Product Detail

Insurance Billing, Claims, & Collections
Digital Seminar
$199.99 USD
Product Details
Format:
Digital Seminar
Author:
CHERYL HOUSE, RMC, CHI
Publisher:
Vyne Education
Copyright:
3/10/2014
CE Available:
Yes, See CE credit tab for complete continuing education details
Product Code:
WDS020024
Objectives
  • Explain current billing and reimbursement issues
  • Analyze how to make the claims process more efficient
  • Accurately define and summarize medical necessity
  • Assess Evaluation and Management Services Documentation principles
  • Recognize how federal agencies audit
  • Apply current knowledge of billing and coding tools to reduce delays, denials, and rejections
  • Evaluate the appeals and self-auditing process
  • Formulate a compliance plan for auditing
Outline

BILLING & CODING TOOLS

  • Understanding the billing process and billing terminology
  • Current reference materials
  • Written policies and procedures covering billing protocol from insurance contractors
  • ICD-9-CM diagnosis coding expertise (ICD-10 as of 10/1/2014)
  • Well-designed patient information form or EMR (patient demographics)
  • Understanding the insurance claims process
  • Understanding the Health Insurance Portability and Accountability Act (HIPAA) and how it relates to claims processing

 

WHAT PAYERS WANT: DOCUMENTATION PRINCIPLES & MEDICAL NECESSITY

  • The site of service
  • Medical necessity and appropriateness of the diagnostic
  • Therapeutic services provided
  • Information that the services provided have been accurately reported

 

REVALUATING EVALUATION & MANAGEMENT CODING

  • What are the elements of an evaluation and management code
  • Getting paid for what you do

 

CLAIMS APPEALS: A KEY TO REIMBURSEMENT

  • Implementing processes for appeals
  • Determining an auditing staff
  • Collection reports in determining appeals
  • Appeals with EMR
  • Understanding the explanation of benefits and remittance advice
  • Proof of timely filing
  • Developing an appeal letter

 

UNDERSTANDING FEDERAL AGENCIES THAT AUDIT

  • Main governmental agencies auditing
  • What is a CMS medical review?
  • Components of a Medicare review
  • Understanding national coverage determinations
  • CERT, RAC, ZPIC, Medicaid Integrity Contractors
  • Medicare Administrative Contractors

 

AUDITING MEDICAL RECORDS

  • Medicare data banks
  • Goals for an audit
  • Types of audits
  • DATA mining: predictive analysis
  • CMS targets
  • Documentation principles

 

DEFINING FRAUD & ABUSE

  • False Claims Act
  • Anti-Kickback Statutes
  • Physician Self-Referral Law
  • Medicare’s Fraud and Abuse Partnerships
  • Office of Inspector General and HEAT program

 

WHAT IS MEDICAL NECESSITY?

  • Medical necessity: the deciding factor in claims payment
  • Medicare definition of medical necessity
  • AMA definition of medical necessity
  • Diagnoses frequently monitored for medical necessity

 

CREATING A COMPLIANCE PLAN

  • OIG Guidelines
  • Following the OIG work plan for auditing
  • Compliance education
  • Developing a compliance plan for your business office

 

PROPOSED CMS CHANGES FOR 2014

  • OPPS payment changes
  • IPPS payment changes

 

ICD-10: A PREVIEW

  • Structure
  • Principles of ICD-10
  • Training for ICD-10
  • Impact on ICD-10 in your IT departments
  • Physician impact
  • Character meaning
Author

CHERYL HOUSE, RMC, CHI

CHERYL C. HOUSE, RMC, CHI, is the president and partner of CCH Medical Consultants, a consulting and management firm, and the Compliance Auditor for Illinois CancerCare. Ms. House has been in consulting, management, and billing for more than 30 years. She serves on the Illinois Valley Community College as a Healthcare Instructor for their Medical Billing and Coding program.

Formerly, Ms. House served as a Healthcare Director for New Horizons Learning Centers in their Healthcare Information Management Department. Through the course of her career, she has been a health care educator, practice manager, and collections manager for some of the major hospital systems in the Midwest. Ms. House's responsibilities included classroom teaching and reimbursement problem-solving.

Ms. House is author of several coding training manuals and has been the editor of several coding and computer newsletters. Her extensive administrative and financial managed care experience deals with all aspects of health care billing. She is a Registered Medical Coder through The Medical Management Institute and a Certified Healthcare Instructor through National Healthcare Association and certified through AAPC as a Certified Evaluation and Management Coder. Ms. House is a very knowledgeable billing and managed care consultant as well as an excellent seminar instructor.
Continuing Education Credits
Continuing Education Information
This educational offering is designed to qualify for continuing education for many professionals in every state.


Materials that are included in this course could include interventions and modalities that are beyond the authorized practice for your profession. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.


Listed below are the continuing education credit(s) currently available for this educational offering. Please note, your state licensing board dictates what is an acceptable form of continuing education. Please refer to your state rules and regulations. If your profession is not listed, please contact your licensing board to determine your continuing education requirements and check for reciprocal approval. For other credit inquiries not specified below, please contact customerservice@vyne.com or 800-397-0180.


CE information is based on 100% attendance.


Other Professions
This educational offering qualifies for 6 continuing education hours as required by many national, state and local licensing boards and professional organizations. Save your course outline and certificate of completion, and contact your own board or organization for specific filing requirements.

Audience
  • Billing, Insurance, and Coding Personnel
  • Physician Office Managers
  • Insurance Managers
  • Business Managers
  • Financial Managers
  • Medical Assistants
  • Medical Records Personnel
Reviews
Most informative seminar I've been to yet! Cheryl is awesome!
Linda Fleck, Office Manager
Bismarck, ND


This is the most informative seminar I have had the opportunity to attend. Cheryl was extremely knowledgeable and pleasant. This was not a boring seminar.
Terry L. Harrell, Office Manager
Louisville, KY


This seminar, very informative. The book/manual has a lot of valuable information to take back to the office. Excellent manual.
Jeffrey Ware, University of Utah Plastic Surgery
Salt Lake City, UT