The Case for TopGun Audit School

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Confronting Waves of Denials

Hospitals are facing an increasing array of new auditors and audit tactics from government and private payors. Dollars lost to denials are rising, everywhere – and the types of claims being audited and denied are growing, almost monthly.

Physician Advisors are being tapped to stem this rising tide of audits and denials, but their years of training have given them none of the tools needed to combat these problems.

Hospitals can offer little assistance, since their own internal audit processes are either non-existent or woefully outfitted to even know what auditors are looking for in claims and records.

Ultimately, Physician Advisors are at a severe disadvantage when facing external reviewers because they simply don’t know what to expect, nor how to counter these “foreign” tactics and techniques.

TopGun Audit School is designed to meet this threat to hospital financial security, by teaching audit techniques to Physician Advisors to achieve three goals:

  1. Avoid Audits
  2. If audited, Avoid Denials
  3. If denied, have an Appealable Medical Record

TopGun Audit School achieves this in a manner similar to that employed at the US Navy’s Fighter Weapons school, made popular in the movie, “Top Gun.”

Dissimilar Thinking Calls for Dissimilar Training

The US Navy’s Fighter Weapons School, more commonly known as Top Gun, was created to develop, refine and teach aerial dogfight tactics and techniques to selected fleet air crews, using the concept of Dissimilar Air Combat Training (DACT). The technique uses aircraft that are similar to what US pilots face in the skies, instead of just training against their own kind.

In this way, they learn to win aerial combat against even the often faster, more agile enemy aircraft – something that is and will always be a fact of life for a fighter pilot.

The same problem exists for a Physician Advisor, facing an auditor or reviewer who thinks differently, and has much less to worry about than a physician does.

After all, Auditors don’t practice medicine, and they are not dealing with life-and-death issues:

  • Auditors don’t have a patient in front of them
  • Auditors can’t be sued for malpractice
  • Auditors don’t have to review an entire medical record, to decide to pay or deny a claim
  • Auditors have different training, usually much less clinical training than a physician
  • Auditors have differing training on how to conduct and decide audits
  • Auditors have differing goals, depending upon which payor they work for.

Therefore, Auditors are “dissimilar” to a Physician Advisor, just as many enemy aircraft are “dissimilar” to US aircraft.

Facing Audits and Auditors – More than Lectures

TopGun students learn from and face “live” audits from experienced Medical Auditors (sometimes including former TopGun graduates), who are experienced and trained in the tactics and techniques of various payors.

Across 12+ hours of training over 24 weeks, TopGun students are given training in various types of approaches to writing documentation that survives audits and denials, and supports winning appeals. As a part of the training, students are also matched with Live highly experienced Medical Auditors, some of whom are also physicians, to test their skills at working with external audits and auditors, and even an Administrative Law Judge.

Taking TopGun Back Home

All this training is designed for TopGun students to go back to their home facilities and offices and begin to teach their colleagues what they’ve learned – just like the Navy’s TopGun school, where graduates are tasked with going back and training other pilots in their home squadrons. In the same way, an additional goal at TopGun Audit School is to enable graduates to go back to their hospitals, to train other physicians on what they have learned, the tactics they will need to avoid audits and denials, and leave the hospital with appealable medical records when needed.

Continuing Training

To make sure that TopGun graduates stay on top of the most current techniques and auditors that they may face, TopGun offers “TopGun Reloaded” –Audit Tactics Refresher Courses – offered only to graduates of TopGun Audit School as quarterly subscription Live Webinars to update their skills.

Staff Instructors

Our Core Instructors include these highly experienced industry veterans:

  • Bernard Bettencourt, Jr. DO MBA CMAS
    Medical Director and Certified Medical Auditor
    Alicare Medical Management
    Board Member, Council for Certification of Medical Auditors
     
  • Ernie de los Santos, MBA SSA SAC
    Founder and Faculty Chair, Director of the RAC Shadow Agency
    Appeal Academy & TopGun Audit School
    Board Member, Council for Certification of Medical Auditors
    Board Member, Healthcare Solutions Alliance
  • Sharon Easterling, MHA RHIA CCS CDIP CPHM FAHIMA
    CEO at Recovery Analytics, LLC
    Fellow of the American Health Information Management Association
    Advisory Board Member, American College of Physician Advisors
     
  • Elizabeth Lamkin, MHA ACHE
    CEO and Partner, Former Hospital System CEO
    PACE Healthcare Consulting, LLC
    Board Member, Healthcare Solutions Alliance
    Advisory Board Member, American College of Physician Advisors
  • William L. Malm, ND RN CRCR CMAS
    Director, Revenue Integrity and Certified Medical Auditor
    Wake Forest Baptist Medical Center
    Board Member, Council for Certification of Medical Auditors
  • Deepak Pahuja, MD MBA FACP
    Chief Medical Officer and Former RAC Auditor
    Aerolib Healthcare Solutions, LLC
    Fellow of the American College of Physicians
     
  • Bob Soltis
    Consultant, Speaker and Former OMHA Administrative Law Judge
    Advocacy Akademie

 

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