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Understand the complexities of federal health care program payments and make sure your organization is getting the reimbursement it deserves.
State Medicaid programs rely on a number of program integrity mechanisms to detect and investigate fraud, ranging from criminal investigations to a number of different audit procedures. However, like their Federal Medicare counterparts, Medicaid audits may be aggressive and result in demands for large sums of money. This topic will cover several common types of Medicaid audit processes, describe how they affect providers, and what they can do to get ready.
State Medicaid programs rely on a number of program integrity mechanisms to detect and investigate fraud, ranging from criminal investigations to a number of different audit procedures. However, like their Federal Medicare counterparts, Medicaid audits may be aggressive and result in demands for large sums of money. This topic will cover several common types of Medicaid audit processes, describe how they affect providers, and what they can do to get ready.
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Overview of Medicaid Program Integrity Functions
- Medicaid Agency Fraud Detection and Investigation Program
- Medicaid Fraud Control Units
- Medicaid Integrity Program
- Medicaid Recovery Audit Contractors
- Scope of Review
- Notice to Providers
- Submission of Records for Reviews
- The Audit Process Itself
- Collection of Overpayments
- Appeals
- Provider Burdens
- Accuracy
- Tranparency
- Conduct an Internal Assessment
- Know Where Previous Improper Payments Have Been Found
- Dealing With the Auditing Entity
- Being Aware of Deadline
- Knowing Appeal Rights
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Hugh M. Barton - Hugh M. Barton, P.C.,
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This webinar is designed for medical records directors, health information managers, billing managers, hospital administrators, compliance officers and coders.
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