Compliance Analytics: Post Pandemic Preparations

2020 Evaluation and Management Symposium: Virtual Conference

Presented Friday, September 25, 2020

Summary

CMS giveth and CMS taketh away. At least that is the experience of pretty much every organization that has undergone an audit by a RAC, ZPIC, UPIC, CERT, OIG, MAC or any number of other alphabet soup auditing entities. CMS and most all private and other government payers are now relying on advanced statistical models such as predictive analytics and machine learning capabilities to identify high value targets to audit. Unless you're embracing risk-based auditing, you are just asking for financial trouble. Analytics has become the central focus of every auditing entity out there and they are using those analytics against you. Why? Well, mostly because they know so much more about how the numbers work than we do. It is time to level the playing field. Frank will demonstrate how you can both discover and address your risks before you get audited. This includes modeling for inpatient (DRG, PCS, HAC, POA, etc.), outpatient (APC, OPPS) and physician services (CPT codes and modifiers). Lastly, gain critical insights on audit analytics and requirements for Telehealth services, many of which are already under review by the OIG.

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Presenters

Frank Cohen, MPA, MBB — Director of Business Intelligence — DoctorsManagement

Frank Cohen is the Director of Analytics and Business Intelligence for DoctorsManagement, LLC. He has authored, co-authored and published numerous articles, studies and books on health care analytics. His expertise includes applied statistics, data mining, predictive analytics, and process improvement. His latest book is titled, “RVUs: Applications for Medical Practice Success”. Frank has trained thousands of physicians, administrators, CPAs and other healthcare professionals in all areas of healthcare analytics. His experience includes eight years as a Physician Assistant in both the Navy and as a civilian, clinic administrator and hospital CEO. His clients include hospitals, large and small medical practices, medical and professional associations, legal and accounting professionals, government agencies and other health care professionals.

Stephanie Allard, CPC, CEMA, RHIT - Senior Compliance Specialist, Doctors Management

Stephanie Allard is a Senior Compliance Specialist for DoctorsManagement. She is a multispecialty auditor with proficiency in more than 40 specialties including, but not limited, to orthopedics, cardiology, vascular, neurology, general surgery, OB/GYN, PM&R, and PT/OT. In addition to performing external audit reviews, Stephanie provides feedback and education to help clients implement practices and strategies that will reduce risk in the future. She also performs forensic auditing that includes focused reviews to be used in court cases.

Stephanie brings more than a decade of medical and management experience and a strong understanding of the entire medical billing and coding process. She has managed large teams of coders and understands the importance of quality reviews, productivity tracking and coding education. Clients appreciate that Stephanie stays current with the ever changing regulations and is able to convey new information in a way that helps improve their overall results. She often provides guidance and support to other coding professionals.

Stephanie holds the Certified Professional Coder (CPC®), the Certified E&M Medical Auditing (CEMA®), and the Registered Health Information Technician (RHIT®) designations. She is an active member of the National Alliance of Medical Auditing Specialists (NAMAS), the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).

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