Description
"The Centers for Medicare & Medicaid Services (CMS) has fully resumed all medical review activities. Getting selected for an audit has significant ramifications, including the need to devote resources to responding to and dealing with the results. Post-payment reviews, such as Unified Program Integrity Contractor (UPIC) audits, can put $100,000 on the line, potentially reaching into the millions. Providers must be aware of risk factors and trends in agency documentation that may prompt review or denial. It is crucial to reduce risk continuously and respond assertively to reviews. The Medicare Review Choice Demonstration (RCD) does not protect agencies from UPIC activity, and audits clearly show the provisional nature of pre-claim review affirmations. With numerous reviews of medical records and multiple contractor audits, prevention is the best course of action. In the face of financial disruptions resulting from a review, prompt positive actions and knowing your options are key to keeping your agency solvent. This presentation is based on 25 years of experience assisting agencies with medical reviews, as well as current UPIC audit trends."
Objectives
The following are some examples of learning objectives to be covered:
- Understanding of current CMS (especially UPIC) and Medicare Advantage medical review activity, internal and external risk factors for triggering a review.
- Knowledge of what actions to take when in receipt of a MR record request.
- Understanding of how to interpret results, key documents in the process, and timelines for response.
- Comprehension of what type of assistance is needed and when it is needed.
- Areas for agency self-assessment to minimize chances of medical review.
- Conclusion
Certificate
By completing/passing this course, you will attain the certificate HCAF Course Certificate
Learning Credits
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