AUDITCON 2021

Join Us November 1-2, 2021

Join us in November for AUDITCON, a virtual medical auditing conference. Whether you’re brand new to auditing or a current compliance officer, administrator, or payer, we have a track of sessions made for you.

For audit beginners, we have a dedicated track, providing in-depth information on the eight steps required to complete an audit. This track provides an in-depth overview of auditing services and gives you an inside look at what auditors do from day to day. Each session builds on the previous one, so participants must attend the entire track.

The conference also features two advanced tracks with deep dives into audits for the 2021 E/M guidelines for office/other outpatient services, risk adjustment, payer recovery, telemedicine/telehealth, service specific audits (e.g., behavioral health), and much more.

Virtual-only Conference | November 1-2, 2021 | 3 Tracks, 24 Sessions | 13 CEUs

Pricing: ($545) $445

Register Today

Members can pre-submit questions to be answered during sessions. Submit your questions here.

Monday, November 1, 2021

General Session

Back to top

9:00 AM - 10:00 AM, MDT | 1.00 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

GS1: Panel

TBA

Breakout Session 1

Back to top

10:15 AM - 11:30 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

1A: Beginner: Role and Responsibility of an Auditor – Difference Between a Coder and an Auditor

Jeanmarie Loria, CPC

In this session we will be discussing the fundamental differences between a coder and an auditor, along with outlining the roles and duties of each. We will also discuss medical necessity and how it plays a role in accurate coding and auditing.

10:15 AM - 11:30 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

1B: Advanced: Recovery Audit - Include the Process Differences and Attorney Client Privilege

Eric Rubenstein

10:15 AM - 11:30 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

1C: Advanced: Auditing Behavioral Health

Heather Greene, CPC, CIC, CPMA

Understand documentation requirements for behavioral health services. Be able to identify unsupported or unbillable charges. Be able to cross reference medical policies for a thorough medical necessity-based review.

Breakout Session 2

Back to top

12:15 PM - 1:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

2A: Beginner: Scope of an Audit

Jaci Kipreos, COC, CPC, CDEO, CPMA, CRC, CPC-I, CEMC

In the session we will discuss the framework of the audit..the "scope". How are all the elements selected? Who makes those decisions? And of course we will discuss the meaning and intent of this part of the audit process.

12:15 PM - 1:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

2B: Advanced: Auditing 2021 EM Guidelines - The Need to Think Differently and Understand Clinical Complexities

Rhonda Buckholtz, CPC, CDEO, CPMA, CRC, CENTC, CGSC, COBGC, COPC, CPEDC, Approved-Instructor

With the new E/M guidelines it is essential for auditors to understand clinical conditions and complexities in order to correctly work with providers and others. Now more than ever it is important to understand the nuances of documentation and the clinical condition. In this session we will explore: • Medically relevant exams and histories • Complexities that can drive medical decision making • How some of the most frequently coded conditions play into the complex maze of medical decision making • The best tools at your disposal to help you succeed

12:15 PM - 1:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CCC, CCVTC, CIC, CPB, CPCO, CPPM, CRC

2C: Advanced: Auditing Cardiovascular Surgery

TBA

Auditing cardiovascular procedures are more complex than most specialties. Knowledge of anatomy and orders of the vascular system are very important in addition to the coding guidelines. There are unique guidelines associated with cardiovascular catheterization coding especially when it comes to diagnostic procedures on the same day of the intervention.

Breakout Session 3

Back to top

1:45 PM - 3:00 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

3A: Beginner: The Basics for Choosing Your Sample for Audit

Kathleen Michele Rowland, BSN, RN, CHC, CPC, CPC-I, CEMC

Audits have become necessary with the increased oversight of federal and commercial payers. Understanding how to correctly identify the focus of the audit, the methodology and the sampling are critical steps in auditing. This session will also provide the basics in developing the appropriate sample size for your audit. Sample size is important as too small a sample may lead to inaccuracies and too large a sample may waste valuable resources such as time and money.

1:45 PM - 3:00 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

3B: Advanced: Auditing Risk Adjustment and How To Address Conflicts With Polices

Jacob Swartzwelder, CPC, CRC, CEMC

1:45 PM - 3:00 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

3C: Advanced: Auditing Drug Administration

Leonta Williams, CPC, CPCO, CRC, CEMC, CHONC

Compliance for appropriate drug billing does not begin at the time of administration, but rather at the time of the provider order. To identify risk areas in its entirety, a wholistic approach is needed. The auditor needs to identify all the documentation sources needed for the audit. In addition to medical record components, external policies such as payer policies, existing contracts, National Drug Code (NDC) info, drug indications, etc. may be required. Drug billing is an area of intense focus because of the high dollar assigned to some of these drugs. There are many focus areas involved such as drug waste, proper documentation of start/stop times, billed units and more. Regular auditing of these services should be a part of your comprehensive compliance plan. This session will help you either create a more robust audit program or validate the program you have in place is efficient.

Breakout Session 4

Back to top

3:15 PM - 4:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

4A: Beginner: Performing the Payer Audit

Toni Lynn Slocum, CPC, CPC-P

3:15 PM - 4:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

4B: Advanced: Auditing From the Payer Perspective

Tracy Lynn Hunt, CPC, CPMA

In this session we will be discussing the basics on how the Special Investigations Unit identifies cases for medical record review. How medical reviews are done using insurance, CMS and Medicaid policies. In addition, the role medical policies play in auditing.

3:15 PM - 4:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

4C: Advanced: Auditing for COVID Related Services

Stephanie M Sjogren, COC, CPC, CDEO, CPMA, CPC-I

In this presentation we will address how to audit for COVID-19 services. We will dive into the OIG's workplan and what they are looking at and how you can stay prepared. The main areas we review are how to audit COVID-19 services in the areas of telemedicine, laboratory services/testing and related services, vaccinations, home health, remote monitoring and cost share waivers.

Tuesday, November 2, 2021

General Session

Back to top

9:00 AM - 10:00 AM, MDT | 1.00 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

GS2: Panel

TBA

Breakout Session 5

Back to top

10:15 AM - 11:30 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

5A: Beginner: Document Audit Findings – Part 1

Amy Lee Smith, CPC, COC, CPMA, CIA, CRMA, CHIAP, CHFP, MBA

Documenting Audit Findings – Part 1 will focus on the detailed audit spreadsheet. We will discuss how to set up an audit spreadsheet, data fields to include based on audit scope, how to summarize findings and totals on the spreadsheet, etc. We will learn how planning the spreadsheet layout helps in developing the report.

10:15 AM - 11:30 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

5B: Advanced: Analyze Audit Findings and Determine Next Steps in Payer Resolution

Michael D Miscoe, Esq, CPC, CPCO, CPMA, CASCC, CCPC, CUC

Attendees will be presented with information that will assist in the analysis and resolution of adverse payer audit findings resulted in a claimed overpayment. Specifically, attendees will learn how to analyze each alleged error to determine whether the allegation is justified under the relevant provider contract/medical policies or represents post hoc application of criteria as a basis for substantiating error. Attendees will also learn how to differentiate allegations that justify re-payment from those that require mere corrective action as a basis for continuing the provider’s participating status. Attendees will also be presented with strategies for resolution, if and when to involve counsel and (potentially) experts, and issues to wary of regarding settlement agreements.

10:15 AM - 11:30 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CIC, CPB, CPCO, CPPM, CRC

5C: Advanced: Auditing Pain Management

Jessica Whitney, CPC, CPMA

The OIG is auditing Medicare payments for spinal pain management. including facet joint injections, facet joint denervation sessions, lumbar epidural injections, and trigger point injections. Know the Medicare policies not only for covered diagnoses, but also for frequency requirements as well as clinical requirements to ensure proper reimbursement. As auditors, you will have to review documentation and abstract both ICD-10-CM and CPT codes along with appropriate modifiers, know the coding guidelines for appropriate application of ICD-10-CM codes and CPT codes and know the Medicare policies associated with the procedures to ensure proper reimbursement and avoid paybacks if audited.

Breakout Session 6

Back to top

12:15 PM - 1:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

6A: Beginner: Document Audit Findings – Part 2

Amy Lee Smith, CPC, COC, CPMA, CIA, CRMA, CHIAP, CHFP, MBA

Documenting Audit Findings – Part 2 will transition into the written report portion of an audit. We will learn how to present audit findings in a professional manner, what should be included in a written report, how to structure the report format, who should receive the report, and how to summarize findings from the detailed spreadsheet. We will also touch on when and how to make recommendations for corrective actions.

12:15 PM - 1:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

6B: Advanced: Post Audit Education

Jaci Kipreos, COC, CPC, CDEO, CPMA, CRC, CPC-I, CEMC; Angela Clements, CPC, CPMA, CEMC, CGSC, COSC, Approved-Instructor

Do you love auditing and educating providers, but get frustrated with trying to convey the message to a provider who may not be receptive? In this session, we will have two seasoned auditor/educators role play the delivery of results between an auditor and a provider to assist with ways to defuse a difficult provider. Learn how to deliver audit results to the provider based on various types of responses a provider could give while professionally deescalating any defensive feelings from the provider.

12:15 PM - 1:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CFPC, CIC, COBGC, CPB, CPCO, CPEDC, CPPM, CRC

6C: Advanced: Auditing Primary Care Services

Robin Linker, COC, CPC, CPC-P, CPC-I

Breakout Session 7

Back to top

1:45 PM - 3:00 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM

7A: Beginner: How Do You Get Results From Your Audit Reports?

Stephani Scott, CPC

Let’s face the truth! Facts, figures and coding speak like “mutual exclusive edits” don’t stick in the minds of physicians. On the flip side, financial officers embrace facts and figures, because numbers can solve problems faster. It’s all about telling a great story to the right audience. In this session learn how to tell a great story by learning how to: • Understand the audience • Develop effective audit reports • Writing executive summaries

1:45 PM - 3:00 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

7B: Advanced: Auditing Telemedicine/Telehealth

Leonta Williams, CPC, CPCO, CRC, CEMC, CHON

CMS and other payers are conducting audits right now aimed at your telehealth visits. This session will provide an overview of billing for this specialty in a manner that is compliant with the ever-changing directives and executive orders released during the COVID-19 PHE. We will discuss the internal policies and procedures you should have in place to monitor these changes and make the necessary updates related to IT modifications, provider education, patient communication and more. Many believe telehealth and telemedicine is here to stay. If you are one of the many, how are you preparing for the future? Positive outcomes rely heavily on valid data and knowledgeable staff. Let’s bring all that we’ve learned to this session and explore methods to audit effectively, reduce denials and optimize reimbursement.

1:45 PM - 3:00 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CFPC, CIC, CPB, CPCD, CPCO, CPPM, CRC

7C: Advanced: Understanding the Scope of Wound Care Services Performed in all Health Care Settings

Linda Martien, COC, CPC, CPMA, CRC

Gain insight into the rules and regulations guiding the wound care including but not limited to: Fiscal Intermediary, Carriers, and Medicare Administrative Contractors; National Coverage Determination and respective Local Coverage Determinations; the Centers for Medicare & Medicaid Services, The Joint Commission, and the American Medical Association; and so on.

Breakout Session 8

Back to top

3:15 PM - 4:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CPB, CPCO, CPPM, CRC

8A: Beginner: Communication of the Findings

Jaci Kipreos, COC, CPC, CDEO, CPMA, CRC, CPC-I, CEMC; Angela Clements, CPC, CPMA, CEMC, CGSC, COSC, Approved-Instructor

Communication of audit results are vital to a provider's future success of documentation and coding. Two experienced auditor/educators will role play the communication between the auditor and the provider to provide effective and professional communication techniques. We will discuss how to prepare beforehand can provide a successful outcome. The role playing will reflect actual scenarios and look at how to handle various personalities and some uncomfortable situations.

3:15 PM - 4:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CANPC, CASCC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC

8B: Advanced: Peer Review Audits and Escalation of Medical Necessity

Amy C Pritchett, CPC, CDEO, CPMA, CRC, CPC-I, CANPC, CASCC, CEDC

In this course, we will review the definition of “Medical Necessity” as it relates to Medicare and Commercial insurance carriers. The objective of this course is to “relearn” the meaning of medical necessity and how working with physicians promotes greater insight. During the presentation, we will discover resources for medical necessity guidance and regulations. We will also discuss peer review and how this relates to medical necessity within the healthcare field.

3:15 PM - 4:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CIC, CIRCC, COSC, CPB, CPCO, CPPM, CRC

8C: Advanced: Auditing Spine Surgeries

TBA

General Session

Back to top

4:30 PM - 5:30 PM, MDT

GS3: Virtual Networking Happy Hour

TBA

Looking for Exhibiting Opportunities or Group Discounts?

Contact us at 877-524-5027.

Which certification is right for you?

Call 877-290-0440 or have a career counselor call you.

Which eNewsletters are right for you?

Call 844-334-2816 to speak with a specialist now.

Which books are right for you?

Call 877-524-5027 to speak to a representative.