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Protect from Audit and Recoupment to Unlock Revenue with Effective Demand Letter Response
Format: On-Demand Webinar
Duration of the training: 60 Minutes
Location: Online Webinar
By: J. Paul Spencer, CPC, COC

Conference Materials (Password Required)

Whether you want it or not, it’s coming. The dreaded letter stating that you owe money and they want it. Everyday thousands of providers are audited and then sent notice of overpayment demand letters. The first line of audit response is in the correspondence received by your practice. Simply accepting the terms laid out in demand letters, subpoenas and audit notifications could prove to be a huge mistake for your practice. You can reverse these investigations, audits and recoupment request with an effective response to these demand letters.

Compliance Expert J Paul Spencer, walks you through the different types of audit correspondence you may receive, the level of importance of each, and tips for successful response to the payer. It’s all in the response! Paul will help you successful response plan, but also he will tell the step-by-step process every practice must utilize to successfully respond to every type of demand letter you might receive.

Learning Objectives:
  • Understand what types of demand letters a practice might receive
  • Understand what the letters are actually requesting
  • Know when the matter can be handled at the practice level
  • Learn when it might be beneficial to get a 3rd party opinion
  • Understand when legal counsel is useful or required
  • Review and Dissection of Various Types of Audit and Investigation Letters and How to Approach Each
  • Lean best practices for defending Overpayment Recoveries
  • Understand medical necessity
  • Understanding False Claim Act
Areas Covered in the Session:
  • ADRs (Additional Documentation Request)
  • The False Claims Act
  • Medical Necessity
  • SIU (Special Investigative Unit) Overpayment Demand
  • Notice of Investigation vs Demand for Records
  • Responding to Payer
  • Appeal Documentation
  • Reversing Payer Decision
  • Types of Audit and Investigation Letters
  • Approaching Techniques to different Audits and Investigation Letter
  • Defining “Medical Necessity”
  • Commercial Payor Trending Report
  • Recovery Audit Contractor
  • Unified Program Integrity Contractor (UPIC)
  • Overpayment Rescission
Suggested Attendees:
  • Billing Managers
  • Practice Managers
  • Providers
  • C-Level Executives
  • Office Staff and Billing Managers
  • Medical Billing Companies
  • Hospital Revenue Cycle Staff
  • Physician
  • Nurses
  • Physician Assistants
  • Nurse Practitioners
  • Medical Assistants
  • Practice Manager
  • Office Managers
  • Coders
  • Auditors
  • CDI Specialists
  • Collection Staff
  • Compliance Officers
  • Telemedicine System Vendors
  • Patient Accounts Personnel
  • Medical Record Supervisors
  • Health Information Management Administrators and Technicians
  • Other Personnel Interested in Billing Privileges with the Medicare Program
Presenter Biography:

Paul has over 30 years of experience on the administrative side of healthcare, including six years with health insurance carriers. In his present role as a senior compliance consultant, Paul focuses on physician education, with an emphasis on documentation improvement for Evaluation & Management and surgical services.

Paul has assisted in creating compliance plans for a major diagnostic laboratory provider, as well as for multiple third-party billing companies. As the former director of coding and regulatory compliance for Providence Health Services in Washington, DC, he worked to solidify retrospective audit responses to commercial and governmental insurance carriers. He has extensive experience in a wide range of physician specialties, including anesthesia, emergency medicine, advanced wound care, orthopedic, general & neurosurgery, outpatient physical therapy, and pain management, among others.

Paul has served on the editorial board of RACMonitor and has been a frequent guest on that publication’s “Monitor Monday” broadcast, where he focuses on Medicaid audit and physician audit issues. He has carried the Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) credentials from the AAPC since 1998.


This is a Live Virtual session.

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TESTIMONIALS

“Jim Sheldon-Dean’s insights on privacy and security were very much helpful to our team, it was great to learn from an instructor like him. Appreciate!” CHRISTINE JACOB MD, CDI SPECIALIST

“This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course.” MELISSA PRESTON, HEALTH INFORMATION MANAGEMENT STAFF

“The workshop was very insightful and made absolute sense in terms of the regulations and their compliance. I am thankful for having the opportunity to attend.”BARBARA CAPRIOTTY, REHABILITATION DIRECTOR

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