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Billing Auditing and Monitoring Effectively: Measure to Manage Risk!

Webinar Date/Time: June 5, 2014 at 1:00 PM to 2:00 PM EST

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Data have been a game changer.  Organizations must know how to appropriately bill and whether that is being done!  Learn in this complimentary webinar:

  1. How to better manage your claims data using measures.
  2. How to get ahead of the game and think like contractors.
  3. How to use data to manage and measure risk.

Billing Auditing and Monitoring (A&M) has always been a core component of an effective compliance program and a critical success factor to revenue integrity.  However, a change in how claims data can be used for and against you can render current Billing A&M programs stale.    If you want to retain what has been billed, you must be able to verify revenue integrity through metrics and measured results.  Revenue integrity cannot be managed effectively without well defined metrics, routine versus non-routine approaches, phasing, risk analysis, data querying, and appropriate sampling techniques.  These must be put in place as part of your Billing A&M program, or your organization is at risk.  This presentation will address:

  1. Effective Billing A&M in an era of data analysis/mining;
  2. Keeping up with contractor reform;
  3. How to effectively use auditing tools to retain earned revenue;
  4. Strategies that deflect recovery contractors;
  5. How to use metrics, sampling, and phasing to monitor billing effectively; and
  6. How auditing and monitoring, using metrics, can assist enormously in defending against demand letters.

Who Should Attend?

  • Claims Processing and Reimbursement Managers
  • Attorneys with clients in distress over revenue integrity issues
  • Quality Assurance Managers
  • Compliance Officers
  • Financial Services Staff


Cornelia M. Dorfschmid, PhDExecutive Vice President Strategic Management Services, LLC has over 20 years of   experience in compliance consulting, and is a recognized expert in the areas of corporate compliance, HIPAA and compliance risk assessments, enterprise risk management (ERM), RAT-STATS sampling and overpayment estimation, and litigation consulting. She specializes in providing senior advisory services in “turn around” situations to health care organizations ranging from hospital systems, group practice networks to managed care, labs, disease management, and DME organizations. She works with various law firms and their clients as an expert relating to payment error issues, overpayment settlements, fair market value issues, and self-disclosure. Her advisory services cover such areas as corporate compliance program development and implementation, compliance program effectiveness assessments, including enterprise risk management/Committee of Sponsoring Organizations of the Treadway Commission (ERM/COSO), litigation and self-disclosure support (SDP) and resolution, RAT-STATS sampling and estimation of overpayments by payers.  She is widely published and has presented at various associations and professional organizations and events on such issues as Risk Management and Methodologies, Compliance Risk Areas, Benchmarking Compliance Program Effectiveness, and HIPAA Privacy and Security.

Richard P. Kusserow, Chief Executive Officer, served 11 years as the Department of Health and Human Services (DHHS) Inspector General and currently is Chief Executive Officer of Strategic Management Services, LLC that specializes in developing, implementing, and measuring effective compliance operations and programs.  The Firm provides a broad range of advisory services including organization assessments, financial/legal fact-finding, values and vulnerabilities assessments, program analyses, special studies/reports, policy development, and specialized education/training programs.  He has assisted organizations by providing interim and designated compliance officer services.  He provides specialized expertise on fraud and abuse, sanctions, exclusion, and debarment processes, as well as regulatory issues arising from the Centers for Medicare & Medicaid Services (CMS). He possesses special and unique expertise involving fraud and abuse laws and regulations, such as the Anti-Kickback Statute, qui tam actions, as well as environmental and product safety regulations and government contracting ethics. Under his personal leadership, Strategic Management has provided consulting assistance to over 2,500 companies, facilities, organizations and entities, large and small, for-profit and non-profit.  He has published eight books on compliance and countless journal articles.

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