Uncover the ways that you can prepare for audit activity

Wednesday, July 6, 2022

Editor’s note: Diane Weiss, CPC, CPB, CCP, CHRI, vice president of reimbursement for RestorixHealth, will present “Navigating Today’s World of Audits” on Day 2 of the Revenue Integrity Symposium, which takes place on September 19-20 at the Hilton Phoenix Resort at the Peak. Prior to joining RestorixHealth, Weiss became the provider education representative for Pinnacle Medicare Services, providing CMS Medicare Part B provider education and denials management for providers throughout Louisiana and other states within the MAC’s jurisdiction. For those 12 years with Medicare, Weiss conducted provider education workshops and seminars, and spoke to a variety of specialty societies, coding groups, and medical manager associations.

NAHRI: What are you most excited about with this year’s conference?
Weiss: I am looking forward to reconnecting face-to-face with my revenue integrity colleagues.  We’ve done a great job with connecting virtually, but there’s something much more positive and engaging about a live meeting. This year’s conference includes a great lineup of speakers and topics that are helpful to anyone with revenue integrity related responsibilities. I’m particularly looking forward to getting any updates and resources related to all the payer audit activity going on, especially CMS’ audit activity.

NAHRI: What's a great piece of advice you've received regarding revenue integrity?
Weiss: I’ve gotten a lot of great advice throughout my career, especially through working with NAHRI and participating in the Revenue Integrity Symposium. Ironically, some of the best guidance that I've carried forward for years is don't hesitate to challenge burdensome regulatory rules or changes. Questioning payers, submitting comments to draft LCDs, and working through the appeals processes are often the best ways to affect change with payers. Ironically, I saw just how collaborative and successful that process worked while I was a provider education rep for one of the Medicare administrative contractors. Don’t ever hesitate to challenge or question coverage guidelines!

NAHRI: What’s the biggest challenge in revenue integrity right now? How does your session help tackle this?
Weiss: I think the biggest challenge in revenue integrity right now is the increasing amount of external audit activity from both government and commercial payers. Many of our hospital systems and providers have had to mobilize teams just to monitor, respond, and track all of the activity that we’re subjected to in today’s environment, which can be challenging. The session I’m co-presenting provides an overview of all the current audit activity and how to manage and track that activity. Our goal is to help attendees stay a step ahead and prepare for the scrutiny and audit activity that we face.