Tugba Koca
Director of QA and TrainingACU-Serve CorpAs Director of QA and Training, I take pride in sharing my expertise and guiding providers through the complexities of LCDs, NCDs, Policy Articles, Supplier Manuals, Medicare Program Integrity Manuals, and industry regulations. My mission is simple: help providers stay compliant, reduce errors, secure timely reimbursement, and protect their payments.
Beyond consultation, I deliver documentation training, risk analysis, coding guidance, charge capture support, and coverage determinations. I also train staff on front office processes, insurance verification, and billing practices while conducting presentations, coaching teams, and addressing compliance questions.
I have managed numerous complex rehab cases, high-dollar claims, and appeals, successfully overturning denials through RAC, ZPIC, UPIC, CERT, SMRC, HMS, PERM audits, and QIC discussions. I’ve worked on extrapolation appeals—including one valued at nearly $1 million—and have extensive experience representing providers in ALJ hearings, achieving many favorable outcomes.
My legal studies built a strong foundation in responsibility, integrity, competence, and compliance. This background strengthens my ability to explain and apply the False Claims Act, Stark Law, Anti-Kickback Statute, and related regulations in my audit work.
The healthcare industry is ever-changing, and I remain committed to staying current, embracing change, and sharing knowledge. My personal motto: never stop learning, never stop growing.
CRT03: CRT – Topic 1 – Reviewing a Patient File for Medical Necessity
We will propose a sample redacted patient file review aligned with the Medicare coverage checklist to help clarify documentation expectations. Frequen…We will propose a sample redacted patient file review aligned with the Medicare coverage checklist to help clarify documentation expectations. Frequently, suppliers review the coverage criteria and then examine the patient’s medical records, but they…We will propose a sample redacted patient file review aligned with the Medicare coverage checklist to help clarify documentation expectations. Frequently, suppliers review the coverage criteria and then examine the patient’s medical records, but they often struggle to make the necessary connections between the two. This disconnect can lead to incomplete documentation or missed elements that are critical for reimbursement. By walking through a sample file, we can demonstrate how to identify and extract the relevant information from clinical notes, physician assessments, and supporting documentation to meet Medicare’s requirements. This exercise will provide practical insight into how coverage criteria should be interpreted and applied within real-world patient records, ultimately improving compliance and reducing claim denials.Show MoreClick the title to see all details
CRT05: CRT – Topic 2 – CRT Order Prep for Billing Essentials
This course will outline the essentials of preparing a detailed order based on medical record qualification and utilizing the quote, along with accoun…This course will outline the essentials of preparing a detailed order based on medical record qualification and utilizing the quote, along with accounting for items that are not covered. When to utilize an ABN, how the order and POD documentation wil…This course will outline the essentials of preparing a detailed order based on medical record qualification and utilizing the quote, along with accounting for items that are not covered. When to utilize an ABN, how the order and POD documentation will reflect the free vs chargeable upgrades to make it clear for any reviewer. How to review the quote against the medical records to prepare an order that accounts for correct coding, items requiring specific dx and non-covered services. 1.5 hours should be allocated to this course, if selected. (Continuation from Topic 1 Reviewing patient file for medical necessity)Show MoreClick the title to see all details
WK04: Advanced Billing Workshop
This session builds upon the foundational content presented last year, offering a more comprehensive examination of critical challenges within the int…This session builds upon the foundational content presented last year, offering a more comprehensive examination of critical challenges within the intake, billing, collections, compliance, and audit processes. Attendees will gain insights into common…This session builds upon the foundational content presented last year, offering a more comprehensive examination of critical challenges within the intake, billing, collections, compliance, and audit processes. Attendees will gain insights into common operational pain points and receive actionable guidance for effectively addressing these issues. The presentation will feature interactive discussions and real-world case studies to enhance engagement and practical understanding. Key Topics of Discussion 1. Intake Process The session will underscore the importance of thorough insurance verification, including an in-depth discussion on CMS’s consolidation of billing across Skilled Nursing Facilities (SNF), Hospice, and Home Health (HH).Strategies will be presented for obtaining essential documentation when initial records lack sufficient detail to support medical necessity.Guidance will be provided on assembling a complete, billing-ready file, including accurate identification of the appropriate payment category for each product and a clear understanding of the corresponding billing requirements. 2. Billing and Collections Emphasis will be placed on the creation of clean claims that align with payer-specific billing guidelines, including the correct use of modifiers, narratives, span dates, and other critical elements. The variability among payers will be addressed.The session will explore best practices for achieving and maintaining a healthy accounts receivable, including key performance metrics and strategies for monitoring and responding to denial trends. 3. Compliance and Audit A review of CMS Quality and Supplier Standards will be conducted, highlighting the most frequent violations and offering practical approaches to mitigate risk.Attendees will gain an understanding of the various auditing entities and learn effective strategies for successfully navigating audit processes. Subject matter experts will present essential performance metrics across each operational area, equipping suppliers with the tools to monitor organizational health and drive continuous improvement. Participants will leave the session informed, confident, and empowered to implement best practices within their respective organizations.Show MoreClick the title to see all details
