Presented Thursday, September 24, 2020
Moderator: David Womack, President, CEO Practice Management Institute
How do payers, providers, and attorneys evaluate a note for medically necessary services and complexity of care differently? Is it the same? How can non-clinician coders and auditors do the same? In this panel session, four experts from diverse professions in healthcare related fields join forces to tackle your questions and will provide insights from their unique perspectives on important concepts related to Medical Decision Making (MDM).Ashley Morgan is Senior Counsel at Liles Parker PLLC and focuses her practice on regulatory health care compliance matters, fraud and abuse, and reimbursement issues. Ashley represents health care providers across the country in connection with a wide variety of health law issues including coverage disputes, documentation concerns, compliance, medical board complaints, and revocation / exclusion issues. Ashley has worked with an assortment of providers including dentists, home health companies, hospice agencies, primary care and specialty physicians, mental health professionals, physical therapists, durable medical equipment suppliers, and licensed acupuncturists.
Ashley has handled claims disputes with major payors including Medicare, Medicaid, various BlueCross BlueShield entities, UnitedHealthcare, and Delta Dental. She has extensive experience working on administrative appeals of large alleged extrapolated overpayments assessed by the Centers for Medicare and Medicaid Services’ (CMS) contractors including Unified Program Integrity Contractors (UPICs) and Medicare Administrative Contractors (MACs) and by private payors. Ashley has also successfully defended providers against medical board and nursing board complaints.
Ashley is a Certified Medical Compliance Officer and helps clients implement effective compliance programs and provides counsel on mandatory state and industry-specific policies and procedures. In this capacity, Ashley provides on-site walk-throughs to review OSHA compliance and performs training for staff members on HIPAA and other mandatory compliance regulations. Ashley is also a Certified Professional Coder in addition to a Certified Medical Reimbursement Specialist and conducts GAP Analyses of provider’s medical record documentation to determine areas for improvement with any CMS or private payor documentation requirements.
Ashley is originally from Bethany Beach, Delaware and now lives with her husband and son in Northern Virginia and works in Liles Parker’s Washington, DC office.