80+ publications/presentations, 20+ years of progressive achievement in the health care management industry. Rebecca Busch is a pioneer in conducting technology and process-enabled audits of health care claims & processing. She developed proprietary data analysis tools and currently has a patent pending on a data anomaly profiler. She is a registered nurse and an MBA as well as a certified fraud examiner (CFE), health care fellow in financial management (FHFMA) and internal auditor (formal CIA accreditation pending). In 1991 Rebecca founded Medical Business Associates with the vision of delivering a multi-disciplined approach to conducting comprehensive audits for Major Employers, Hospitals and Insurance Companies. Her proprietary methodology employs statistical analysis of claims and procedural data -- specifically targeted to identifying the most probable areas of operational breakdowns, exposure to fraud, financial errors, and cost savings. Ms. Busch’s ability to quickly identify anomalies from vast amounts of data has distinguished her and Medical Business Associates as an invaluable source of dramatic cost-savings for clients. Ms. Busch currently has a patent pending in the area of medical and financial errors in health care; has testified as an expert in the area of health care reimbursement, internal controls, life care expense analysis, patient care documentation and respective damages and she has authored, healthcare fraud audit and detection guide, Wiley Publications available after October 2007 and a how to book that will teach American families how to detect fraud in reviewing their own families medical bills. Additionally she is a faculty member of the Association of Certified Fraud Examiners who has published numerous articles and is a frequent public speaker.
Description
Learning Objectives:
1. Describe the basis for "usual" and "customary" health care pricing.
2. Discuss the review and audit methodologies for healthcare price determinations.
Case law is passing in various states on entering bills into medical evidence. Combined with determinations and appropriate methodologies in pricing your life care plan, today's LNC must be ready to address both reimbursement issues as well as making usual and customary determinations. This workshop will address these issues for consideration along with pitfalls to avoid in order to become a successful life care planner.