Massachusetts Medical Society: Payer Audits and Payment Recoupments

Payer Audits and Payment Recoupments

Payer Audits and Payment Recoupments

Payer Audits and Payment Recoupments

The retrospective audit is becoming an increasingly attractive method for payers to determine overpayments and recoup money. Evidence suggests that the number of public and commercial payer audits increased significantly in recent years and the trend is not going away any time soon. Physician practices can and should take steps before an audit occurs to ensure that all documentation and coding practices are in accordance with CPT and payer policies. In this webinar, you will gain practical advice on how to handle payer audits, minimize your exposure, and limit future audits.  Furthermore, you will learn from an industry expert what rights you have to appeal and the steps that need to be taken in the event of a payment recoupment demand.

Learning Objectives

  • Identify the types of audits that exist (public vs commercial) and how to handle requests for payment recoupments effectively in order to limit future risk
  • Determine what needs to be done if/when receiving an audit notification/request from a public or commercial payer
  • Outline what rights physicians have to appeal requests and/or payment recoupments


Elizabeth Foley, Esq
Elizabeth-Ann S. Foley is an Associate Attorney in the firm's Health Law practice, where she specializes in healthcare fraud, waste and abuse, white-collar criminal investigations, physician disciplinary matters, government investigations, corporate compliance and litigation. 
Elizabeth has a wide range of experience handling complex matters before the district and state superior trial courts throughout the Commonwealth of Massachusetts. She counsels hospitals, physician practices, and skilled nursing facilities with issues involving billing and coding, data security breaches, HIPAA, PPACA, ACA, Anti-Kickback statutes, and the federal False Claims Act, among others. Elizabeth has expertise in advising healthcare practitioners with licensing and/or disciplinary actions before various professional boards, such as the Massachusetts Board of Registration in Medicine. She also guides clients through all phases of state and federal governmental inquiries and investigations, including responding to subpoenas, rendering grand jury testimony, and the execution of search warrants.

Course Fees

Massachusetts Medical Society (MMS) Member: $15.00
Non-MMS Member: $30.00
Allied Health Professionals: $12.00


Slides & Video

CME Credit

1.00 AMA PRA Category 1 Credit™

Accreditation Statement  
The Massachusetts Medical Society is accredited by the Accreditation Council for Continuing Medical
Education to provide continuing medical education for physicians.

AMA Credit Designation Statement
The Massachusetts Medical Society designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MOC Approval Statement 
Through the American Board of Medical Specialties ("ABMS") ongoing commitment to increase access to practice relevant Maintenance of Certification ("MOC") Activities through the ABMS Continuing Certification Directory , this activity has met the requirements as an MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

Allergy and Immunology
Colon and Rectal Surgery
Family Medicine
Nuclear Medicine
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Psychiatry & Neurology
Thoracic Surgery

National Commission on Certification of Physicians Assistant (NCCPA).

Physician Assistants may claim a maximum of 1.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

A score of 70% or higher is required to receive  AMA PRA Category 1 Credit™.

Activity Term
Original Release Date: November 15, 2015
Review Date: May 15, 2017
Termination Date: November 15, 2018

System requirements

Windows, XP, Vista, 7, 8 
Mac OSX 10.6 higher 
Most modern browsers including: 
Firefox 18.0+ 
Chrome 26+ 
Safari 5+ 
Flash player is required for some Online CME courses. 

iOS devices beginning with OS version 5 or higher (includes, iPhone, ipad and iTouch devices) 
Android devices including tablets and phones. 
Windows RT and tablets on Windows 8 are also supported.


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