Jackson Davis HealthCare
Stop Medicare Fraud & Abuse
(303) 586-5003

support@stopmedicarefraud.com
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The Healthcare Provider's #1 Medicare Compliance Resource
Medicare Audit & Compliance Tools - Medicare Appeals - CMS Program Integrity Resources

To report Medicare fraud, please contact the Office of Inspector General at (800) 447-8477 or HHSTips@oig.hhs.gov

Medicare Audits & Medicare Appeals Education - $259 Webcasts (* includes copy of presentation)

Join our industry-leading clinical documentation auditors, billing compliance professionals and legal support staff for the nation's best CMS audits and CMS appeals webcasts!  Call or e-mail us today for registration at education@stopmedicarefraud.com or (303) 586-5003.

August 17, 2010 - 2:00pm - 3:00pm EST
Managing the Risk of CMS Audits & CMS Appeals - Medicare & Medicaid (RAC Audits, PSC Audits, ZPIC Audits, MIC Audits & One PI)

This presentation will address the wide range of ongoing CMS efforts to stop Medicare fraud, CMS audits & law enforcement fraud initiatives.  Congress has allocated an unprecedented level of financial resources to insuring adherence to CMS payment criteria by providers nationwide - Medicare RAC audits, Medicare PSC audits, Medicare ZPIC audits, etc.  Jackson Davis works closely with hospitals, physicians, inpatient rehabilitation facilities and physical medicine groups facing day-to-day challenges of both responding to audit requests and managing the risk of potential fraud allegations.  This is a critical education session for provider executive management and physicians. 

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than August 13.  You will receive an e-mail confirmation with sign-on information and password prior to August 16.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

August 24, 2010 - 2:00pm - 3:00pm EST
Short Stays - Chest Pain & Related Diagnoses (MS-DRG 312 & MS-DRG 313)- Inpatient or Observation?

This presentation will address the CMS payment criteria and Medicare coverage criteria for inpatient admission of Chest Pain and Chest Pain related cases presenting to the Emergency Room for care (primarily MS-DRG 312 and MS-DRG 313).  Short stays or the "inappropriate admission" of these diagnoses has been the leading focus for CMS probes, evaluations and claim challenges for the past 15 years.  This discussion will provide an in-depth look at implementing CMS admission criteria and the use of Case Management professionals in the Emergency Room.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than August 20.  You will receive an e-mail confirmation with sign-on information and password prior to August 23.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

August 31, 2010 - 2:00pm - 3:00pm EST
Extensive OR Procedures Unrelated to Primary Diagnosis - MSDRGs 981 - 983

This presentation will address the CMS payment criteria for the appropriate submission of hospital claims being grouped to MSDRG 981 - 983 (extensive OR procedures unrelated to primary diagnosis).  Critical aspects of ICD-9 coding, HIS business rules and the claim submission process will all be discussed in detail.  This will be a great discussion for HIM leadership.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than August 27.  You will receive an e-mail confirmation with sign-on information and password prior to August 30.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

September 7, 2010 - 2:00pm - 3:00pm EST
Bringing It All Together - Medicare RAC Audits, Evidence-Based Coverage, Value-
Based Purchasing (VBP) & Pay-For-Performance (P4P)

This presentation will address Medicare's new reimbursement structure and how CMS is fitting all the pieces together.  FY 2010 will truly be a transformational year for providers and Medicare's EBM structure will be the biggest change to healthcare since the implementation of PPS almost 30 years ago.  This will be a great discussion for financial & executive leadership.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than September 3.  You will receive an e-mail confirmation with sign-on information and password prior to September 6.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

September 14, 2010 - 2:00pm - 3:00pm EST
The CMS Appeals Process for Healthcare Providers - How the Game Has Changed

This presentation will address issues associated with CMS audits / CMS appeals - RAC appeals, ZPIC appeals, Medicare overpayment determinations and the Medicare appeals process.

Over 118,000 RAC audit claim denials were appealed by providers in California, Florida & New York - CMS has prevailed in 66% of all RAC audit cases.  This discussion will provide an in-depth look at the Medicare appeals process and explore a wide range of opportunities for providers to proactively address RAC appeals (as well as Medicare PSC appeals, Medicare ZPIC appeals & MIC appeals).

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than September 10.  You will receive an e-mail confirmation with sign-on information and password prior to September 13.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

September 21, 2010 - 2:00pm - 3:00pm EST
CMS Payment Criteria - Automated RAC Audit Focus Areas

This presentation will address all the major, automated RAC audit focus areas and their related CMS payment criteria (hospital / physician / physical medicine only - no DME session today).  Specific focus areas include Blood Transfusions, Untimed Codes (Physical Therapy initial and re-evaluation codes), IV Hydration Therapy, Bronchoscopy, once in a lifetime procedures and a handful of other major automated focus areas.  This discussion will include all major areas for each of the 4 regions.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than September 17.  You will receive an e-mail confirmation with sign-on information and password prior to September 20.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

September 28, 2010 - 2:00pm - 3:00pm EST
Skilled Nursing Facilities - Program Safeguard Contractors, RUG Assignment & Documentation

Under fire from Medicare Program Safeguard Contractors, SNFs can be highly susceptible to losses from missing documentation, an inability to document acute stay requirements and challenges relating to appropriately billing MDS components for Medicare Part A coverage.  This presentation will address a wide range of topics including responding to Additional Documentation Requests from Program Safeguard Contractors, considering the applicability of acute stay documentation, performing self-audits and some of the major areas where providers struggle to support RUG level assignments.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than September 24.  You will receive an e-mail confirmation with sign-on information and password prior to September 27.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

October 5, 2010 - 2:00pm - 3:00pm EST
Inpatient Rehabilitation Facility - 2010 CMS Payment Criteria

Detailed discussion of 2010 IRF Regulations - This presentation will address CMS Payment Criteria for Inpatient Rehabilitation Facility admissions.  RAC audits recouped almost $60m in perceived overpayments from California IRF providers during the Medicare recovery audit demonstration and we will discuss the CMS "not so vague" concepts of IRF medical necessity, preadmission screening criteria and required clinical documentation.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than October 1.  You will receive an e-mail confirmation with sign-on information and password prior to October 4.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

October 12, 2010 - 2:00pm - 3:00pm EST
Percutaneous Coronary Intervention (PCI) & ICD Surgical Procedures - Inpatient or Outpatient?

This presentation will address one of the primary CMS audit focus areas and specifically considers CMS challenges to performing these surgical procedures in the "wrong setting".  Critical issues such as the CMS Inpatient Only list, inpatient admitting criteria, documentation requirements and case management will all be discussed in detail.  This will be a great discussion for Case Management, HIM and financial staff.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than October 8.  You will receive an e-mail confirmation with sign-on information and password prior to October 11.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

 October 19, 2010 - 2:00pm - 3:00pm EST
CMS Appeals for Healthcare Providers - Applicability of the Treating Physician Rule & Other Legal Arguments

This presentation will address CMS efforts to stop Medicare fraud, CMS audits, CMS appeals and the applicability of the "treating physician rule".  CMS and a wide range of judicial findings have determined the relative weight to be given to attending physician testimony, CMS payment criteria, independent medical evidence and other issues in pending appeal matters.  With Medicare RAC audits, Medicare PSC audits, Medicare ZPIC audits and Medicaid Integrity Contractor audits (MIC audits) rolling out nationwide and over 1 million RAC appeals being widely anticipated, it is critical that providers understand prior Medicare Appeals Council and U.S. court findings relating to these very important issues.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than October 15.  You will receive an e-mail confirmation with sign-on information and password prior to October 18.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficiary.

October 26, 2010 - 2:00pm - 3:00pm EST
On the CMS Audit Radar - Emergency Room Visits & Use of Modifier 25

This presentation will address a key focus area that is anticipated to be on the permanent CMS audit program radar - Emergency Room Visits & Use of Modifier 25.  Several previous CMS audits, error evaluations, probes and directives have highlighted a wide range of challenges regarding the accuracy of ER visit definitions.  This discussion will provide an in-depth look at ER visit definition, billing, claim submission requirements and the most recent CMS directives regarding modifier 25.

Please send your registration request and contact information to us via e-mail at education@stopmedicarefraud.com.  Registrations must be received no later than October 22.  You will receive an e-mail confirmation with sign-on information and password prior to October 25.  The cost is $259 per healthcare provider, health plan, health law attorney, consulting organization or Medicare beneficary.

For questions regarding CMS efforts to stop Medicare fraud & abuse, Medicare audits, Medicare appeals, RAC audits, ZPIC audits, MIC audits, CMS auditing tools, CMS reference documentation, CMS PI Warehouse or other Medicare legal support services, please contact us directly at (303) 586-5003 or support@stopmedicarefraud.com.
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