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Maintaining Your Sanity and Practice Viability as a Medicaid Provider: Embracing Program Integrity
Description
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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:

 
  1. Implement efficient, productive practice protocols to enhance practice viability.
  2. Recognize and avoid fraud and abuse allegations.
  3. Recognize the value of program integrity within your practice.
  4. Understand the role of medical necessity in treatment planning.
  5. 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:

  1. Medicaid Fraud & Abuse
  2. Overview
  3. Medicaid Audits
  4. Communication and Documentation
  5. Integrity in the Era of Accountability
  6. Paradigm Shift: volume to value
  7. Data analysis: We know who you are and how you practice!
  8. Audits: Third Party Payer Perspective
  9. Value of Medical Necessity
  10. Importance of Risk Assessment
  11. Maintaining a Legally Sound Record: Truth or Consequences
  12. Why keep records?
  13. What constitutes a dental record?
  14. Importance of documenting “why” you did what you did
  15. Medical Necessity trumps everything
  16. Examples
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