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Watch recorded webinar: http://go.kareo.com/twssaud Physician practices can and must decrease their audit risk from both government and private payers. How can they do that? Stop, look and listen. This one-hour webinar will present five preventive strategies that will decrease coding risk in your medical practice. At the end of the session, you will be able to: • List three sources of coding risk in your own practice • Describe the OIG Work Plan, it’s importance, and where to find it • Implement two key strategies to decrease coding risk
Citation preview
PAGE 1 KAREO | CONFIDENTIAL
5 Critical Activities to Prevent a Government Audit
We will begin in just a bit…
PAGE 2 KAREO | CONFIDENTIAL
5 Critical Activities to Prevent a Government Audit
Starting Now…
PAGE 3 KAREO | CONFIDENTIAL
Your Hosts Today…
Betsy NicolettiMS, CPC
Lea ChathamContent Marketing Manager, Kareo
PAGE 4 KAREO | CONFIDENTIAL
How to Participate Today…
PAGE 5 KAREO | CONFIDENTIAL
How to Participate Today…
Type your questions
Arrow opens and closes your panel
PAGE 6 KAREO | CONFIDENTIAL
How to Participate Today…
Follow us on Twitter @GoKareoWe’ll be tweeting live using the hashtag #KareoTip
Join our other social media channels for constant updates!
PAGE 7 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Betsy
2 5 Critical Activities to Prevent a Government Audit
3 Discover Kareo’s Role
4 Answer Questions
PAGE 8 KAREO | CONFIDENTIAL
Betsy Nicoletti, MS, CPC
Speaker, writer, and consultant in coding education, billing, and accounts receivable
Author of The Field Guide to Physician Coding
Founder of Codapedia.com
Developer of The Accurate Coding System
MS in organization and management
20 years experience in medical billing
Member of MGMA & HFMA
Betsy Nicoletti, MS, CPCwww.betsynicoletti.com
@BetsyNicoletti
PAGE 9 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Betsy
2 5 Critical Activities to Prevent a Government Audit
3 Discover Kareo’s Role
4 Answer Questions
PAGE 10 KAREO | CONFIDENTIAL
Agenda
• At the end of the session, participants will:1. List three areas of coding risk2. Describe the OIG Work Plan and where to find it3. Implement two key strategies to decrease coding risk
©2013 Betsy Nicoletti
PAGE 11 KAREO | CONFIDENTIAL
Five activities
1. Be a copy cat2. Compare and contrast3. Audit high risk activities4. Don’t be a “WNL” victim (We never looked)5. Ignorance is never bliss: educate, educate,
educate
©2013 Betsy Nicoletti
PAGE 12 KAREO | CONFIDENTIAL
Be a copy cat!
©2013 Betsy Nicoletti
PAGE 13 KAREO | CONFIDENTIAL
If the government is interested, so are we
• Office of Inspector General publishes a Work Plan every year
• Recovery Audit Contractors post areas of interest
• No surprises!
©2013 Betsy Nicoletti
PAGE 14 KAREO | CONFIDENTIAL
OIG Work Plan for 2013
Published at: https://oig.hhs.gov/reports-and-publications/archives/workplan/2013/Work-Plan-2013.pdf
©2013 Betsy Nicoletti
PAGE 15 KAREO | CONFIDENTIAL
• Gives physicians fair warning of OIG areas of interest
• Assesses not just provider accuracy and coding, but the accuracy of the Medicare contractors in paying claims— Reports issued as a result, with recommendations for
us and CMS
©2013 Betsy Nicoletti
PAGE 16 KAREO | CONFIDENTIAL
• Released every year in October• Describes areas of interest for the OIG to review
— Some continuations, some new starts— Brief, some might say obscure descriptions of areas
of interest
©2013 Betsy Nicoletti
PAGE 17 KAREO | CONFIDENTIAL
For 2013
• List of 33 items on the OIG Work Plan related to Part B services
• Some are new starts, some continuations from previous years
©2013 Betsy Nicoletti
PAGE 18 KAREO | CONFIDENTIAL
Something for everyone on the Work Plan
• Topics related to enrollment and assignment of benefits
• High volume of services, cloned E/M notes, use of modifiers in global period
• Specialty services: ESRD, chiropractic, sleep, organ procurement,
©2013 Betsy Nicoletti
PAGE 19 KAREO | CONFIDENTIAL
Something for everyone on the Work Plan
• Place of service errors• Incident to services, Nonphysicians• Lab tests, including HgbA1c• Imaging, EMGs, partial hospitalizations,
anesthesia, ophthalmology
©2013 Betsy Nicoletti
PAGE 20 KAREO | CONFIDENTIAL
Your mission critical task
• Review the Work Plan• List services you provide that are on the Work
Plan• Review coding requirements for each one you
do• Audit each
©2013 Betsy Nicoletti
PAGE 21 KAREO | CONFIDENTIAL
Mission critical activities
• Review OIG WP each year
• Audit areas of interest• Educate
©2013 Betsy Nicoletti
PAGE 22 KAREO | CONFIDENTIAL
What about the RACs?
• Four RACs: search for the RAC for your region at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/recovery-audit-program/index.html?redirect=/rac/
©2013 Betsy Nicoletti
PAGE 23 KAREO | CONFIDENTIAL
RACs required to post issues
• One, Diversified, has 630 issues listed• Connolly also has many hundreds listed
—Can sort this list by type of service—Look at areas of interest in your region—to
numerous to mention….
©2013 Betsy Nicoletti
PAGE 24 KAREO | CONFIDENTIAL
RACs: some professional areas
• E/M services in global period• Minor surgery and modifier 25• Pulmonary diagnostic procedures and E/Ms• Duplicate claims• Add on codes without primary code• Not a new patient• Place of service• E/M with allergy services
©2013 Betsy Nicoletti
PAGE 25 KAREO | CONFIDENTIAL
RACs some procedures
• Barium swallow studies• Cardiac Caths• Chemo administration• Injection and infusion
codes• Units of medication
©2013 Betsy Nicoletti
PAGE 26 KAREO | CONFIDENTIAL
CMS warnings in Rules
• From CMS in Baltimore or your local contractor• Sign up for email lists • Be a copycat: if the government is worrying
about it, worry about it.• OIG reports a source of information
©2013 Betsy Nicoletti
PAGE 27 KAREO | CONFIDENTIAL
Results from OIG WP: reports
• Level of E/M services—Found level of service increased in past 10 years, all
categories of codes, all specialties—Identified 1700 clinicians who billed two highest level in
each category more than 90% of the time
• Incident toNon qualified professionals performing professional services
©2013 Betsy Nicoletti
PAGE 28 KAREO | CONFIDENTIAL
What are high risk activities?
• Items on OIG Work Plan/RAC areas of interest• High volume services• High RVU services• Ancillaries• New provider billing
©2013 Betsy Nicoletti
PAGE 29 KAREO | CONFIDENTIAL
Go beyond E/M auditing
• E/M—except for a clinician reporting all high levels—may not be your highest risk area
• Incident to a source of huge confusion• Modifiers
©2013 Betsy Nicoletti
PAGE 30 KAREO | CONFIDENTIAL
• Use of modifiers— Pay particular attention to use of modifiers 25 and 59
which override payment edits— Frankcohengroup.com Some free info, some for
sale— Compare each individual with CMS norms and
practice average
• Most frequently billed codes• E/M level of service
How risky is our business?Compare your data
©2013 Betsy Nicoletti
PAGE 31 KAREO | CONFIDENTIAL
New Percentage Established Percentage
99201 1.35% 99211 3.91%
99202 15.82% 99212 4.34%
99203 45.07% 99213 48.03%
99204 30.63% 99214 40.10%
99205 7.12% 99215 3.61%
CMS norms for Family Practice
©2013 Betsy Nicoletti
PAGE 32 KAREO | CONFIDENTIAL
Normative data
• Typically not free, unfortunately• Compare within group quarterly
©2013 Betsy Nicoletti
PAGE 33 KAREO | CONFIDENTIAL
Compliance plan activities
• Not required to audit the same services every year
• Select high volume or high dollar value services
• Select services that are confusing to group• Be a copy cat
©2013 Betsy Nicoletti
PAGE 34 KAREO | CONFIDENTIAL
WNL
• Common phrase—physicians use it to mean “Within normal limits”
• Wikipedia also notes it as “we never looked”
©2013 Betsy Nicoletti
PAGE 35 KAREO | CONFIDENTIAL
What shall we look for?
• Copying from previous notes
• Sequential visits for patients with chronic illnesses
• Same complaint (frequency) for multiple patients
©2013 Betsy Nicoletti
PAGE 36 KAREO | CONFIDENTIAL
Now, don’t be a copy cat
• HPI copied from previous note
• Assessment and plan is a list of patient’s medical history, not issues addressed today
©2013 Betsy Nicoletti
PAGE 37 KAREO | CONFIDENTIAL
Is the note complete?
• Weekly, run a report of non signed/opened notes
• Some groups do not submit claims unless note is complete, some do
• If a clinician is chronically behind, do not submit claims— No RVUs, no revenue
©2013 Betsy Nicoletti
PAGE 38 KAREO | CONFIDENTIAL
Non-completed notes
• Medical liability• Compliance risk• Set a policy about when
notes must be completed• Run a report: date of
service, date completed
©2013 Betsy Nicoletti
PAGE 39 KAREO | CONFIDENTIAL
Ignorance is bliss? Not for coding
• OIG Compliance Plan for Small Practices includes education as a component
• On or off site• Webinars, seminars, books• Document attendance
©2013 Betsy Nicoletti
PAGE 40 KAREO | CONFIDENTIAL
Source citations
• AMA is the definitive source for coding (www.ama-assn.org)
• CMS, payers develop reimbursement policies (www.cms.gov)
• CMS manuals and Contractor billing guide good source of coding/reimbursement for Medicare
• Specialty societies
©2013 Betsy Nicoletti
PAGE 41 KAREO | CONFIDENTIAL
Start with CPT
• Editorial comments• See and see also, report and do not report• Professional edition also references CPT
Assistant
©2013 Betsy Nicoletti
PAGE 42 KAREO | CONFIDENTIAL
Specialty societies
• Terrific source of coding information related to your specialty
• Specialty societies have high validity with physician members
• Often allow 3-5 free coding questions/year to physician members
• Some offer in person coding seminars
©2013 Betsy Nicoletti
PAGE 43 KAREO | CONFIDENTIAL
Commercial vendors
• General coding and specialty specific• Look for vendors with long history and good
reputation• Consultants are not source citations but often
have access to source citations to support their points
©2013 Betsy Nicoletti
PAGE 44 KAREO | CONFIDENTIAL
Resources
• Critical to budget for newsletters, books, seminars
• Document attendance in compliance files• Physicians often more receptive in smaller
increments
©2013 Betsy Nicoletti
PAGE 45 KAREO | CONFIDENTIAL
Predict and protect
• No crystal ball needed
• Government tells us what it is worried about
• Protect your practice with a robust compliance plan
©2013 Betsy Nicoletti
PAGE 46 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Betsy
2 5 Critical Activities to Avoid a Government Audit
3 Discover Kareo’s Role
4 Answer Questions
PAGE 47 KAREO | CONFIDENTIAL
Discover Kareo’s Role
“…Make Your Practice a Best Practice!”
PAGE 48 KAREO | CONFIDENTIAL
Discover Kareo’s Role
• PAHCOM has approved 1 CEU credit.
• Each attendee will receive an email today with a link to request certification. Certificates will be mailed within the next few days.
• Attendees must be logged into the webinar to receive credit.
• Questions - email [email protected]
“…Make Your Practice a Best Practice!”
PAGE 49 KAREO | CONFIDENTIAL
Discover Kareo’s Role
• Cloud-based• Medical Billing• Patient Payment Services• Insurance Billing & Remittance• Scheduling & Practice Management• Electronic Health Records• Medical Billing Services
17,000 Providers Nationwide
PAGE 50 KAREO | CONFIDENTIAL
Discover Kareo’s Role
•Audit Tools• E&M Productivity
Report
PAGE 51 KAREO | CONFIDENTIAL
Discover Kareo’s Role
•Audit Tools• E&M Productivity
Report• Prevent Duplicate
Encounters and Claims
PAGE 52 KAREO | CONFIDENTIAL
Discover Kareo’s Role
•Audit Tools• E&M Productivity
Report• Prevent Duplicate
Encounters and Claims
• Fine-tune Clinical Documentation Templates
PAGE 53 KAREO | CONFIDENTIAL
Discover Kareo’s Role
PAGE 54 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Elizabeth
2 5 Critical Activities to Prevent a Government Audit
3 Discover Kareo’s Role
4 Answer Questions
PAGE 55 KAREO | CONFIDENTIAL
Let’s Answer Your Questions
Is it too late to think about Stage 1 attestation?
Questions Now
888.775.2736 [email protected]
Questions After the Webinar
For Kareo…
For Betsy…[email protected]
PAGE 56 KAREO | CONFIDENTIAL
5 Critical Activities to Avoid a Government Audit
Thank you for attending!