Session Information
HFMA's MAP Event: Leading for Revenue Cycle Excellence
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Universal Health Services: Using Comprehensive Medical Necessity Review to Reduce Exposure to RACs & MACs
Track
:
General
Program Code:
PR5
Date:
Sunday
,
November
7,
2010
Time:
4:40 PM to 5:30 PM
EST
SPEAKER
(S):
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about each speaker.
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about each speaker.
Maribeth Jenquine, CPA, Vice President, Patient Financial Services, Universal Health Services, Inc.
Description
Preparing for the Age of Healthcare Audit Accountability:
Winning is Possible, but Your Goal is to Avoid Playing
Worried about the RACs? The MACs? The OIG?
Are you certain that your hospital is in compliance with 42CFR482.30 that mandates certain Utilization Management practices as a condition of participation in the Medicare program? Does your UR plan provide for the review of Medicare and Medicaid patients with respect to the medical necessity of admissions and duration of stay?
Have you fully implemented the federal medical necessity requirements necessary to ensure the integrity of your Medicare payments and your institutions ability to satisfy Medicares Conditions of Participation?
Would a pre-audit peek under the covers show fragmented processes and Medicare payment errors, or, worse yet, would the phrase reckless disregard be applicable?
Will the dawn of the Era of Medicare Medical Necessity Audits, led by federal audit programs denials and recoupments, have major negative impact on your compliance, past quality of earnings, organizational value and creditworthiness?
Join this session to learn how to prepare for the age of healthcare audit accountability to maximize compliance and minimize risk.
About Executive Health Resources
Endorsed by the AHA, EHR is the only company that provides hospitals with 7-day-a-week teams of specially-trained, technology-supported Physician Advisors. To date, EHR's Physician Advisors have successfully performed more than 1.5 million medical necessity reviews, conducted hundreds of audits at client hospital facilities and successfully identified and reversed thousands of inappropriate medical necessity denials at all federally mandated levels of appeal. Today, EHR works with more than 1,000 hospitals and health systems across the country and employs more than 300 physicians. For more information, please visit www.ehrdocs.com.
Winning is Possible, but Your Goal is to Avoid Playing
Worried about the RACs? The MACs? The OIG?
Are you certain that your hospital is in compliance with 42CFR482.30 that mandates certain Utilization Management practices as a condition of participation in the Medicare program? Does your UR plan provide for the review of Medicare and Medicaid patients with respect to the medical necessity of admissions and duration of stay?
Have you fully implemented the federal medical necessity requirements necessary to ensure the integrity of your Medicare payments and your institutions ability to satisfy Medicares Conditions of Participation?
Would a pre-audit peek under the covers show fragmented processes and Medicare payment errors, or, worse yet, would the phrase reckless disregard be applicable?
Will the dawn of the Era of Medicare Medical Necessity Audits, led by federal audit programs denials and recoupments, have major negative impact on your compliance, past quality of earnings, organizational value and creditworthiness?
Join this session to learn how to prepare for the age of healthcare audit accountability to maximize compliance and minimize risk.
About Executive Health Resources
Endorsed by the AHA, EHR is the only company that provides hospitals with 7-day-a-week teams of specially-trained, technology-supported Physician Advisors. To date, EHR's Physician Advisors have successfully performed more than 1.5 million medical necessity reviews, conducted hundreds of audits at client hospital facilities and successfully identified and reversed thousands of inappropriate medical necessity denials at all federally mandated levels of appeal. Today, EHR works with more than 1,000 hospitals and health systems across the country and employs more than 300 physicians. For more information, please visit www.ehrdocs.com.
- Discuss how federal audit processes will identify overpayment errors and establish false claims allegations
- Outline the tools needed and steps to take to proactively shape a compliant process that will deliver revenue integrity and compliance across regulatory enforcement initiatives
- Recognize through first-hand experience sharing the impact on hospital financial and data metrics, costs, exposures and other consequences that result from non-compliance (e.g. Length of Stay (LOS), mortality rates, market share, creditworthiness and patient revenue)
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