What the OIG expects from your Auditing and Monitoring Process Controls Presented by Angela Miller and Nadine Smith
Webinar Level: Intermediate
Webinar Live Date: March 8th, 2023
This program is valid for 1 CHBME credit.
We will discuss why auditing is important and how controls can reduce erroneous claims. These processes can also increase collections by improving clean claims. We will discuss the critical outcome that is expected is preventing errors and fraud.
Course participants will be able to:
To identify what an audit program is, why controls are important as well as discussing how to reduce errors and improve clean claims with these processes. The attendees will also have ideas of signing up for list servs for their payers which will help improve processes and get changes early on as well as Identify risk areas the payer is auditing.
Angela Miller, BBA, CHC, CMC, CDC, CDBS, of Medical Auditing Solutions in Dallas, TX is a 25+ year Healthcare Consultant who is certified in healthcare compliance, medical coding, and dental coding. As a healthcare compliance and billing expert, she works with hospitals, physician practices, dentists, mental health, DME suppliers and various other healthcare providers. She is experienced in OIG Compliance programs, HIPAA requirements, billing and coding issues, process improvement, accreditation, payer audits and defense audits, and investigations. Angela has extensive experience with Medicare, Medicaid, and Commercial Plans. She is very experienced with assessment systems and identifying problems that cause cash flow problems as well as identifying gaps in claims processing internally. Angela prepares all projects as though they are for a defense case. She understands the needs of attorneys for their clients and when a client needs legal counsel to better support their business.
Angela creates and provides Regulatory compliance programs, policies, training related to management, billing, coding and cash flow & collections analysis. She is experienced in private and government audits and investigations, self disclosures and internal investigations and understands the importance of being proactive based on her experience.
Angela spent 12 years in corporate compliance with a durable medical equipment (DME) supplier. She rose from billing to compliance and for the final five years, served as the Compliance Officer for a large US DME company. Angela, with support of the executive team, improved cash flow by working closely with staff; provided specifically tailored training which ensured faster cash turnaround; and reduced audits and overpayments.
In January 2005, she started the company to work with healthcare providers in the same areas with about 80% of clients being defense cases, meaning a payer or government post payment audit/investigation. It is important to her to see providers be successful and this industry is difficult to really have successful and timely billing and collections.
Her practice covers acute care, physicians, pharmacies, labs, dentists, DME, home health, and some payer work. Over 99% of the business is defense, on a rare occasion they will assist in calculating medical expenses on established medical bills in plaintiff suits.
Presenter #2 Bio
Nadine Smith is the Managing Partner of Equinox Provider Practice Solutions (EquinoxPPS), a physician billing firm supporting small to medium healthcare practices.
Ms. Smith has over 30 years of healthcare operations experience to include: business office management, physician/institutional billing, privacy, corporate compliance, and pharmaceutical access and reimbursement. She is experienced in all aspects of the revenue cycle, process improvement, assessment of internal controls, management of compliance workplan activities and the development of effective training and corrective actions aligned with Federal OIG guidance and Corporate Integrity Agreement requirements. She focuses on the small provider to ensure they excel in revenue yet maintain the required billing compliance requirements. She developed this expertise while working with larger teaching facilities and corporate owned provider practices and integrated health systems in the Southern United States.
Ms. Smith holds a Bachelor of Science in Business Administration from Nicholls State University. She successfully completed certifications in both Healthcare Compliance and Privacy Compliance from the Health Care Compliance Association (HCCA). She has received designation as an approved billing compliance monitor by the Texas Medical Board.