PART 1 -
- Why reviews are occurring
- Who is doing review
- Differences between reviewers OIG "red flags" for review
- Types of reviews: ADRs, probes, audits
- Current CMS focus: Targeted Probe & Educate
- ADR requests from MAC/ZPIC/UPIC/RAC/CERT
- Responding to an ADR Probes and Results
PART II -
- Current denial trends
- Reading a denial
- Targeted Medical Review Appeals (Level 1 and Level 2)
- ALJ hearing preparation, attendance
- Financial concerns: extrapolation, recoupment
- Compliant charting Face to Face requirements