Health Plan Audit Reviews

Thursday, December 3, 2009

9:00am - 1:00pm
Hilton Garden Inn
Burlington, MA

$149 MHA Member Rate
$249 Non-Member Rate

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With the start of the Medicare RAC audits looming as well as several other related federal and state audits, hospitals need also to be aware of current audits and reviews that HMOs have been conducting on hospital claims. This program will provide hospitals with an understanding of how HMOs review and audit claims, as well as discuss the top areas that HMOs have audited.

The goal is to help providers develop better internal quality improvement mechanisms to reduce billing errors and improve medical documentation. For this program, MHA has requested that a group of Massachusetts insurers discuss the issues that will help hospitals submit better claims that will not be denied or recalled in an audit. Speakers will be announced soon; space will be limited, so please register early.

AGENDA

8:30 AM REGISTRATION & CONTINENTAL BREAKFAST

9:00 AM        Opening Remarks/Overview
                         Anuj K. Goel, JD, MPH, Vice President, Legal & Regulatory Affairs
                         Massachusetts Hospital Association

9:15 AM Health Plan Overviews of Key Areas of Concern
Brief presentations from the health plans discussing how they handle:

                         • The general criteria they use to review and audit claims
                         • Key ways they determine if the claim meet specific medical necessity
                            or coding standards
                         • Key areas or “Top 10” errors identified by their plan for hospitals to
                            watch out for
                         • Specific best practices they can suggest for hospitals to improve
                            coding, billing, documentation, and delivery of patient care

                            Invited Health Plans:

                                     Blue Cross/Blue Shield of Massachusetts
                                     Tufts Health Plan
                                     Harvard Pilgrim
                                     Fallon Community Health Plan
                                     BMC HealthNet
                                     Network Health
                                     Neighborhood Health Plan

12:00 PM       Documenting Patient Care: Best Ways to Avoid Coding Errors
                          Margaret Fortin, Senior Manager, Baker, Newman & Noyes

1:00 PM ADJOURN

REGISTER

Credit Card - FAX 781.272.0466
Check Payable to MHA - MAIL
MHA Education Department
5 New England Executive Park
Burlington, MA 01803-5096

CEUs

Four (4.0) hours of pre-approved Category II (non-ACHE) continuing education credits will be granted for this program toward advancement or recertification in the American College of Healthcare Executives.