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Evaluation

Billing and Coding

Business & Technology

(CME104) Clinician’s Guide to Audits: Know the Triggers, Manage the Risks, Stay Ahead

Thursday, March 26, 2026
10:30 AM - 11:30 AM PT
Room: Grand Ballroom CD
CE: 1
CMD Management Credit Recording
CME: (1.0) MOC: (1.0) CMD Management: (1.0) AAFP (1.0)
Session Summary: This interactive session provides practitioners with real-world insights into how documentation impacts coding accuracy, billing compliance, and audit exposure. Using post-acute and long-term care (PALTC) examples, we’ll explore what auditors look for, how patterns trigger reviews, and why well-intended notes may fail standards.

Learners will engage with national/local coverage guidelines (NCD/LCD), audit and appeals processes, and understand why quality (not quantity) matters. Through case-based learning and interactive polling, this session empowers primary care providers to document confidently, support accurate coding, and enhance compliance, reimbursement, and clinical outcomes.

By building audit literacy and documentation skills, healthcare professionals strengthen their roles as clinical leaders, supporting revenue integrity, educating peers, and reducing risk in the PALTC setting.

Learning Objectives:

At the completion of this session, learners will be able to:
  • Describe the audit process from initiation to completion, including how providers/practices are selected, common PALTC audit triggers, and key elements auditors review in documentation.
  • Apply proactive strategies to reduce audit risk, such as pre-audit reviews, coding to medical necessity using NCD/LCD guidance, and identifying high-risk patterns.
  • Outline post-audit appeals and recoupment processes (e.g., CERT, RAC) and begin developing an action plan to strengthen audit readiness and compliance in their practice or organization.