Hi
This video is about mistakes on Medicare claims
and a new, simpler way to help you identify and correct them.
First of all, everyone makes mistakes. All of us.
leisure suits
the gadgets we buy from infomercials at 3 a.m
those weird wrinkled cats that look like Yoda.
You make mistakes and I make mistakes.
This tie
hiring my brother-in-law to be my financial advisor.
Unfortunately, mistakes can make our lives difficult.
Mistakes on Medicare claims and incomplete supporting documents mean delays in getting reimbursed or
not getting reimbursed at all.
And no one — not you, not us at the Centers for Medicare and Medicaid Services
wants valid Medicare claims to get caught up in a review process because of an easily corrected mistake.
So we've come up with a new audit process that's simpler and more collaborative.
It's designed
to help you eliminate mistakes and omissions that can cost you time and money.
Now, before I explain how this works, I want to make an important point:
Many of the mistakes we see are easy to fix.
This one is missing the doctor's signature
This one is missing notes from the doctor
to explain why the patient needs a wheel chair
and this one needs the initial certification
to support that the patient is eligable for home care
By working with you to identify these common mistakes
we can help you make Medicare claim reimbursement much easier.
Maybe as easy as changing this tie.
thanks
Maybe you could could give my brother-in-law a few tips?
Okay
Here's a quick look at how our new audit process works
it's called it's called targeted probe and educate
Most providers never need TPE.
it's designed for providers with high denial rates or unusual billing practices.
If you're selected for a TPE audit
a Medicare Administrative Contractor
what we call a MAC
will review 20 to 40 of your claims and supporting medical records.
If the review shows you've had denied claims
you will get a one-on-one education session to show you how to fix it.
I'm here in the gym to show you want we mean by doing "one-on-one education sessions.”
We won't actually make you go to the gym to do them
but doing these sessions as part of TPE is like working out with a personal trainer.
Some of us need help doing our workouts
Our technique is off.
We repeat the same little mistakes over and over,
and that keeps us from getting the results that we want.
In TPE, you can eliminate those little mistakes
with education sessions from a Medicare Administrative Contractor.
Your MAC
This is a big MAC
Your MAC is sort of a like a personal trainer.
He or she will help you to identify and correct claims mistakes.
You'll then have 45 days to apply what you've learned as you file new claims
The goal is to help you get it right
Now, Mac and I are going to walk you through the process
First, how do you know if you're selected for a TPE audit?
You get a letter from a MAC
a Medicare Administrative Contractor
It will look something like this
After you receive the letter,
the MAC will review a sample of your claims and accompanying records
if there are problems
then we do the one-on-one education session
Then you get 45 days to clean things up
If you improve sufficiently
If you improve sufficiently you'll get your claims approved and unless you change your billing practices significantly
you'll get your claims approved and unless you change your billing practices significantly
you won't be reviewed again for that item or service for at least one year
If you don't improve enough you go through the process again
You can go through up to three rounds of reviews and education
before your MAC contacts CMS for next steps
Most of the providers who have been through Targeted, Probe, and educate so far
have improved and not been referred to CMS.
That's more honest mistakes avoided
and more honest providers getting paid without problems
And for those not being honest
well
well, the outcome is not so good.
So this is it in a nutshell
Providers with high denial rates or unusual billing practices get identified
issues are pinpointed and feedback is shared with the provider
Then there are up to three rounds of education sessions and reviews.
If providers sufficiently improve
and make no significant changes in their billing practices
they will not go through another TPE audit for that item or service for at least one year
hey thanks for your help
and thanks for watching
so who is your financial person
I've got this brother in-law