Note from the speaker: Sharing TPE and audit success

Wednesday, July 24, 2019

by Diane Weiss CPC, CPB, CCP, CHRI

This year’s Revenue Integrity Symposium (RIS), to be held October 15–16 in Orlando, is a must-attend event—particularly when it comes to CMS audits and reviews. Facilities need to know how to respond to documentation requests as part of any CMS audit or review. Preparing a complete and proper reply makes all the difference in the outcome or results of those audits and reviews.

At my organization, I’m the designated lead for the team that monitors all target, probe, and educate (TPE) and audit activity for my organization, which manages the outpatient wound care departments for more than 200 hospitals. It’s terribly frustrating to submit what you think is needed only to receive unfavorable results. Through our work, we appreciate how critical it is to know how to successfully navigate through the audit and review process and how to then, when needed, navigate through the appeals process. We’ve been instrumental in guiding our hospital partners successfully through these processes.

Our overall goal is to help others become just as successful in responding to documentation request as well as learning when to push back and use the appeals process when needed. During my session at RIS, “Today’s World of Audits and Reviews: A Look at CMS’ Audit Programs, Their Contractors, and Other Federal Oversight,” I’ll share some best practices, tips, and guidance we’ve learned firsthand. Attendees can expect to come away with a good understanding of the overall audit process conducted under the TPE program as well as other CMS-driven reviews. Based on the widespread request for documentation through the numerous audit and reviews that we’re all now subjected to, this is a topic that I hope will help others.

I’ve attended RIS in the past and am excited about attending again this year! For our organization, revenue integrity is a fairly new area that grew from a combination of revenue cycle and compliance functions. I look forward to meeting other revenue integrity professionals, attending helpful sessions, and collecting the resources and knowledge to solidify our revenue integrity team while at RIS. I have really benefited from RIS in previous years and look forward to continuing to learn from my colleagues so I can help build the most solid revenue integrity program for my organization.

At RIS, I’ve been able to ask questions and share information with a remarkable group of other revenue integrity professionals. I was also inspired to work on achieving a revenue integrity certification, which I just recently completed! I hope you’ll join me there.

Editor’s note: Weiss is the vice president, reimbursement, for RestorixHealth in Metairie, Louisiana. Weiss serves as an advisory board member for NAHRI. 

NAHRI members get free admission to a special members-only networking reception on October 14, the night before RIS officially kicks off. It’s a great chance to plan to meet face-to-face with NAHRI members and leadership you may have connected with on the NAHRI forums, heard speak on members-only quarterly calls, or through other NAHRI initiatives. NAHRI members attending this reception should RSVP online as soon as possible to reserve their space. 

Professionals wishing to earn support from program administrators to attend the 2019 Revenue Integrity Symposium may adapt our justification letter proposal.