Additional Documentation Requests (ADRs), Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), and More: What’s All the To-Do and Is Your Agency at Risk?
Summary:Understand all types of reviews that can place your agency at risk.
HCSSA Topic(s) Addressed:
- §558.259[d]agency responsibilities
- §558.260[a]basic principles of management in a licensed health-related setting
- §558.260[a]risk assessment and management
- §558.260[a]financial management
Faculty: Whitemyer, Brandi
Program Description: With the current array of pre- and
post-payment reviews, the Centers for Medicare and Medicaid Services (CMS) continues to make new efforts to assure program integrity and compliance.
While pre-payment reviews can significantly interrupt cash flow to your agency, post-payment reviews can be just as costly and burdensome.
This program helps home health agency administrators, directors, and other staff understand the importance of a clear and directive response
to all types of medical reviews, as well as measures that can be taken to avoid placing your agency at risk.
Program Objectives: Upon completion of this program, the viewer will be able to:
- Recognize the types of CMS medical reviews including RACs, ADRs, and ZPICs
- Describe practices which place agencies at risk for pre and post payment reviews
- Evaluate the appeals process following CMS medical reviews
About the Presenter:
Brandi Whitemyer, RN, COS-C, HCS-D, HCS-O, AHIMA Approved ICD-10 Trainer/Ambassador is a 14-year veteran
of home health and hospice as a Registered Nurse. She has experience as a field nurse, director, administrator, and regulatory affairs executive with agencies, both large and small.
She holds both an Associates Degree in Nursing, as well as a Bachelors Degree in Psychology from Kent State University. She is currently a Senior Associate Consultant with Selman-Holman &
Associates and the owner of Transitions Health & Wellness Solutions, a home health & hospice coding and consulting agency. Brandi works closely with home health and hospice agencies
nationally in providing consulting services, survey compliance, managing medical reviews and appeals of Medicare denials, writing Corrective Action Plans, developing staff education,
policy development, developing coding and quality assurance processes, and development of coding education. Brandi is certified as a Homecare Coding Specialist-Diagnosis (HCS-D),
Homecare Clinical Specialist-OASIS (HCS-O), and is certified in OASIS competency, COS-C. She is also an AHIMA Approved ICD-10-CM Trainer and Ambassador.
- 1.50 Hr(s) HCSSA Administrator/Alternate
 Additional Documentation Requests (ADRs), Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), and More: What’s All the To-Do and Is Your Agency at Risk?