A Day with Medicare. An educational event focusing on the Comprehensive Error Rate Testing (CERT) Program

Transcription

1 A Day with Medicare An educational event focusing on the Comprehensive Error Rate Testing (CERT) Program 8/20/2015 Hyatt Regency Indianapolis One S Capitol Ave Indianapolis, IN (800) /03/2015 Diamond Center Grand River Ave. Novi, MI (248)

2 Table of Contents Continuing Education Credits (CEUs) 3 Responding to Coding Questions.. 3 Disclaimers... 3 Daily Schedule... 4 Registration 4 Breakfast. 4 Lunch... 4 Materials... 4 Breakout Sessions 5 Session Descriptions.. 6 WPS Medicare Staff Bios. 13 Please write to us at surveymail@wpsic.com if you have questions or concerns 2 P a g e

3 Continuing Education Credits (CEUs) CEUs for CMS-sponsored webinars and workshops are accepted by the American Academy of Professional Coders (AAPC) at a rate of one CEU per hour. These CEUs may come from CMS or Medicare Administrative Contractor (MAC) offices. A certificate of attendance or completion with the CMS logo is necessary to show participation. To claim CEUs, attendees will enter certificate information onto their CEU Tracker using the No Index Number option. A copy of the certificate does not need to be provided to AAPC unless the member is selected for verification purposes. Responding to Coding Questions Contractors are prohibited from providing coding advice. Based on CMS Medicare Contractor Beneficiary and Provider Communications Manual, Publication , Chapter 6, Section , providers are responsible for determining the correct diagnostic and procedural coding for the services they furnish to Medicare beneficiaries. For details, please refer to: Disclaimers These presentations are a tool to assist providers. Every reasonable effort has been made to ensure the accuracy of the information; however, the provider has the ultimate responsibility for correct submission of claims. WPS Medicare bears no liability for the results or consequences of the misuse of this information. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. We will not be able to answer specific claims questions as no system access will be available. We reserve the right to change a participant s sessions (only if necessary). Recording or videotaping these educational presentations is prohibited. Thank you for silencing your cell phone during all sessions. 3 P a g e

4 Daily Schedule 8:30 9:00 AM Registration and Breakfast 9:00 9:20 AM Welcome and General Session 9:30 10:30 AM Breakout Session 1 (5 concurrent sessions) 10:30 10:40 AM Break 10:40 11:40 AM Breakout Session 2 (5 concurrent sessions) 11:40 1:00 PM Complimentary Lunch/Keynote Speaker 1:10 2:10 PM Breakout Session 3 (5 concurrent sessions) 2:10 2:20 PM Break 2:20 3:20 PM Breakout Session 4 (5 concurrent sessions) 3:20 3:30 PM Refreshments 3:30 4:30 PM Questions and Answers with WPS Medicare Staff Registration Staff at the registration table will be available all day to answer questions and assist with locating sessions. Breaks Morning and afternoon breaks will consist of a beverage service. Light refreshments will be offered prior to and during the Question and Answer session. Breakfast A Continental breakfast will be available beginning at 8:30 AM. Lunch Please join us for lunch following Session 2. Materials All materials and handouts will be provided at the event. 4 P a g e

5 Breakout Sessions Event Title Session 1 Physician Inpatient Hospital Services - The Good, the Bad and the Ugly The Comprehensive Error Rate Testing Program - Get the Scoop! Signed, Sealed and Delivered - Ensuring Orders, Signatures and Notes Support What is Billed The CERT Forecast - If It Gets Stormy, Will You Be Ready? Documenting Medical Necessity for Major Joint Replacements (Hip and Knee) Session 2 Moving to the Next Level - Using the Medicare Appeals Process to Your Advantage Part B CERT Errors - All Hands on Deck! No Denials, No Recoupments, No Errors! Avoiding Recoupment and Retaining Dollars - SNF Certification/Recertification Statements Hospital Admission Criteria Session 3 SNF Consolidated Billing - To Bill, or Not to Bill, That is the Question Evaluation and Management (E/M) Services - Reducing Errors Through Education (Part 1) Increase Your Inpatient Psychiatric Facility (IPF) Revenue by Decreasing Your Errors Take Aim at Reducing Part B Claim Errors The Do s and Don ts of Diagnostic Laboratory Tests Session 4 Avoid Payment Errors Present on Admission (POA) Indicators and Patient Discharge Status Codes Documentation Through the Eyes of Medicare Reviewers Who s Reviewing Your Claims? The ABC s of the Initial Preventive Physical Exam & Annual Wellness Visit Evaluation and Management (E/M) Services - Reducing Errors Through Education (Part 2) Provider Type A B A A A B A You will select the sessions you wish to attend during the online registration process. If a topic does not appear, that session is full. Note: If you are selecting Evaluation and Management two sequential sessions are offered and you are required to register for and attend both. 5 P a g e

6 General Categories and Session Descriptions Appeals Moving to the Next Level Using the Medicare Appeals Process to Your Advantage Janet Mateo, Analyst, Provider Outreach & Education Thom Ryan, Senior Analyst, Provider Outreach & Education What does a provider do if they disagree with an initial determination? Do you know how the claim reopening process differs from the appeals process? Learn about the Medicare Appeals process, the new coding requirements for reopening a claim, the difference between the claim reopening and the appeals process, and receive guidance on filing both actions correctly. Also, learn what happens when a change or addition to a claim is discovered beyond the timely filing limits. Target Audience: Part A & B, Coders, Billers, Office Staff Comprehensive Error Rate Testing (CERT) Part B CERT Errors All Hands on Deck! Sue Brewer, Analyst, Provider Outreach & Education Mary Muchow, Senior Analyst, Provider Outreach & Education Denise Stanley, Supervisor, MR CERT Join us for an interactive experience where you will review examples of actual documentation reviewed by the CERT contractor and test your knowledge of Medicare Part B regulations! After a short overview of the most common Part B CERT error findings, all participants will dive into the documentation. You will then bring to the surface your decision of whether a CERT error was assessed for each case. Providers, clinicians, coders, billers, and compliance staff should consider attending this informative session to learn more about how to avoid denials with proper documentation of Medicare claims. Target Audience: Part B, Coders, Billers, Office Staff No Denials, No Recoupments, No Errors! Aileen Sigler, Analyst, Provider Outreach & Education Karen Kroupa, Analyst, Provider Outreach & Education Tanya Hardiman, Analyst, Provider Outreach & Education Stay on top of your game and don t get struck out by denials on your Part A claims. In this session, we ll examine some of the latest errors found by the CERT contractor. Join your Part A teammates and develop a game plan for hitting a home run on every claim by avoiding denials. Target Audience: Part A, Administrators, Billers, Office Staff, Clinicians, Coders 6 P a g e

7 Take Aim at Reducing Part B Claim Errors Sue Brewer, Analyst, Provider Outreach & Education Mary Muchow, Senior Analyst, Provider Outreach & Education With the implementation of CMS medical review initiatives, comes the likelihood that your Part B Medicare claim may be selected for medical review by one of CMS contractors. Based on historical data, the error categories and types of errors have remained quite consistent. Providers, clinicians, coders, billers, office staff, and compliance staff should consider attending this informative session to learn the most common Part B claim errors, and how to avoid them. In addition to the identification of historical and forecasted Part B claim errors, we will demonstrate, through the use of the WPS Medicare website, the multitude of educational resources created to prevent and avoid the same errors in the future. Target Audience: Part B, Coders, Billers, Office Staff The CERT Forecast If It Gets Stormy, Will You Be Ready? Jan Ervin, Analyst, Provider Outreach & Education This session will focus on the services CERT is projecting to look at when conducting reviews. We ll look at reasons why CERT is forecasting these services and what they ll be looking for. Don t miss this opportunity to prepare your facility to weather the storm. Target Audience: Part A, Coders, Billers, Office Staff, Administrators The Comprehensive Error Rate Testing Program Get the Scoop! Denise Stanley, Supervisor, MR CERT You may have seen CERT in the headlines, but do you have all of the information you need to fully understand why it was implemented, how it works and what your role is in the process? This informative session will help you better understand the fine print about the CERT contractors, the process, CERT review results, CMS goals and potential outcomes. Designed for practitioners, coders, billers, office staff, and compliance staff, participants will benefit from gaining a better understanding of the CERT program and its importance to all Medicare contractors and providers alike. Target Audience: Part A & B, Coders, Billers, Office Staff, Administrators 7 P a g e

8 Claim Review Who s Reviewing Your Claims? Sue Brewer, Analyst, Provider Outreach & Education Mary Muchow, Senior Analyst, Provider Outreach & Education Denise Stanley, Supervisor, MR CERT CMS has implemented a multitude of program integrity and medical review initiatives, each with a slightly different focus, but all with an eye toward the goal of detecting and correcting improper payments to and from Medicare. These efforts are an important step toward the prevention of waste, fraud and abuse in the Medicare program. Join us to better understand how the role of the Medicare Administrative Contractor medical review staff and CMS medical review contractors differ, what contractors are reviewing, and the potential outcomes of all respective medical review activities. Designed for practitioners, clinicians, coders, billers, office staff, and compliance staff, participants will recognize the importance of complete and correct documentation, preparation and submission of Medicare claims and the impact of those claims on the national paid claims error rate. Target Audience: Part A & B, Coders, Billers, Office Staff, Compliance Staff Documentation Documenting Medical Necessity for Major Joint Replacements (Hip and Knee) Mary Sue Gardner, RN/BSN, Senior Nurse Analyst, Provider Outreach & Education Cheyenne Santiago, RN, Senior Nurse Analyst, Provider Outreach & Education Please join us for a discussion on documenting medical necessity for major joint replacements (hips and knees). This educational event is intended to improve compliance with documentation requirements for major joint replacement surgery. Target Audience: Part A & B, Utilization Review Staff, Admitting Personnel, Physicians, Practitioners Documentation Through the Eyes of Medicare Reviewers Mary Sue Gardner, RN/BSN, Senior Nurse Analyst, Provider Outreach & Education Cheyenne Santiago, RN, Senior Nurse Analyst, Provider Outreach & Education What do claim review contractors look for? What are the top errors and how can these be avoided? What needs to be included in the documentation? Find out the answers to these questions and more in this session that will focus on reviews performed by various Medicare contractors. Based on historical data, we will share information on the most common error findings and will provide tips and resources to prevent future documentation and coding issues. Target Audience: Part A & B, Coders, Billers, Practitioners, Compliance Staff 8 P a g e

9 Signed, Sealed and Delivered Ensuring Orders, Signatures and Notes Support What is Billed Aileen Sigler, Analyst, Provider Outreach & Education Would your claim get a stamp of approval? Are all the components of your documentation in place, complete and accurate to support payment for the services you ve billed? In this session, we will review orders and signature requirements and how any missing pieces can affect receiving proper reimbursement from Medicare. Target Audience: Part A & B, Administrators, Billers, Clinicians, Coders The Do s and Don ts of Diagnostic Lab Tests Mary Sue Gardner, RN/BSN, Senior Nurse Analyst, Provider Outreach & Education Cheyenne Santiago, RN, Senior Nurse Analyst, Provider Outreach & Education Laboratory denials continue to be a growing error across all review entities. Join us as we discuss: Beneficiary information required to be submitted with each claim or order for laboratory services The medical condition for which a laboratory test is reasonable and necessary The medical documentation that is required by a Medicare contractor at the time a claim is submitted for a laboratory test Record keeping requirements in addition to any information required to be submitted with a claim, including physicians obligations regarding these requirements. Target Audience: Part A & B, Coders, Billers, Practitioners, Compliance Staff Evaluation and Management Services (E/M) Evaluation and Management (E/M) Services Reducing Errors Through Education Parts 1 and 2 Ellen Berra, Senior Analyst, Provider Outreach & Education PLEASE NOTE THIS BREAKOUT CONSISTS OF 2 PARTS Those choosing this breakout must register for both sessions. In this session, you will be provided information on the CMS guidelines for choosing an E/M procedure code based on the documentation. We will discuss the three key components used in choosing a procedure code and when an alternative method may be used. We will have examples of recent CERT results on actual documentation submitted. This will be a lively discussion on one of the areas of concern in the CERT program! Target Audience: Part A & B, Practitioners, Compliance Staff, Coders, Billers, Office Staff 9 P a g e

10 Physician Inpatient Hospital Services The Good, the Bad and the Ugly Ellen Berra, Senior Analyst, Provider Outreach & Education Karen Kroupa, Analyst, Provider Outreach & Education Tanya Hardiman, Analyst, Provider Outreach & Education Medicare has identified inpatient hospital visits as an area of concern. Come join us to discuss the documentation requirements for these services. We will discuss the E/M components and what we and other reviewers are expecting to see in the documentation. We will provide documentation examples of the good, the bad and the ugly and discuss the concerns of the reviewers along with additional helpful hints. Target Audience: Part A & B, Administrators, Billers, Clinicians, Coders Facility Based Services Avoid Payment Errors Present on Admission (POA) Indicators and Patient Discharge Status Codes Janet Mateo, Analyst, Provider Outreach & Education Are you reporting Present on Admission indicators correctly? Did you know that inaccurate reporting of a patient discharge status code can lead to an underpayment or overpayment? During this session, we will review the POA reporting guidelines and discuss common miscoded POAs. We will also review common patient discharge code errors and look at how incorrect coding leads to claim errors. Target Audience: Part A, Coders, Billers, Office Staff Avoiding Recoupment and Retaining Dollars - SNF Certification/Recertification Statements Jan Ervin, Analyst, Provider Outreach & Education The CERT Contractor has been recouping dollars from Skilled Nursing Facilities due to their failure to obtain proper certification or recertification statements. Don t let this happen to you! During this session, we will discuss common medical practices and how to properly document acceptable certification and recertification statements. Target Audience: Part A, Skilled Nursing Facilities All Staff 10 P a g e

11 Hospital Admission Criteria Mary Sue Gardner, RN/BSN, Senior Nurse Analyst, Provider Outreach & Education Cheyenne Santiago, RN, Senior Nurse Analyst, Provider Outreach & Education CMS has fundamentally altered the manner in which hospitals define how inpatient status and outpatient observation is determined. It is critically important for physicians and hospitals to work together to apply the correct payment policy for Medicare patients. Join us for this session on hospital admission criteria and learn what you need to know when requesting a hospital bed. Target Audience: Part A & B, Utilization Review Staff, Admitting Personnel, Physicians, Practitioners Increase Your Inpatient Psychiatric Facility (IPF) Revenue by Decreasing Your Errors Janet Mateo, Analyst, Provider Outreach & Education Jan Ervin, Analyst, Provider Outreach & Education Is your facility losing money on denials resulting from insufficient documentation errors, medically unnecessary services, or treatment errors? In this session we will review the IPF CERT errors, provide examples of IPF improper payments and provide guidance to avoid errors. Target Audience: Part A, Billers, Office Staff Preventive Services The ABC s of the Initial Preventive Physical Exam (IPPE) & Annual Wellness Visit (AWV) Thom Ryan, Senior Analyst, Provider Outreach & Education Aileen Sigler, Analyst, Provider Outreach & Education The IPPE and AWV focus on disease detection, prevention and lifestyle modifications that can help beneficiaries live longer, healthier lives. Many providers still have questions and struggle with completing all the elements to make it a covered service. Join us as we explore the fundamentals of these important benefits. Topics include: the components of the IPPE and AWV, who can perform the service, how to correctly bill for them and so much more! Target Audience: Part A & B, Coders, Billers, Office Managers, Compliance Staff 11 P a g e

12 Skilled Nursing Facility Consolidated Billing SNF Consolidated Billing To Bill, or Not to Bill, That is the Question Karen Kroupa, Analyst, Provider Outreach & Education Tanya Hardiman, Analyst, Provider Outreach & Education Thom Ryan, Senior Analyst, Provider Outreach & Education Join us in this audience participation session to get your SNF Consolidated Billing questions answered. This unique breakout session brings Part A SNFs and all other providers together for an interactive discussion on when to bill the SNF or Medicare program for services rendered. Learn how to use best practices to bill correctly the first time. We ll show you resources recommended by CMS to add to your own best practices to make SNF CB easier. Target Audience: Part A & B, Coders, Billers, Office Staff, Compliance Staff 12 P a g e

13 WPS Medicare Staff Bios Bringing you over 200 years of Medicare experience! Ellen Berra, POE Senior Analyst, has over 25 years of experience in the Medicare program and joined Provider Outreach and Education in Ellen s experience in Medicare includes Claims, Appeals, Congressional Inquiries, and Fair Hearings. She has led many teams in creating Medicare educational material for standard educational topics and specific material for specialty societies and associations. She contributes educational articles on many different subjects to the website, e-news and Communiqué. Sue Brewer, POE Analyst, has 25 years of Medicare experience. Her responsibilities include presenting seminars on a variety of topics. Previous positions held include Supervisor of Claims Development and Medicare Secondary Payer (MSP) units, Training Specialist and Fair Hearing Officer. Sue graduated from the University of Wisconsin at Madison. Maria Diaz, POE Customer Service Specialist, has over 13 years of Medicare experience and has been in her current position for the last 5 years. She is responsible for reporting, assisting with educational material, and working with the provider community. Prior to this, Maria held positions as a Medicare Customer Service Representative, assisting providers with billing questions; as an internal trainer, teaching staff all aspects of Medicare billing, system usage and regulations; and in the technical department testing new implementations and solving technical issues with claims. Jan Ervin, POE Analyst, has over 9 years of Medicare experience and has been in her current position since Her Medicare background began with Mutual of Omaha Medicare in 2006 as a Cost Report Auditor. Her primary job responsibilities involve facilitating educational seminars, webinars and teleconferences for various facilities throughout the United States. Jan earned her BSBA in accounting at University of Nebraska at Omaha. Mary Sue Gardner, RN/BSN, POE Senior Nurse Analyst, brings over 13 years of Medicare experience the POE team. She has a Bachelor of Science in Nursing (RN/BSN) from Methodist College of Nursing, in Omaha, Nebraska. Prior to working in Medicare, Mary Sue spent many years practicing clinically in various inpatient and outpatient settings. She has worked in the Medical Review department as well as POE. Mary Sue provides clinical education in all WPS contracts of work throughout the United States. Tanya Hardiman, POE Analyst, brings 11 years of Medicare experience to her current position. She spent three years as a Customer Service Representative before joining the POE team. Her duties include conducting Medicare seminars, teleconferences, and webinars as well as developing selfservice educational tools on various Medicare topics. Tanya is a graduate of Southwest Minnesota State University with a degree in Sociology. 13 P a g e

14 Karen Kroupa, POE Analyst, has over 11 years of experience in various Medicare departments. She started as a Claims Examiner, then as a Customer Service Representative before joining POE. Prior to working for Medicare, she worked in Mutual of Omaha Insurance Company s Large Group Health Plan department. Karen has a BA in English, Art and Art History from the University of Nebraska at Omaha. Janet Mateo, POE Analyst, has over 16 years of Medicare experience. Janet s primary job responsibilities include education and training for Medicare providers in various states. Before joining Mutual of Omaha in 1999, Janet was employed by the National Multiple Sclerosis Society for 10 years at local chapters in New Jersey and Illinois. Janet possesses a Masters in Social Work Administration and a Bachelor of Science degree from Rutgers University in New Brunswick, New Jersey. Janet also received training from the Center for Postgraduate Studies in Psychotherapy in Red Bank, New Jersey. Mary E. Muchow, POE Senior Analyst, has over 34 years of Medicare experience. Mary held previous positions in Claims Examination/Entry, Medical Review, and Training. Prior to joining the POE team, Mary worked in the Benefit Integrity Unit as an investigator and trainer. Later, as the Medicare Fraud Information Specialist (MFIS), Mary represented multiple contractors as a liaison between federal investigators, prosecutors, CMS, and other agencies. In this role, Mary often presented relevant Medicare fraud and abuse topics to law enforcement and audiences on a national level. Mary joined POE in 2003 where she provides outreach activities, provider education and the development of partnerships with various societies and associations. Thom Ryan, POE Senior Analyst, has over 10 years of Medicare experience. He began his career with WPS in the Tricare division. In 2005, he joined POE where his primary focus is technology and face-to-face education. Thom holds a bachelor degree in Social Work from Winona State University. K. Cheyenne Santiago, RN, POE Senior Nurse Analyst, brings over 8 years of experience to the POE team. She is responsible for clinical education for the provider community including training on Medicare rules, regulations and clinical coverage criteria, as well as current health care practice trends. She holds an Associate of Science in Nursing (RN/ASN) from Excelsior College School of Nursing, in Albany, New York. Aileen Sigler, Outreach Analyst, has over 17 years of Medicare experience. Her primary job responsibilities include developing and facilitating seminars, teleconferences and webinars for the provider community. She held prior positions in the Claims, Customer Service and internal Training departments before joining Provider Outreach & Education in June of P a g e

15 Denise Stanley, Supervisor, has 17 years of experience in the Medicare program, including 5 years in the Benefit Integrity Unit investigating potential fraud and abuse. Denise is currently the CERT Supervisor in the Medical Review department. In this role, she serves as a liaison between the CERT contractors and the provider community. Her responsibilities include analysis of CERT review findings, providing current content for the WPS Medicare CERT web page, responding to provider inquiries for CERT review results and collaboration with POE for educational events. Sheryl Torres, Manager, has 20 years of experience in the Medicare program. In this role, she oversees the day to day operations of Provider Outreach and Education activities. In addition to her current role, Sheryl has held various positions in Customer Service, Quality Assurance and prior POE responsibilities. Thank you for joining us today! 15 P a g e

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