Resolving Coding Disputes: Analyzing Agreements, Identifying Code Standards, Leveraging Expert Opinions

A live 90-minute CLE video webinar with interactive Q&A


Wednesday, August 11, 2021

1:00pm-2:30pm EDT, 10:00am-11:30am PDT

or call 1-800-926-7926

This CLE webinar will guide healthcare counsel on resolving coding disputes. The panel will examine identifying code standards through analysis of coding authorities, regulations, policies, and provider agreements. The panel will discuss working with coding experts as well as spotting potential issues in determinations by third-party payors. The panel will also discuss best practices for resolving coding disputes.

Description

Healthcare providers strive to make coding decisions accurately, and payers have a similar objective when reviewing those decisions. Despite these efforts, disputes arise when those decisions must be substantiated and during the claims review and audit processes. Both healthcare providers and payers turn to healthcare counsel and experts to resolve disputes over the coding of physician services and supplies.

One of the challenges of coding is the lack of consistently applied code selection rules. The inconsistency makes it difficult to determine if a particular code is the most accurate for certain services. This is true for providers and payers, and often results in substantive disputes between the two. In addition, to identify the correct code to use, it is prudent for counsel to evaluate the other party’s code selection.

Listen as our panel of healthcare attorneys examines the role of healthcare counsel in resolving coding disputes. The panel will discuss identifying code standards by analyzing coding authorities, manuals, provider agreements, and regulatory provisions. The panel will discuss working with coding experts and ensuring that their opinions are correctly supported. The panel will also address issue spotting in reviewing claims decisions and payment audits. The panel will offer best practices for resolving coding disputes.

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Outline

  1. Identifying code standards
    1. Analysis of coding authorities, regulations, manuals, policies, and agreements
    2. Evaluating the  position of other parties
  2. Coding experts
  3. Best practices for resolving coding disputes

Benefits

The panel will review these and other important issues:

  • How can healthcare counsel use analysis of coding authorities, regulations, manuals, and provider agreements to identify whether the correct code standards are used?
  • What steps should counsel take to identify the appropriate coding standard and rules?
  • What best practices should counsel for healthcare providers and payers use to resolve coding disputes?

Faculty

Howard, Delena
Delena S. Howard

Advisor
Hall Render Killian Heath & Lyman

With more than 25 years of experience in healthcare documentation and revenue cycles, Ms. Howard possesses a deep...  |  Read More

MacCarthy, Sara
Sara J. MacCarthy

Attorney
Hall Render Killian Heath & Lyman

Ms. MacCarthy has a broad range of litigation and appellate experience. Her work involves the representation of...  |  Read More

Wanerman, Robert
Robert E. Wanerman

Member
Epstein Becker & Green

Mr. Wanerman’s practice concentrates on regulatory, reimbursement, and compliance matters affecting healthcare...  |  Read More

Zeko, Kenneth
Kenneth Zeko

Principal Advisor
Hall Render Killian Heath & Lyman

With more than 25 years of regulatory compliance experience, Mr. Zeko leads the firm’s Advisory Services’...  |  Read More

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You may pre-order a recording to listen at your convenience. Recordings are available 48 hours after the webinar. Strafford will process CLE credit for one person on each recording. All formats include program handouts.

To find out which recorded format will provide the best CLE option, select your state:

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