AI, Algorithms, and Extrapolations in Audit Defense

A panel presentation with the CMS approved Deemed Status Accrediting Organizations for 2027 offering a discussion with the participating accreditors and an opportunity for questions from the audience. Moderated by Mary Ellen Conway

Eagle-eyed reimbursement experts Stephanie Robinson, VGM and Dan Fedor U.S. Rehab will review some of the most horrific DME claim denials as they assembles the pieces left behind to determine the culprit. They will, along with the witnesses (the attendees), will re-create the scene of the denial / non affirmation and investigate each one to determine if it was an innocent error, or intentional, or something even darker.

This is an interactive session where the attendees WILL participate during the investigation of some of the most hair-raising denials (claim submission, prior authorization, post pay audit). Bring your smart phone or computer to participate in the investigations. The investigators WILL uncover what went horribly wrong from the intent of the policy to that fateful day of the denial with the objective to resurrect the current denial(s) and implement procedures to reduce (eliminate) the chance of these horrible denials in the future.

DMEPOS suppliers face increasing scrutiny from CMS and other regulators making enrollment compliance more important than ever. A revocation of a supplier’s Medicare PTAN can have significant operational and financial consequences, ranging from payment disruptions to lengthy reenrollment bars. Understanding the enrollment process, maintaining compliance with the Medicare Supplier Standards, and effectively responding to adverse enrollment actions are critical to protecting a supplier's business.

This webinar will provide a practical overview of Medicare DMEPOS enrollment requirements, common enrollment pitfalls that lead to revocations, and the appeals process available to suppliers. Attendees will gain insight into revocation authorities, reenrollment bars, corrective action plans, reconsideration requests, and strategies for building a successful defense when CMS or its contractors come knocking.