Medically Unlikely Edits: Compliance and Denials Management
AUDIO CONFERENCE ON CD OR ON-DEMAND
Sponsored by Briefings on APCs
Presented on October 20, 2011
Denials due to medically unlikely edits—MUEs—tie up your cash flow and create a lot of additional work for your staff. Common MUE problem areas include reporting multiple evaluation and management (E/M) codes for one visit, inappropriately charging for multiple units, and omission of modifiers for multiple lab tests .
During this 90-minute audio conference, our speakers give you processes and best practices to combat MUE denials. They discuss front and back end processes, explain how some of the codes should be reported, show you how to identify potential edits before you submit a claim, and manage denials.
Note: This is a basic to intermediate program. Participants should have a general understanding of CPT codes, units of service, and how to bill them.
At the end of the program you will be able to:
- Describe the difference between MUE and NCCI edits
- Evaluate processes to identify MUE edits before claims are submitted
- Analyze edits that payers return to determine the reason for the denial
- Identify your organization’s top MUE edits
- Definition of MUEs
- Differences from NCCI edits
- Determination of allowable units of service
- Common issues with MUEs
- Identifying and charging correct units of service
- Reporting multiple E/M codes
- Managing denials
- Process flow and how some of the codes should be reported
- Reviewing official CPT guidelines for common MUEs
- Keeping up with the quarterly MUE updates
- Dealing with unpublished MUEs
- Appending modifiers correctly
- Managing MUEs on the front-end
- Claims scrubber
- Chargemaster and hard-coded services
- Staff-reported codes
- Best practice tips
- MUE denials management process
- Due to the charge process
- Due to HIM-generated codes
- Best practice tips
- Case studies
A question and answer session follows the presentation.
Lolita M. Jones, RHIA, CCS, is the sole principal of Lolita M. Jones Consulting Services (LMJCS) in Fort Washington, MD. She has more than 25 years of experience in coding and consulting and is an AHIMA-Approved ICD-10-CM/PCS Trainer.
Sarah L. Goodman, MBA, CHCAF, CPC-H, CCP, FCS, is president/CEO and principal consultant for SLG, Inc., of Raleigh, NC. She is a nationally known speaker and author on the charge description master, outpatient facility coding, and billing compliance, and has more than 28 years experience in the healthcare industry.
AAPC: This program has prior approval of AAPC for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by AAPC of the program, content or the program sponsor.
AHIMA: This program has been approved for 1.0 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).
Please note the expiration date for this audio is 10/20/12.
BONUS MATERIAL INCLUDED IN YOUR MATERIAL PACKET!
In addition to the expertise and information presented during this audio conference, you'll also receive these helpful “take-aways” provided within your materials pack:
- Chart of CPT codes where MUEs are a factor and official guidelines for reporting those codes
- List of common chargemaster issues
- Sample UB-04 form
WHO SHOULD LISTEN?
HIM directors and managers, billing managers and staff, outpatient coding managers and staff, compliance managers and staff, chargemaster coordinators and teams, revenue management staff, denials management staff, internal auditing, finance managers, APC coordinator/RAC coordinators, administrative directors of clinics
In addition to the regular participation options for HCPro audio conferences—live, CD, or combination packages—we are pleased to offer an audio on-demand, which allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase an CD or audio on-demand or CD 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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SOURCE CODE: EMEDFIND