Improve your knowledge of level of service audits to reduce practice risk and promote accurate claim submission. You can pay a consultant to do it, wait for an audit letter, or take a proactive stance and implement ongoing self-audit procedures.
This program will demonstrate a step-by-step process to implement an internal audit program. Adopting a systematic approach to cross-checking records ensures that you always know where you stand and improves communication with providers and staff. Review the general principles of medical record documentation and learn how to review documentation to ensure correct assignment of Evaluation and Management (E/M) codes. Understand how to select the level of E/M services based on medical decision making or time. Apply the information learned in multiple case studies and receive tips for avoiding carrier audit triggers.
MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.
Participants will learn the value of an internal self-audit protocol and be in a position to discover missed revenue opportunities when auditing charts based on fact.
No prerequisites. Content assumes basic knowledge of medical charts and coding of E/M claims. CPT® and ICD-10-CM code set manuals may be beneficial when reviewing sample audit cases.
Self-paced online program includes unlimited review of previously recorded instruction and access to downloadable companion course materials for 6 months.