GS1 / Auditing Telehealth Now that the PHE has Ended with Extensions in Place / Christine Hall, CPC, CPB, CPMA, CRC, CEMC, AAPC Approved Instructor
With the rapid expansion of telemedicine during the COVID-19 pandemic, it is imperative to assess its effectiveness, compliance, and security post the public health emergency (PHE). Get an overview of telemedicine during the PHE and come to understand what the end of the PHE means for providers, why it is important to audit telemedicine claims, and key areas of focus.
1A Beginners Track / Deciding What to Audit and How to Obtain the Sample Services / Stephanie Sjogren, CCS, HCAFA, CPC, CRC, CDEO, CPMA, CPC-I, COC
There are a few key steps in coding audits, but first and foremost is deciding what to audit and how to obtain the sample. During this presentation, we will address how to develop the scope of a coding audit and how to pull that sample from your data. This will include how to identify setting types, volume of records, random or focused, time frame, and whether it will be pre- or post-billing. Additionally, we will also discuss the pro/cons of including the diagnosis code audit as part of a CPT®/HCPCS Level II audit.
1B Advanced Administrator Track / How to Prepare for TPE Audits / Amy Pritchett, CPC, CPCO, CDEO, CPMA, CRC, CANPC, CASCC, CEDC, CDEI, AAPC Fellow, AAPC Approved Instructor and Robin Peterson
In this session, you will learn what a Targeted Probe and Education (TPE) audit is, education on who performs TPE audits and why, common errors addressed in a TPE audit, and how a TPE audit works. You will also learn how to prepare for a TPE audit.
1C Advanced Auditor Track / Ask the Auditor/ Consultant Panel / Jaci Kipreos, CPC, COC, CDEO, CPMA, CRC, CPC-I, CEMC, and Angela Clements, CPC, CPMA, CEMC, CGSC, COSC, AAPC Approved Instructor
In this panel, the attendees get to pick the topics! We will be prepared to discuss the good, the bad, and the ugly of auditing and consulting. This session will speak to those already in the game, as well as to those who are thinking about this venture. We will concentrate our discussion on the responsibility of being an auditor and/or a consultant and how, at the end of the day, all we really have is the documentation.
2A Beginners Track / CPT® 2024 Changes / Christine Hall, CPC, CPB, CPMA, CRC, CEMC, AAPC Approved Instructor
This presentation highlights the significant changes introduced by the American Medical Association (AMA) to CPT® 2024. Medical professionals, billing and coding specialists, healthcare administrators, and insurance companies must be aware of these changes and how they impact the way medical procedures and services are documented, reported, and reimbursed. Come learn about the new, revised, and deleted procedure codes and the rationales and guidance for these changes.
2B Advanced Administrator Track / How to Handle Provider, Auditor, and Coder Disagreements / Kathleen Spaulding, CCS, COC, CPC, CPCO, CDEO, CPMA, CRC, AAPC Approved Instructor
In this presentation, we will discuss various tactics for handling disagreements and sticky situations when reporting audit findings to both providers and coders. We will talk about strategic steps to build into your audit program to help minimize potential misunderstandings and close the feedback loop.
2C Advanced Auditor Track / OIG and DOJ Audits in Medicare Advantage / Colleen Gianatasio, CPC, CPCO, CPC-P, CDEO, CPMA, CPPM, CRC, AAPC Approved Instructor
Medicare Advantage is under scrutiny. This session will discuss what the Office of Inspector General and the Department of Justice are looking for to ensure program integrity. Participants will leave with a comprehensive checklist of audit targets they can implement in their own programs.
3A Beginners Track / Moving From Internal Audits to External — the Life of an Auditor / Erika Fisch, CCS, CPC
Have you considered the jump into the vast world of consulting? Come to this session to learn about the transition from being an internal auditor/educator to an external consultant. We will discuss the many challenges you may encounter during the first year and provide solutions for tackling the obstacles, so you can enjoy the growing pains.
3B Advanced Administrator Track / Setting up a Resilient Audit Program for Your Risk Adjustment Team / Todd Husty, DO
Risk adjustment auditing is much more than just getting codes on charts. A risk adjustment process should focus on defensible revenue. The entire process is important, starting with physician documentation and including accurate coding. The focus should not just be on lost revenue but also on documentation that supports the assignment of codes. And if the process aims at improvement, there should be ongoing education for auditors and physicians. Come learn how to accomplish these tasks and create a resilient audit program for risk adjustment.
3C Advanced Auditor Track / Enhancing Compliance with AI-Powered Audit Tools and Techniques / Jacob Swartzwelder, CPC, CIC, CRC, CEMC, AAPC Approved Instructor
Attendees will explore the impact of augmented intelligence (AI) in enhancing coding and documentation compliance, demonstrating how AI can enable the identification of coding risks, timely error detection, and proactive compliance mitigation. We will discuss the benefits of AI adoption, including improved coding accuracy and optimized revenue cycle management. Ethical considerations surrounding AI use in auditing will be emphasized, ensuring fairness, transparency, and responsible implementation. By the end of the session, participants will grasp the potential of AI-powered audit tools to elevate compliance standards, streamline auditing workflows, and support healthcare organizations in navigating dynamic regulatory environments.
4A Beginners Track / Facility Auditing - Design and Execution Tips / Amy Lee Smith, CPC, COC, CPMA, MBA, CHFP, CIA, CRMA, CHIAP
Let’s start with the basics of why audits are important, then we will move to topics such as: How to design a facility audit (with tips on hot topics to audit); sampling tips; performing the audit; and presenting audit findings. This session will focus on auditing in the hospital/facility setting only.
4B Advanced Administrator Track / The Due Diligence Audit - Key Details to Remember / Jaci Kipreos, CPC, COC, CDEO, CPMA, CRC, CPC-I, CEMC
In this session, participants will learn the ins and outs and pros (no cons) of completing a successful compliance audit. We will begin with the importance of conducting this level of audit. We will review scenarios of missed opportunities and risks when the compliance diligence audit is not conducted. There will be discussion on how to start, what to look for, and what items are often missed. Participants will gain knowledge of what resources to use and how to find them. We will discuss what to do when the diligence audit goes “ugly” and legal is needed to complete the audit. We will delve into what to do with the findings, how that works in a diligence audit, and strategies for education and follow-up. There are many important steps to get it all done correctly. Bring your questions and let’s talk auditing!
4C Advanced Auditor Track / Importance of Correct Coding for Chronic Conditions / Rhonda Buckholtz, CPC, CDEO, CPMA, CRC, CENTC, CGSC, COBGC, COPC, CPEDC, AAPC Approved Instructor
We knew when ICD-10 was coming that diagnosis coding was facing significant changes. The evolution of risk adjustment and quality programs has amplified those correct coding scenarios and the impact during the audit process. In this session, we will discuss the top chronic conditions and scenarios where making sure we capture the impact through audit is crucial for documentation improvement, as well as financial success. We will cover the top chronic conditions and their impact on coding, the importance of capturing the guidelines in the coding audit process, and tying the education back to the impact for future improvements.
GS2 / How to Go From Coder to Auditor / PANEL
In this session, we will open up a discussion of the challenges and pitfalls that can be encountered when moving from a coding role into the role of an auditor. In this panel discussion we hope to also reflect on the end results of all that hard work. The panel will answer questions about how the two paths are similar, as well as key differences. The panel will share what it is like to be an auditor versus what a typical day is like as a coder. Bring your questions and let’s talk careers!
5A Beginners Track / How to Audit for Incident-to / Sandra Giangreco Brown, MHA, BS, RHIT, CHC, CCS, CCS-P, CPC, COC, CPC-I, COBGC, PCS, AAPC Approved Instructor
Incident-to services have clear criteria that have to be met to bill the services under the physician. Auditing these services is complex but necessary. During this session, we will walk through the requirements for billing incident-to, discuss what needs to be included in the auditing of incident-to services, and review the process of auditing these services. We will also review alternatives to billing incident-to in order to reduce the risk to a practice.
5B Advanced Administrator Track / Impact of Population Health in Today’s Value-Based Care Model / Marianne Durling, MHA, RHIA, CPC, CPCO, CIC, CDEI, CCS, CDIP, AAPC Approved Instructor
Does population health impact value-based care or does value-based care impact population health? This session will do a deep dive on this relationship when it comes to today’s healthcare and financing that care. We will review the impact these will have on daily healthcare moving forward. We will also discuss the true impact understanding population health has on patients, providers, and the healthcare system as a whole.
5C Advanced Auditor Track / Infusion Confusion for the Auditor / Lori Cox, MBA, CPC, CPMA, CPC-I, CEMC, CGSC, CHONC
Embark on an enlightening journey into the realm of advanced infusion auditing in this exclusive webinar designed for seasoned coding professionals and auditors. Infusion services remain a critical aspect of healthcare delivery, and conducting thorough audits is paramount to ensuring coding accuracy, compliance, and revenue optimization. In this advanced session, we will delve deep into the intricacies of auditing infusion procedures, exploring complex coding scenarios, documentation requirements, and regulatory nuances. Gain invaluable insights into the audit process and strategies to identify potential pitfalls and discrepancies. Through in-depth case studies and interactive discussions, attendees will gain the expertise needed to conduct meticulous infusion coding audits, fortify compliance measures, and enhance revenue integrity.
GS3 / Networking Lunch
6A Beginners Track / Infusion Confusion for the Beginner / Lori Cox, MBA, CPC, CPMA, CPC-I, CEMC, CGSC, CHONC
Join our highly informative webinar to learn the basics of CPT® coding guidelines for infusions. Infusion services are crucial components of modern healthcare, and accurate coding plays a pivotal role in ensuring proper reimbursement and maintaining compliance. In this session, we will provide a beginner’s look at the latest CPT® coding guidelines pertaining to infusions, covering key topics such as drug administration, time-based coding, and concurrent infusions. We will share practical insights, real-life case studies, and best practices to empower attendees with the knowledge and confidence needed to navigate these complex coding scenarios with ease.
6B Advanced Administrator Track / Hiring the Right People for Your Auditing Team / Rhonda Buckholtz, CPC, CDEO, CPMA, CRC, CENTC, CGSC, COBGC, COPC, CPEDC, AAPC Approved Instructor
In the fast paced world of auditing, you need more than just someone who can count elements or interpret regulations; you need someone who can communicate, educate, and innovate to deliver effective results. In this session, we will talk about hiring trends and history, how to determine the right candidates for your team, and how to train and mentor your current team for success.
6C Advanced Auditor Track / Documentation Discrepancies in OIG Audits: A Review of Case Studies / Amy Pritchett, CPC, CPCO, CDEO, CPMA, CRC, CANPC, CASCC, CEDC, CDEI, AAPC Fellow, AAPC Approved Instructor
We will review top Medicare Advantage OIG targeted audits, discuss findings of each audit, how to implement compliance audits within your organization to comply with targeted audits and discuss why the OIG is targeting Medicare Advantage plans. We will also review case studies to determine if the audience would allow HCC diagnosis codes based on documentation submitted. We will end with Q&As.
7A Beginners Track / Value of Pre- and Post-Reviews / Stephani Scott, CPC
With the transition to value-based care models through Accountable Care Organization partnerships, it is important for physicians and healthcare organizations to understand the impact on patient care and reimbursement. Risk adjustment coding reviews are an essential component of financial success in these valued-based contracts. In this session, we will discuss pre-encounter and post-encounter reviews, along with their pros, cons, and best practices. Join me to learn more about how to perform risk coding reviews for financial success in valued-based contracts.
7B Advanced Administrator Track / Creating an Audit-the-Auditor Program / Stephanie Sjogren, CCS, HCAFA, CPC, CRC, CDEO, CPMA, CPC-I, COC
You have heard the term "audit the auditor" -- sometimes called quality assurance audits or independent audits. Whatever you call them, it is important to understand that creating an unbiased, independent evaluation of your documentation and medical coding audits is important. In this session, we will discuss how to identify whether regulatory and compliance standards were followed, how to look for and discuss deficiencies and weaknesses in the audit, identify risks, and implement controls in future audits.
7C Advanced Auditor Track / Documentation Challenges Associated with Data for E/M / Leonta Williams, MBA, RHIA, CPC, CPCO, CRC, CEMC, CHONC, CCS, CCDS
We are now several years into the new evaluation and management (E/M) guidelines for office and other outpatient services. Even with the time lapse, there are still some pressing questions and remaining ambiguity around assigning data points for medical decision making (MDM). Join us as we discuss some pain points associated with this middle MDM category. Get answers to your questions by fully understanding the criteria around data and how to explain these criteria to providers for enhanced documentation that supports billing.