice, Office of Inspector General, state agencies, CMS, part B carriers and part A intermediaries throughout the country in sessions designed to assure accurate reimbursement and coding of services provided by health care providers.    

Margaret Nusbaum BA, CPC. Senior Organizational Integrity Specialist, Trinity Health. Ms. Nusbaum is responsible for performing reviews of medical record documentation, coding, and billing practices for professional services rendered throughout Trinity Health.  She serves as a resource for coding, documentation, and compliance issues and presents monthly educational forums on professional coding and billing topics.  

WHO SHOULD LISTEN?

Professionals employed by hospitals and health system with multiple physician practices, as well as large physician networks. Relevant titles for this material include:

• Compliance officers
• Auditors
• Healthcare administrator
• Director of Finance
• Director of Corporate Compliance
• Coders
• Physician practice management

PROGRAM MATERIALS:

Program materials are provided with PDF links.

Purchase a CD or audio archive of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.

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