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1:20-2:10 p.m.

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Easing Through the Wave of Seasonal Audits

Seasonal payer audits continue to increase, including multiple requests related the same patients due to payers using multiple subcontractors. Are we totally at the mercy of the payers?

Attend this session to learn more details behind the reasons for the most common types of audits, how each audit can impact the organization financially, and what actions could help reduce the burden of answering the requests while also protecting against, or at least limiting, negative financial impact of the organization.

This presentation will address both hospital and physician office audits and will include tips for working with payers, subcontractors, contracting and legal teams to try to reduce the burdens on HIM teams during seasonal waves of record requests.

Learner Outcomes

After this session, attendees will be able to:

• Understand the types of and reasons for the most common payer requests, including HEDIS and risk adjustment audits.
• Discuss the role of subcontractors in the request process, and why they may receive duplicate requests.
• Identify costs, administrative burden and charging options.
• Describe possible contracting opportunities within their organization, bringing HIM, billing, contracting and/or legal teams to the table, so they can better understand organizational financial impacts for each area, provide the best solutions to serve payers reasonably, and ensure a united response.

Speaker


Sue Chamberlain, RHIA, CDIP, CCS-P
Compliance, RRS Medical Media, PA
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