The State of Affairs with Hospice Audits
Includes a Live Event on 02/17/2021 at 2:00 PM (EST)
Despite the COVID-19 pandemic, hospices continue to experience unprecedented payment-related scrutiny from The Centers for Medicare and Medicaid Services’ (CMS) contractors including Medicare Administrative Contractors (MAC), Unified Program Integrity Contractors (UPIC), Supplemental Medical Review Contractors (SMRC), and the Office of Inspector General (OIG). Responding to these audits during “normal” times is challenging enough; however, preparing the audit submission and taking any necessary compliance-related next steps, if any, during a pandemic bring on an entirely new set of challenges. In this webinar, we will discuss the reasons for these continuing audits and discuss strategies to ensure a timely and comprehensive audit response (in light of the current pandemic challenges). Also, we will discuss the importance of executing any compliance-related next steps in response to the audit in an effort to address any potentially problematic audit findings and/or to mitigate future payment-related scrutiny.
Topics covered in this webinar include:
- The correlation between aberrant and/or outlier PEPPER Report data and payment-related scrutiny;
- The CMS contractors currently conducting hospice-specific payment-related audits and what data each audit is focusing on;
- Strategies to ensure a timely and cohesive audit submission – particularly in light of the current COVID-19 pandemic challenges all hospices are facing; and
- Determination and execution of any post-audit next steps to ensure an appropriate compliance response to any potentially problematic audit findings and/or to mitigate future payment-related scrutiny.
Carrie Cooley, RN, MSN
Principal / Chief Executive Officer, Weatherbee Resources
Carrie Cooley is the Principal / Chief Operating Officer with Weatherbee Resources. Carrie joined Weatherbee in 2009 as an Associate Consultant and was hired as the Consulting Coordinator in 2012. In 2014, Carrie was promoted to Director of the Consulting Division and in July 2015, she assumed the COO position. Carrie's operational, clinical, and regulatory expertise has been instrumental in her professional growth with Weatherbee and in serving Weatherbee's clients.
In her role as COO, Carrie leads the strategic growth initiatives for Weatherbee, providing invaluable expertise to individual hospices and the entire field. Carrie's mission is to prepare and support hospices navigating the ever-changing regulatory hospice environment. Carrie and the Weatherbee team focus on delivering consulting services and education that is specifically tailored to meet each client's individual needs.
Carrie's regulatory expertise and extensive consulting experience includes forensic clinical record auditing, baseline compliance audits/mock surveys, interim management, clinical due diligence, and executive coaching. Carrie also works directly with clients' legal counsel in preparation for arbitration and other hearings; she serves as an expert witness. Weatherbee also works extensively with clients who are under a Corporate Integrity Agreement (CIA); Carrie and the Consulting team manage the Independent Review Organization (IRO) audit activities required by the Office of Inspector General (OIG). Carrie's excellent rapport with executives and staff alike – coupled with her regulatory and clinical acumen, and knowledge of best practices – assures excellent consulting outcomes.
Under Carrie's leadership, Weatherbee has assisted hundreds of clients under investigation by Zone Program Integrity Contractors (ZPIC), Benefit Integrity Support Centers (BISC), Recovery Auditors (RA), the Department of Justice (DOJ), and OIG.
As a member of Weatherbee's Speaker's Bureau, Carrie teaches a broad range of hospice, regulatory, and leadership-related topics nationally and is a member of the faculty for Weatherbee's renowned Hospice Regulatory Boot Camps. Carrie also frequently speaks at state and national hospice conferences on compliance-related topics.
Carrie is a registered nurse and holds a Master's degree from Samford University with a specialty in nursing leadership and healthcare finance.