Video Library

Purchase Access to All 5 Videos

Special discount and access to all 5 videos from the 2009 PAHCS National Conference!

Your access includes these speakers and topics:

• Billing and Reimbursement Compliance Plan by Sarah Holmes
• Dealing with Denials by Kathleen Mueller
• Modifiers in Practice presented by Marie West (developed by Marge McQuade)
• Reimbursement Challenges and Strategies by Arlene Morrow
• Recovery Audit Contractors (RACs) by Dedra Dyer

Billing and Reimbursement Compliance Plan

• The goal is to put procedures in place that will, if properly followed, prepare the practice for audits, protect the practice during audits and minimize or negate some potential legal actions that could arise if such a manual was not developed or followed. Documentation is key.
• This presentation was recorded at the PAHCS national conference in Atlanta, GA on November 5, 2009 and discusses the need for an office Billing and Reimbursement Compliance manual and the items that should be in this manual.
• Running time is 50 minutes.

Dealing with Denials

• Prevent errors that cause your claims to be returned unpaid
• Tips for clean claim submissions
• How to reduce denials

Modifiers in Practice

• When to Use Modifiers
• Why Use Modifiers
• Surgery Modifiers: -24, 25, 57
• Global Period Modifiers: -76, 77, 78, 79
• Medicare Modifiers: -GA, GY, GZ, Q5
• General Guidelines for Using Modifiers

Reimbursement Challenges and Strategies

• Ensure you have sound authority for the codes you use
• Practice “Defensive Coding”
• What value based purchasing is
• 2010 will see increased Audits
• What is new for 2010?

Running time is 1 hour and 45 minutes.

Recovery Audit Contractors (RACs)

The goal is to give listeners information about Recovery Audit Contractors (RACs). Who they are, what their purpose is, when they came into being, how they can impact your office and why they exist. Also discussed is the potential impact Recovery Audit Contractors on hospitals and your practice. RAC appeals process is also covered in this presentation. Proper documentation, exacting coding, training and preparation are keys to sucess.

• RAC is paid based on how much they recover, the more they look the more they make.
• As of July 2008 RAC identified more than 1.3 BILLION dollars in improper Medicare payments. Of that RACs collected 187.2 million in fees.
• Every medical practice and hospital is subject to RAC.

Test Taking Tips and Coding for an OP Report

Marge McQuade is a certified medical manager and a certified multi-specialty coder with 30 plus years experience in the medical field as an office manager and coder. She is an instructor for coding and medical office procedures and lectures on practice management and coding topics. Currently Ms. McQuade is the Director of Education for PAHCS.

Special discount and access to all 5 videos from the 2008 PAHCS National Conference!

Your access includes these speakers and topics:

• John F. Bishop - Utilization of NPP's and "Incident To" Regulations
• Marie West - CMS Updates
• Michael Lowe - Legal Obligations of Coders
• Cecile Katzoff - Chart Auditing Part I
• Dawn Cloud - Chart Auditing Part II

If you have a NPP in your office this program is a MUST SEE!!!

• Identify physician supervision rules that apply
• Can NPPs perform initial assessment exams?
• Get managed care companies to recognize and pay
• Learn which modifiers to use and when for NPPs
• "Incident To" – How, who, when and why?

Do you know what your legal obligations are?

This covers basic principles of statutes impacting coders. Educating coders on the basics of applicable health care regulatory laws and hot focus areas in billing and coding by government agencies and private health insurers. Also discussed is liability issues for billers and coders helping them to be aware of how those issues can impact the day-to-day performance of their job duties. Learn more on:

• Stark Law
• Federal Anti-Kickback Law
• Federal False Claims Act
• Florida Law
• Physician risk areas
• 2008 OIG Work Plan
• Incident-to
• Prevention of billing/coding errors

More money is being allocated for identifying and prosecuting fraud and abuse. The chances of being audited are higher than ever before. Coders need to minimize audit exposure and maximize reimbursement so it is critical every practice review a sample of medical records compared with the CPT/HCPCS and ICD-9 codes billed. PAHCS feels two perspectives from two very knowledgeable coders is invaluable.

• Why Audit
• Number of services and how often
• Selecting the sample
• Prepare the audit
• Part 1 tips on computer aided auditing
• Part 2 tips on paper based auditing

During this program Marie will cover:

• How to use “Modifier 25”. This is important since, according to the OIG finding in 2005, 35% of claims filed using “Modifier 25” did not meet program requirements resulting in $538 million in improper payments; further, 28% of providers used “Modifier 25” on more than 50% of their claims. Are you using “Modifier 25” correctly?
• What the OIG will be looking at in 2009
• What value based purchasing is
• ICD-9 v/s ICD-10. How should you prepare for the coming ICD-10 and why you really don’t need to panic.

Marge McQuade is a certified medical manager and a certified multi-specialty coder with 30 plus years experience in the medical field as an office manager and coder. She is an instructor for coding and medical office procedures and lectures on practice management and coding topics. Currently Ms. McQuade is the Director of Education for PAHCS.