16th Annual NAMAS Conference

"Who's on First, What's on Second."
Receiving a notification from a payer initiates a critical phase that demands a meticulous approach to ensure compliance and financial stability.

This session provides a comprehensive, step-by-step guide to structuring audits in alignment with specific audit scopes and payer policies. Participants will learn how to effectively define and refine audit scopes to address the specifics outlined in payer notifications. Practical methods for incorporating National Correct Coding Initiative (NCCI) edits, and Current Procedural Terminology (CPT) guidelines into audit procedures will be explored, enhancing accuracy and compliance by identifying and addressing coding discrepancies.

Best practices for integrating Clinical Documentation Improvement (CDI) strategies specific to ICD-10-CM coding will also be covered, ensuring thorough documentation review essential for compliance and optimized reimbursement. Essential techniques for conducting comprehensive documentation reviews will be emphasized, focusing on thoroughness and compliance with payer guidelines to mitigate audit discrepancies. Participants will gain insights into effectively applying payer-specific policies and coding guidelines during audit processes to ensure audits are conducted accurately and in alignment with payer expectations.

The session will also explore the optimal use of coding and compliance tools to streamline audit workflows, enhancing efficiency, accuracy, and overall audit outcomes. Through practical insights and real-world examples, attendees will be equipped to confidently navigate payer notifications, leveraging structured audit approaches that uphold compliance and financial integrity.