ZPIC Audits What We’ve Learned from 2011 and other Audit Risks Webinar


Edward Vishnevetsky, healthcare attorney with Munsch Hardt has asked Angela Miller to join him as a guest speaker during his presentation next Thursday, February 9, noon-1pm CST.  Audits are inevitable at this point, so better be prepared and proactive for the audits that are coming.  Join us as we discuss ZPIC audits and other audits you can expect in 2012, such as HIPAA, OCR, Medicaid RAC, Commercial audit expansion. Also learn how best to prepare and prevent  adverse outcomes.

You are Invited to Join our Complimentary Medicare ZPIC Audit Webinar

Featuring Topics on:

Changes to Medicare ZPIC and RAC Audits
The Office of the Inspector General’s (OIG) take on Audits in 2012 based on the 2012 OIG Work Plan
Which HCPCS codes may be most vulnerable and subject to scrutiny
How DME suppliers can work with physicians, hospitals and manufacturers to assist in responding to audits
Tips on how to effectively respond to audits (based on lessons learned in 2011)
Other Audit Risk and Prevention

Presentation Given By:

Edward Vishnevetsky

Attorney at Munsch Hardt Kopf & Harr, P.C.

Featuring Guest Speaker:

Angela Miller

President of Medical Auditing Solutions LLC

Date: Thursday, February 9th, 2012

Time: 12:00-1:00 PM CST

Cost: Complimentary

To reserve your Webinar seat, please click here.

After registering you will receive a confirmation email containing information about joining the Webinar.

If you have any questions, please contact Ashley Thomas.

Edward Vishnevetsky has successful defends over 40 physicians, DME providers and HHAs against ZPIC, CERT, MAC and RAC Audits; achieved 100% success rate in removing providers from pre-payment audit.  Successfully defended over 100 providers through all stages of Medicare appeals, including the Administrative Law Judge (ALJ) level.  Read more at Munsch-Vishnevetsky

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

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Medtrade Fall 2010 – Got Your KX? Get Cash $$


I will be speaking at Medtrade Fall 2010, November 18 at 8:30am-9:30am.  Learn the misconceptions of filing with the KX Modifier.  Also learn what you must have in your file for medical necessity documentation to submit a claim with the KX Modifier.  With so many audit contractors (RAC, ZPIC, payor, OIG) going after the DME industry and KX modifier products, it is critical that you attend and hear proactive measures to protect your business.

Universal Software Solutions is sponsoring my presentation.  I greatly appreciate their support and sponsorship.

You will be able to find Universal and myself at booth 335.  I will be speaking at their booth on November 17 at 11am and 3pm as well as November 18 at 10am.  All topics will be billing and collections related.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

Date of Death Audits for DME & Inpatient Facilities


Beware, this is just one region that has published the date of death audit for DME and inpatient facilities such as rehab, hospital, LTC, SNF facilities.  This audit is done periodically and most suppliers are hit with a few thousand to upwards of $20K in overpayment refund requests.  Be prepared with a reserve of cash based on the size of your business.  At a minimum, I would suggest a set back of $5K even if you are outside of Region A.  Region A tends to publish this type of information earlier than other areas. These audits typically take place about every three years which is why the dollar amounts are so high.

We all know that payment after date of death will never be paid; however accidents will happen.  Ensure your billing staff doesn’t just “resubmit” claims without working the denial, this can cause a fraud audit even if you are not getting paid!  Likewise, if payment does occur it is usually less than 90 days from date of death when family fail to contact suppliers because they think the equipment belongs to the patient.  It could be a pick up ticket was not entered or a facility span date was not stopped at date of death instead of the full episode.  Note these are being audited by the RAC!

Republished:
NHIC, Corp.
DME MAC A ListServe
For Immediate Release
August 12, 2010

CMS Approved Audit Issues Posted for Region A Recovery Audit Contractor

DCS, the Medicare Recovery Audit Contractor (RAC) for Region A, recently posted new CMS approved audit issues for RAC review.

The new CMS approved audit issues are listed below and apply to the states of Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.

* Date of Death – DME
* Date of Death – Inpatient

See the CMS approved audit issues at DCS’ RAC website: http://www.DCSRAC.com for more information.

Region A includes the states of Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.

15 Minute Thoughts: NP and PA Visits: Can the non-physician provider be billed under the physician?


Reminder for our call TODAY Wednesday

Program your Phone and Calendar:

Date & Time:                                        August 11, 2010,   8:30am-8:45am CST

MAS Conference Call Dial-in#:     218-862-1300

Conference Code:                               622911

MAS Office number:                          972-459-1508

Who should call in?

Any health care provider, Health care business owner or manager, Attorneys, Compliance Officer, Physicians, Non-physician providers, and Office Managers

Topic

NP & PA Visits: Can the non-physician provider be billed under the physician? I  have heard many questions in the last few months about whether a NP, PA, CNS can be billed under the physician’s provider number for any reason.  Can it be done while the non-physician provider is waiting on their only provider number?

Join myself and guest speaker, Edward Vishnevetsky as he provides input on whether non-physician providers can be billed under the physician provider number.  Mr. Vishnevesky is with Thompson & Coe in the Dallas, Texas office.  Edward L. Vishnevetsky has extensive experience in the area of health law and commercial litigation. He routinely argues before state and federal courts in areas of health law, employment law, and complex commercial litigation, and also represents hospitals, physicians, durable medical equipment (DME) providers and manufacturers before various state and federal regulatory agencies. Edward advises health care clients on operational matters, liability exposure, privacy issues, federal and state health care regulatory compliance, health care reimbursement disputes, as well as risk management issues. Edward is fluent in Russian and has conversational knowledge of Spanish.  To read his complete & extensive biography visit Thompson & Coe or Edward Vishnevetsky.

Join the next discussion in one week:

August 18, 2010         Payer Audits Giving “RAC’d” a Whole New Meaning: Tips to Manage Audits

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

TAHCS Lone Star Conference


REGISTER NOW!   http://www.box.net/shared/5mqkgyr94e Early Bird Pricing Extended 1 week, so hurry!

ALL DAY ONLY $99 INCLUDES LUNCH & free  Happy Hour

I will be participating at the ALL DAY Conference.  We tried to make this a half day conference but there is so much information and so many changes that we just could not fit it into 4 hours.  This conference will include session presented by Thompson Coe, myself and representatives from CIGNA and VGM.  This conference will discuss the many woes that you are facing as health care providers from Competitive Bidding, ZPIC & RAC Audits, Compliance Issues, Effects of the new Healthcare Bill, Reimbursement and Legal Aspects to protect your business.  There will be many vendors that focus on helping health care providers run their businesses more efficiently and save money.

The 2010 LoneStar HME Conference will be held at the Dallas Crown Plaza Market Center Hotel. This one-day event will bring together top professionals in various fields, including numerous lawyers from Thompson Coe, who will present on topics including, but not limited to, the following:
  • Competitive Bidding; the HITECH Act Edward L. Vishnevetsky (Thompson Coe)
  • Medicare’s Latest Changes – Mark Loney (Cigna Health Service)
  • ZPIC/RAC Audits – John G. Browning (Thompson Coe)
  • Governmental Affairs Update – Mark Higley (VGM)
  • DME Manufacturer/Supplier Lawsuits – Jeff Otto (Thompson Coe)
  • Texas Legislative Update in Health Care – Jay Thompson (Thompson Coe)
  • Effective Lobbying of HR 3790 – Barry Johnson (TAHCS)
  • Choice of Business Entity for DME Suppliers – Bruce Bringardner (Thompson Coe)
  • Proactive Chart Documentation – Angela Miller (Medical Auditing Solutions)

You will leave with a great deal of knowledge and only for $99 which includes lunch.  The Free Happy Hour is sponsored by Thompson Coe.  You will have a chance to network and have your questions answered by the best experts in the industry.  Get a double dose of information while enjoying yourself !  Now where can you spend an hour with 3-4 attorneys networking and asking questions for free?

Don’t miss this extraordinary meeting.  Take advantage of our industry experts in a relaxed atmosphere.  Learn how to survive tough times and do not miss the insider information

Early Bird Pricing Extended 1 Week 4/7/10, so hurry!  If you include the following code you can extend the early bird price of $99. 9-52  code- 042610

HME Lone Star Conference

2010 HME Lone Star Conference.
Crowne Plaza – Dallas Market Center
7050 N. Stemmons Freeway
Dallas, TX 75247

April 26, 2010
8:30 to 4:00 pm
Free parking
Lunch included with registration

REGISTER NOW AT:   http://www.box.net/shared/5mqkgyr94e
Make plans to attend this informative
HME meeting featuring nationally
recognized speakers. Presented By: TAHCS & Thompson Coe

RAC and ZPIC Audits: How to have a Successful Payer Audit?


In the last twelve months, there has been more money than ever before put into fighting fraud and abuse.  Contractors are requesting more charts than ever before to review for fraud and abuse.  How do you have a successful payer audit?  The simple answer is provide the documents requested, but there is more to it.

First, Make a checklist for each chart.  Pull each chart and copy all records requested.  The request period may not include the delivery or start date and copies of initial qualifying test results and/or chart notes, include them if it is pertinent to the determination of ongoing medical necessity for example rentals of equipment.  If you did not obtain the test results or physician chart notes at the time of the start of care, request them now because the physician is not penalized if he does not respond.  Physician failure to respond to a request is an error and results in “overpayment/error” paid by the provider.  It is in your best interest to gather and submit each patient record in an organized manner.  This needs to be top priority because you have limited time frame to produce and failure to respond timely results in overpayment calculations!

Have you seen or heard the “error rates” being published?  The way it sounds, ever provider will have an audit with an error rate, it is just a matter of time.  A error rate published March 1, 2010, by Noridian was over 102 files with 86% error rate.  This is a small sample to create a crisis over.

I would recommend you have an independent third party, whether consultant or your health care attorney,  review the records before you send them off.  You can typically be granted one extension.  Do not wait until the last minute to start this process.  If you have a large number, have someone review a sample then expand based on the determined error rate.

If more than 20-30 charts are requested, I would notify outside counsel.  I am receiving new clients weekly with 200, 300, 400 or more charts being requested.  To produce duplicate copies of these records and obtain physician records in 14-21 days may be difficult and still run your business.

If you haven’t received an audit to this point, be prepared for when it happens.  Any overpayment determination in a payer audit requires payment arrangements prior to the appeal process being completed.  Be proactive, have an audit of your business to be prepared for when that day comes.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria.  Ms. Miller has extensive experience with Medicare and Payer audits.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back end collections. You can visit our website at Medical Auditing Solutions LLC.