Description:
Members of the CAPIR Medicaid Provider Advisory Committee will share
insights, opportunities and challenges regarding program integrity, compliance,
fraud, advocacy and how better to safeguard your practice while providing care
to this growing population.
Learning
Objectives:
- Implement efficient, productive practice protocols to enhance practice
viability.
- Recognize and avoid fraud and abuse allegations.
- Recognize the value of program integrity within your practice.
- Understand the role of medical necessity in treatment planning.
- Appreciate the value of clear, concise and accurate patient record
documentation.
Abstract:
Despite misconceptions and fears associated with being a Medicaid provider,
treating this population can be rewarding and not cut adversely into your bottom
line. Members of the CAPIR Medicaid Provider Advisory Committee will share
insights, opportunities and challenges regarding program integrity, compliance,
fraud, advocacy and how better to safeguard your practice while providing care
to this growing population. Special emphasis will be given to the
importance of proper documentation of medical necessity.
Outline:
- Medicaid Fraud & Abuse
- Overview
- Medicaid Audits
- Communication and Documentation
- Integrity in the Era of Accountability
- Paradigm Shift: volume to value
- Data analysis: We know who you are and how you practice!
- Audits: Third Party Payer Perspective
- Value of Medical Necessity
- Importance of Risk Assessment
- Maintaining a Legally Sound Record: Truth or
Consequences
- Why keep records?
- What constitutes a dental record?
- Importance of documenting “why” you did what you did
- Medical Necessity trumps everything
- Examples
