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Auditing - Standing Your Ground with Payers

Date:Tuesday, April 20, 2021
Time:12 noon to 1:00 p.m. Central Time
Course fee:$99
Presented by: Sean Weiss, CHC, CMCO, CEMA, CPMA®, CPC-P, CMPE, CPC, CMC, CMIS, CMOM
Partner, Vice President of Compliance, Doctors Management, NAMAS Instructor and Auditor

Webinar/Audio Conference FAQs

2021 is The Year of the Audit? Some experts are already knees-deep with investigations and audit defense work. The upheaval in healthcare last year resulting from the pandemic along with changes to the 2021 EM Documentation Guidelines is ripe territory for audit scrutiny. Regulatory compliance and audit defense expert Sean M. Weiss predicts problems will continue for providers and health system based on the surge in telehealth services and COVID-19 waivers extended during the Public Health Emergency (PHE) to help providers operate more efficiently. But it's not too late to get things straight!

Despite the ongoing PHE, payor audits have and continue to ramp up. TPE, MAC, OIG, RAC, MIC, CERT and SIU as well as other types of audits are in full swing. Steps you take now can build a better case for the future if errors/oversights are flagged in an audit. It all comes down to establishing a "Culture of Compliance"!

All medical office leaders should make time for this important session. Sean will explain how you can perform a self-audit or bring a professional auditor onsite to guide the process before it becomes a red flag. Sean will also help you to understand how to build a solid defense and the difference between disclosure and refund processes.

Participants in this session will learn how to:

  • Research, locate specific payer policies, utilization guidelines, participation agreements, contracts or any other published guidance documents when you perform audits
  • Secure authoritative guidance from peer-reviewed papers, specialty society publications, and guidance from the AMA, CMS, etc.
  • Challenge payers that try to argue your lack of knowledge or obligation thereof
  • Request that they produce the binding guidance documents that place the responsibility on you or your providers.

Continuing Education Units (CEUs)

PMI CEU APPROVED Earn 1 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).

If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.

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PMIMD instructor

About the Presenter

Sean specializes in medical audit and appeal representation. He serves as Chief Compliance Officer for numerous nationally recognized health care organizations. He develops customized compliance programs including: Standard Operating Procedures (SOPs), Policies, Corrective Action Plans, Investigations and maintaining their Culture of Compliance.

He and a team of coding and compliance experts at the National Alliance of Medical Auditing Specialists (NAMAS) work with large and small healthcare practices that have been targeted by federal (Medicare), state (Medicaid), and commercial insurance payors. Sean delivers measurable financial results while helping clients reduce their financial risk of noncompliance with government agencies as well as providing quality care to their patients. Clients benefit from his knowledge of the inner workings of federal and state agencies such as the Office of Inspector General, Department of Justice and The United States Attorney’s Office. Having protected thousands of physicians, medical practice groups, hospitals, and medical management societies from undue penalties, he is recognized as an expert in the field of medical compliance.

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