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Subscribe NewsletterNo Place to Hide: The New Medicare Auditors and Their New Techniques
Product Id
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600036
Overview: This session will describe the new environment and provide some tips and practical advise on steps labs should take to avoid becoming a target.
In the new era of health care reform, the government hopes to pay for some of the cost by reducing or eliminating waste, fraud and abuse in the Medicare and Medicaid programs. They hope to accomplish this by doing a better job of paying claims accurately and detecting claims that have been paid in error and seek recovery of the improper reimbursements. These tasks used to fall to the Medicare Carriers, Fiscal Intermediaries and more recently the Medicare Administrative Contractors or MACs. Now, and in the future, these tasks will be taken over by several new kinds of contractors that will be focused on auditing and reviewing claims to detect errors, fraud and abuse. These contractors will use innovative and sophisticated computer based techniques that will target, rather than hope to find by random selection, aberant claims and problematic providers. It will be much harder to "slip through the cracks" of this new environment. All providers, including labs will have to get better at claims submittal.
In the new era of health care reform, the government hopes to pay for some of the cost by reducing or eliminating waste, fraud and abuse in the Medicare and Medicaid programs. They hope to accomplish this by doing a better job of paying claims accurately and detecting claims that have been paid in error and seek recovery of the improper reimbursements. These tasks used to fall to the Medicare Carriers, Fiscal Intermediaries and more recently the Medicare Administrative Contractors or MACs. Now, and in the future, these tasks will be taken over by several new kinds of contractors that will be focused on auditing and reviewing claims to detect errors, fraud and abuse. These contractors will use innovative and sophisticated computer based techniques that will target, rather than hope to find by random selection, aberant claims and problematic providers. It will be much harder to "slip through the cracks" of this new environment. All providers, including labs will have to get better at claims submittal.
Areas Covered in the Session:
- Describe the new auditing processes and contractors that will be used to reduce errors, fraud, waste and abuse in Medicare and Medicaid claims processing
- Provide an overview of the links between the various new contractors that will be the functional operators in this new environment and what their roles will be.
- Give practical actions that labs should undertake to avoid unnecessary problems and ensure uninterupted claims payment in this new environment.
Who will Benefit:
- Laboratory and hospital compliance officers
- Billing department managers
- IT department directors and managers
- Financial officers and laboratory CEO and COO