Home Health Audits: ADR’s, RAC’s and ZPIC’s Targets

Event Information
Product Format
Prerecorded Event
J'non Griffin, RN MHA WCC, HCS-D, HCS-C, HCS-H, COS-C
Conference Date
Thu, Nov 30, 2017
60 minutes
Product Description

Identify Common Reasons for Denials in Home Care and How to Reduce Risk of Denials

Do you feel like everyone is looking at your charts? Well they are! Due to the anti-fraud initiative of the Affordable Care Act, the government is increasing audits to ensure that home health is billing, and not filing false claims. This session by expert speaker J’non Griffin will address ADR’s, RAC’s, and ZPIC’s, along with CERTS, UPICs, and various payer audits. J’non will discuss the ADR process, common reasons for denials from each of the MAC’s, scope of work for the ZPIC and RAC auditors for home health. She will also discuss processes your agency needs to have in place to reduce the risk of denials even if (and when) you get audited.

You will learn the common reasons for denials in home care, what issues are trending across the MAC’s, and processes to put in place to reduce your risk of denials in the future. You will be able to define processes your agency needs to follow to mitigate your risk of denials in the future. You will learn about what is and what is not an acceptable, and what you need to know to have a clean claim prior to submission of that claim.

Session Highlights

  • Reasons for the ADR process
  • Common reasons for denials
  • The process for submission of an ADR
  • The dos and don’ts when submitting records
  • The levels of the appeals process

Session Agenda

  • Overview of Medicare contractors
  • Additional development requests (ADRs)
  • Hierarchy of review
  • Payment determinations
  • Post-payment audits
  • Overview of Medicare administrative contractors (MACs)
  • Program Integrity Manual: Restriction on contractors
  • Face-to-face (FTF) encounter for home health services
  • Recovery audit programs (RAC)
    • Audits
    • Restrictions
    • Typical review
  • OIG Work-plan
  • Zone program integrity contractors (ZPIC)
    • Overview
    • Auditors
  • OIG action from report
  • Immediate OIG referral
  • Administrative functions for ADRs
  • Home health denials
  • How to defend against audits
  • Medical necessity

Who Should Attend

  • QA directors
  • Administrators
  • Clinical management staff
  • Owners and operators

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

J'non Griffin


J’non Griffin is a full service consultant for home health and hospice agencies across the country. She has almost 30 years of home health and hospice experience, and has served in many positions with large and small agencies. She has served as a field nurse, supervisor, Corporate compliance, and Chief Operating Officer. J’non has experience in operational analysis, clinical compliance, including coding and OASIS review and ADR appeals....   More Info
More Events By The Speaker

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