PEPPER for Critical Access Hospitals: Identify Your Audit Risk
Product Description:
AUDIO CONFERENCE ON CD OR ON-DEMAND
Sponsored by: Medicare Boot Camp® – Critical Access Hospital Version
Presented on Thursday, July 7, 2011
For the first time ever, PEPPER reports are coming to critical access hospitals (CAHs). PEPPER—Program for Evaluating Payment Patterns Electronic Report—will help you assess your organization’s risk for underpayments, overpayments and medical necessity denials.
During this 90-mintue audio conference, our speakers will explain PEPPER and tell you how to use your report to identify risk areas and protect your organization against potential audit recoupments. They will discuss short stays and medical necessity, the SNF three-day qualifying stays, and readmissions, as well as the purpose for monitoring coding of complications and comorbidities.
Note: If you are NOT a critical access hospital, be sure to listen to the June 23 PEPPER 2011: Identify Changes, Address Vulnerabilities, and Be Audit-Ready audio.
At the end of the program you will be able to:
- Locate the PEPPER reports and user guides
- Evaluate the information contained in the reports and determine what it means for your facility
- Identify risk areas within your facility as compared to state, MAC, and national averages
- Explain best practices for compliance with medical necessity rules for short stays
- Track and trend your PEPPER data
TAKE A LOOK AT THE AGENDA:
I. Understanding PEPPER
a. Background of the PEPPER report
b. Implications for critical access hospitals
c. Locating your organization’s report
II. Interpreting your report
a. Comparing a facility’s report across state and MAC region
b. Examining different areas of the PEPPER report
c. Understanding the PEPPER ratios
III. Identifying risk areas
a. Effect on reimbursement
b. Cost report reopening
c. Data mining for audit protection
IV. Auditing and monitoring hot spots
a. Short stays and medical necessity
b. SNF three-day qualifying stay
c. Readmissions and discharge dispositions
V. Supporting PEPPER report and audit findings
a. CMS guidance
b. Self-auditing
c. Tracking and trending over time
A question and answer session follows the presentation.
MEET THE SPEAKERS:
Stacey Levitt, RN, MSN, CPC, is senior administrative director of patient care management at Lenox Hill Hospital in New York City. She has more than 20 years experience in healthcare management and expertise in utilization and denial management, reimbursement analysis, performance improvement, professional staff development, project management, expert in data management and analysis for hospital and physician reimbursement.
Debbie Mackaman, RHIA, CHCO, is an instructor for HCPro’s Medicare Boot Camp®-Hospital Version and the Medicare Boot Camp®-Critical Access Hospital Version. She is a former hospital compliance officer and HIM director and has more than 20 years of experience in the healthcare industry, including both inpatient and outpatient Prospective Payment Systems (IPPS, OPPS) and Critical Access Hospital (CAH) coding, billing and reimbursement issues.
CONTINUING EDUCATION CREDITS
AAPC: This program has prior approval of the American Academy of Professional Coders for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor.
AHIMA: This program has been approved for 1.5 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
MATERIALS
In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and:
- Tools from http://www.pepperresources.org/
- Resources from Texas Medical Foundation
WHO SHOULD LISTEN?
Billing/reimbursement staff members, HIM directors/managers, HIM staff, coders, clinical documentation specialists, revenue cycle managers/directors, UR committee staff members, case managers, compliance officers, physicians
AUDIO ON-DEMAND
Purchase a CD or an audio on-demand of the audio conference 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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