Skillacquire

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Format:	On-Demand Webinar
Presenter:	Sandra Love, MSN, CCDS, CCDS-O, CPC
Time:	You can access the webinar anytime
Duration:	60 minutes

The goal of the presentation is to provide techniques and practical strategies for healthcare professionals, administrators, and organizations for inevitable RAC (Recovery Audit Contractor) and RADV (Risk Adjustment Data Validation) audits. By focusing on proactive preparation, strategic planning, and bolstering resilience, this presentation will effectively equip healthcare systems with the tools and knowledge necessary to navigate the challenges. Attendees will receive a deeper understanding of audit processes, potential vulnerabilities, and practical strategies to fortify their systems, ensuring compliance and mitigating risks. Ultimately, the goal is to empower healthcare professionals to proactively address audit challenges, optimize operational efficiency, and safeguard the financial integrity of their organizations.

Learning Objectives

Understand the complexity of audit processes
Implement actionable strategies and best practices to lessen denials
Ensure compliance with regulatory requirements and standards related to RAC and RADV audits
Improve operational efficiency and responsiveness to audits
Identify potential vulnerabilities

Areas Covered in the Session

Introduction of RADV and RAC Audit
- RAC (Recovery Audit Contractor) Audit
- RADV (Risk Adjustment Data Validation) Audit
What is the Regulatory Framework
Difference Between RAC & RADV
Understanding The Navigation of Audits
- Audit Selection Criteria
- Data Analysis Methods
- Medical Record Review Process
- Coding and Billing Practices
- Financial Impact
- Continuous Monitoring and Improvement
- Appeal Process
- Operational Challenges
Audit Stages and Challenges
The Process for RAC Audit
The Process for RADV Audits
Regulatory and Standard Requirements
Reasons for Appeal Denials
Appeals and Dispute Resolution
- Procedures for appealing RAC and RADV audit findings
- Common reasons for appeal denials and successful appeal strategies
- Legal considerations in the appeals process
Strategies to Reduce Denials
Compliance for RAC Audits
Compliance for RADV Audits
Improving Operational Efficiency
Identifying Potential Vulnerabilities
Future Trends and Challenges

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Suggested Attendees

Healthcare Executives
Medical Providers
Medical Coders
Medical Billers
Medical Auditors
Clinical Documentation Integrity Professionals
Denials Management Team
Population Health Professionals
Revenue Cycle Management Professionals
Healthcare Administrators
Compliance Officers

About the Presenter

Sandra Love, MSN, RN, CCDS, CCDS-O, CPC, is the director of solutions for Norwood in Austin, TX. She has more than 17 years of nursing experience and 11 years in CDI. Previously, Love served as a manager of outpatient clinical documentation excellence at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina, where she helped implement two pediatric CDI programs and an outpatient CDI program. A past president of North Carolina ACDIS, Love has spoken at ACDIS chapter meetings and past national ACDIS conferences. She is also a former member of the ACDIS Events Committee and ACDIS Leadership Council.

Snippet From Our Previous Session

Course Content

You can access all the webinar materials after successful payment

Webinar Link + Handouts PDF

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