Medical Review & the Targeted Probe & Educate (ADR) Process: FAQs & Tips to Successfully Maneuver Audits

Billing Business Development Clinical Management Compliance Executive Leadership Regulatory & Reporting

On-Demand Webinar

StreamedSep 22, 2021Duration90 minutes

Unlimited and shareable access
two business days after live streaming
Available on desktop, mobile & tablet devices 24/7
Take-away toolkit
Ability to download webinar video
Presenter's contact info for questions

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OIG reports in 2018 and 2019 identified payment and quality-related problems in hospices.

As a result, audits and medical reviews increased, impacting many hospice agencies. As we transition from a Public Health Emergency, it is anticipated that this trend of increased audits will rise even more for both hospice and home health.

AFTER THIS WEBINAR YOU’LL BE ABLE TO:

Define fraud and abuse and the different types of government audits
Explain agency responsibilities, critical timelines, and the ADR process, also known as Targeted Probe and Educate (TPE)
Identify critical compliance areas to minimize audits and ADRs (TPE)
Identify when an agency should appeal a denial

WEBINAR DETAILS

This webinar will review the FAQs related to audits and the medical review process. It will explain the process, agency responsibilities, and where agencies should focus. Discover how to minimize denials and partial denials to targets, probes, and audits. Learn the proper way to submit documentation and the timeline to follow. Participants will also review sample cover letters and the presenter will address when to appeal, when not to appeal, and when to utilize outside resources to increase your agency’s opportunity for a favorable outcome.

THIS WEBINAR WILL BENEFIT THE FOLLOWING AGENCIES:

Hospice

WHO SHOULD ATTEND?

This informative session will contain excellent information for all agency personnel. Administration, finance, clinical management, supervisors, QAPI staff, medical directors, board members, liaisons, and intake staff will all benefit from attending.

TAKE-AWAY TOOLKIT

ADR post-payment review letter example
Guide for Responding to ADRs
Medicare Program Integrity Manual
NGS Hospice Documentation Checklist/CMS Hospice Documentation Checklist
Links to:
- Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Guide
- Postpayment Medical Review Additional Development Request (MR ADR)
- Prepayment Medical Review Additional Development Request (MR ADR)
- User Manual Medical Review Tab Jurisdiction 15
- Additional weblinks to resources and tools
PDF of slides and speaker’s contact info for follow-up questions
Attendance certificate provided, however there are no pre-approved CEs associated with this webinar

NOTE: All materials are subject to copyright. Transmission, retransmission, or republishing of any webinar to other institutions or those not employed by your agency is prohibited. Print materials may be copied for eligible participants only.

Presented By

Kathy Ahearn

ALECC, Inc.