Conducting Outpatient Coding, Billing and Reimbursement Audits

Event Information
Product Format
Prerecorded Event
90 Minutes
Product Description

Here’s how to simplify performing outpatient audits.

Because outpatient coding and billing has become so complicated, it’s up to you to understand the broad spectrum of compliance areas to which hospitals, systems, physicians, and clinics are subjected.

You need to recognize the severity of compliance issues, the auditing process, and associated penalties. You also need to understand the importance of written policies and procedures for coding, billing, and chargemaster.

In this session, you will learn the auditing process and techniques for selecting cases, billing, and remittance information for review.

Expert presenter, Duane C. Abbey, PhD, CFP, will address these important items:

  • The main issues surrounding Medicare APCs
  • Whether MS-DRGs affect outpatient coding and billing
  • What should you do before the OIG and the RACs come.
  • Selecting sample cases
  • What to do in the event of compliance violations.
  • Define “error.”
  • How to handle over- and under-payments.
  • Identify the type of audits.
  • How do RAC and MAC audits affect CBR audits.

This session will help you:

  • Understand the broad spectrum of compliance areas to which hospitals, systems, physicians and clinics are subjected.
  • Recognize the severity of current compliance issues, the auditing process and associated penalties.
  • Appreciate the importance of written policies and procedures for coding, billing and the chargemaster.
  • Learn the audit process and techniques for selecting cases, billing and remittance information for review.
  • Discover statistical techniques for developing formal and informal audit processes.
  • Highlight the role and use of computer technology in maintaining compliance and the process of auditing computer software and its utilization.
  • Draw the line from the auditing process interface to various CBR Policies and Procedures and the CBR compliance program.
  • Underline the need to facilitate the auditing process with various hospital/clinic personnel so that the auditing process can be used effectively as an educational tool.
  • Break down the complexity of inpatient and outpatient reviews.
  • Follow the process of the coding interface to the chargemaster for outpatient coding and billing.
  • Establish an ongoing CBR audit program along with special ad hoc audits.
  • Define RAC audits and the need to prepare with CBR audits.

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

Who should attend? All personnel involved with coding, billing, and reimbursement activities.  Compliance Officers, Compliance Analysts, Chargemaster Coordinators, Internal Auditors, other compliance personnel, financial analysts and other interested administrative personnel, coding staff, health information specialists, claims transaction personnel, .patient financial management personnel.  Nurses and physicians are encouraged to attend.

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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