PPT-Medicare Audits & Patient Access

Presented by Michelle Way Revenue Cycle Integrity Specialist Otani Consulting Group Inc   46th Annual Educational Conference amp Exhibition Patient Access   The First Connection to a Lasting Impression. Presented by:. PHYSICIANS ADVOCACY INSTITUTE . AMERICAN COLLEGE OF EMERGENCY PHYSICIANS. 1. PAI. Founded in 2006 as Result of MDL Managed Care Litigation. Board Comprised of CEOs from 9 State Medical Associations: CA, CO, GA, NE, NY, NC, SC, TN and TX and a Physician. Allegations. . Secret Shops. . Corrective Actions . Audits. An audit is an examination and evaluation of an organization to make sure that their records are accurate, and that the company and their contracted partners are adhering to the requirements of the contract. . Vidya Sellappan. HIT Initiatives Group, CMS. 1. Audit Basics. Any provider that receives an EHR incentive payment for either EHR Incentive Program may be subject to an . audit.. CMS, and its contractor, Figliozzi and Company, will perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers who are participating in the EHR Incentive . Gail Sexton; Ray Swisher; and Deme Umo, CMS. New Changes to Enrollment Rules. Enrollment for Medicare Parts C & D. Center for Medicare/Medicare Enrollment & Appeals Group, and. Medicare Medicaid Coordination Office. Audit Issues. Updated January 2016. Presented . by: . Heather Lopez. Chief Audit Executive, . Internal Audit. Recording date of this workshop is . March 14, 2014. Some of the rules and procedures discussed in this workshop are subject to change.. New TFC. 1. Why do we need Medicare Certification?. Reimbursement of costs via the Medicare Cost Report. Most commercial insurance carriers require their members to utilize Medicare certified transplant centers or no coverage is provided for the transplant.. and Billing. , . and . More: . What . Every University Clinic Must . Know . and Implement. Paul . Pessis. , AuD. Tim . Nanof. , MSW. Disclosures:. Financial. Tim Nanof is employed full time by ASHA.. If you have investments will it affect your Medicare coverage? Find out here what will and won\'t reduce coverage. Find out what should know before applying for Medicare, learn all the Medicare application processes Ramón Castellblanch. . Professor Emeritus, Public Health. San Francisco State. December 2, 2021. Private Insurers’ Impact on Medicare. Profit-taking . Not risk-taking as claimed . Not coordinating care as claimed . Wisconsin SHIP: 1-800-242-1060. Grant Funding Disclaimer. 2. This project was supported by the Wisconsin Department of Health Services with financial assistance, in whole or in part, by grant number 90SAPG0091, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.. Adj. : age/sex/race/prior year hospitalization/comorbidities. Ref: 2012 patients. Abbreviations: CKD, chronic kidney disease.. vol 1 Figure 3.1 Unadjusted and adjusted all-cause mortality rates (per 1,000 patient years at risk) for Medicare patients aged 66 and older, by CKD status and year, . Figure . 7.1 . Sources of prescription drug coverage in Medicare enrollees, by population, 2014. 2016 Annual Data Report, Vol 1, CKD, Ch . 7. 2. a The . catastrophic coverage amount is the greater of 5% of medication cost or the values shown in the chart above. In 2014, beneficiaries were charged $2.55 for those generic or preferred multisource drugs with a retail price less than $51 and 5% for those with a retail price over $51. For brand name drugs, beneficiaries paid $6.35 for those drugs with a retail price less than $127 and 5% for those with a retail price over $127. Table adapted from http://www.q1medicare.com/PartD-The-2014-Medicare-Part-D-Outlook.php. . . CODING & BILLING AUDITS:. . Why They Happen. How to Prevent Them. How to Survive Them. Healthcare Audits & Investigations. DME. MEDIC. SMRC. UPIC. DME. MEDIC. SMRC. UPIC. Healthcare Audits & Investigations.