THURSDAY, OCTOBER 4
8:15 – 9:30 AM
GENERAL SESSION:
Patient Status: Where Two Worlds Collide
Joe Zebrowitz, MD, Executive Vice President, Senior Medical Director,
Executive Health Resources
Document 1
- Describe the priorities CMS and the OIG are focused on
regarding medical necessity documentation
- Understand the financial impact of observation status on
the hospital, doctor, and patient
- Understand the differences in medical necessity and
observation rules for Medicare, Medicaid, and Managed Care
9:30 – 10:45 AM
Enforcement in Physician Practices
Joseph Huzik , Seignior Council HHS, OIG, OCIG Administrative and Civil Remedies Branch
Document 1
- Relationships with pharmaceutical manufacturers and
medical device manufacturers
- Quality of care and medically unnecessary services
- Research misconduct
11:00 AM – NOON
BREAKOUT SESSIONS
101: Telemedicine & Electronic Health Records:
Opportunities & Exposures
Cynthia Stamer, Member, Glast, Phillips & Murray PC
- Physician involvement in telemedicine and electronic
health record strategies: selected emerging models and
practices
- Negligence and other treatment standards, electronic
health record privacy and security, and other selected legal
concerns impacting design and use of telemedicine and
electronic health record strategies
- Practical strategies and tips for evaluating and deploying
electronic health and telemedicine strategies to manage
quality of care, liabilities and costs
102 Medicare Myths
David Glaser, Attorney, Fredrikson & Byron, P.A.
Document 1
- Understand how to determine whether Medicare prohibits
a certain activity
- Learn to recognize when carriers, consultants and lawyers are misunderstanding Medicare requirements
- Avoid common misunderstanding of Medicare
reassignment and “incident to” rules that cause clinics to bill improperly, or to mistakenly believe that they are billing improperly when their actions are perfectly legal
1:30 – 2:30 PM
BREAKOUT SESSIONS
201: Compliance Education Tactics
Michael Lee, VP & Chief Compliance Officer, UW Medical Foundation
Document 1
- Why we do it
- How we do it
- You can do it too!
202 Recent Changes Relating to Billing
Medicare for Consultations
Peggy Blue, Regulatory Specialist, HCPro, Inc.
- Brief participants on recent changes relating to billing
Medicare for consultation services furnished by physicians
and non physician practitioners
- Review hypothetical examples to determine if services rendered should be billed as a consultation or some other type of encounter
2:45 – 3:45 PM
BREAKOUT SESSIONS
301: Combining Disciplines: Quality Improvement,
Risk Management, and Corporate Compliance
D. Scott Jones, CHC, LHRM, Vice President, Corporate Compliance and
Risk Management, PAHPIX/AHPIS / Duane Morris LLP
\Document 1, Document 2
- Review the leading national database of information on
why physicians are sued for medical malpractice—by
medical specialty
- Examine the connections between quality improvement, corporate compliance and risk management in medical practices
- Explain how doctors and practice administrators can protect patients, practices, and physicians through combined quality, compliance, and risk management programs
302 “Only the Shadow Knows”:
Our Road
to Implementing a Clinical Documentation
Improvement Program
Nancy Campbell, CCS, CPC, CCP, Compliance Education Coordinator,
UVA Health Services Foundation
Lynda Hilliard, Senior Manager, Deloitte & Touche LLP
Document 1
- 10 years later in compliance
- The road to a new begining
- Ending the turf battles with multi-disciplinary
resource delegation
4:00 – 5:00 PM
BREAKOUT SESSIONS
401 Legal Issues in Clinical Research:
What You Need to Know
Rachel Nosowsky, Esq., Assistant General Counsel, University of Michigan
Ryan Meade, Esq., Partner, Meade & Roach LLP
Document 1
- Review selected FDA enforcement initiatives
- Provide an overview of recent changes to Medicare
reimbursement of clinical research services
- Discuss Medicaid reimbursement for clinical research
services
- Describe common themes in non-compliance
investigations and practical ways to avoid these problems
402 Whatever Happened to Incident One?:
An Insider’s View
Paul Kim, JD, MPH, Counsel, OBER-KALER
Document 1, Document 2, Document 3,
Document 4, Document 5, Document 6,
Document 7, Document 8
- Comprehend the Medicare incident-to policy
- Avoid errors in filing claims for incident-to services
- Understand the interaction of the incident-to policy with
non physician practitioner services, diagnostic tests, and
Part B drugs and biologicals
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FRIDAY, OCTOBER 5
8:15 – 9:15 AM
Quality of Care in Physician Groups:
How Are They Perceived by the Enforcers?
Steve Morreale, DPA, CHC, Assistant Professor, Worcester State College
Document 1
9:15 – 10:30 AM
Physician Health Care Fraud Investigations
Sean McKenna, AUSA, Northern District of Texas
Document 1
- Criminal and civil cases and settlements
- Investigative tools and procedures
- Problematic financial relationships
10:45 – 11:45 AM
BREAKOUT SESSIONS
501: Top 5 Common Compliance Issues Found in a
Small/Rural Physician Practice
Teri Price, RN, CHC, Medical Compliance Officer,
Cherokee Indian Hospital–Eastern Band of Cherokee
Teresa Bivens, CPC, CHC, Deputy Compliance Officer,
University of Louisville
Document 1, Document 2, Document 3,
Document 4, Document 5, Document 6,
Document 7, Document 8, Document 9,
Document 10, Document 11
- This session will include a discussion of common
compliance issues found in a small/rural physician practice
- Tips and tools will be provided to assist the compliance officer for a small/rural practice
- Areas of risk and audit processes will be included in this session specifically directed toward the compliance officer with limited resources
502 How to Get Your Front End to Meet Your
Back End
Jocelyn Piccone, Chief Operating Officer, Wright State Physicians
Marta Kennedy, Compliance Director, Wright State Physicians
Document 1 ,Document 2, Document 3
- Define front and backend risks
- Private office risk assessment tool—
take away
- 3 easy steps to building a bridge
1:15 – 2:15 PM
BREAKOUT SESSIONS
601 Criminal and Civil Enforcement Involving
Quality of Care and Medical Necessity and
Reasonableness of Health Care Services
Gabriel Imperato, Esq., Managing Partner, Broad & Cassel
Document 1, Document 2, Document 3
- Who decides the level of quality and the medical necessity
and reasonableness of health care services?
- A review of "quality of care" claims under criminal and civil enforcement statutes involving physician services, hospital services and care and treatment in nursing homes
- Warning siginals and lessons learned from recent enforcement actions
602: Regulatory Issues Surrounding Physicians
Assistants (PAs) and Nurse Practitioners (NPs):
It’s Not Just about Billing
Cynthia Swanson, Senior Healthcare Consultant,
Seim, Johnson, Sestak & Quist LLP
Dawnese Kindelt, CHW Corporate Compliance,
Clinics and Physician Services
Document 1, Document 2
- Discuss and utilize a step-by-step tool kit to comply with
physician collaboration and supervision requirements
- Learn how to ensure adherence to your state scope of
practice requirements
- Take away an easy-to-use overview of Medicare rules for“incident to” and shared services tip sheet
2:30 – 3:30 PM
BREAKOUT SESSIONS
701: Reaching Coworkers With Your
Compliance Message
Ronda Tews, CPC, CHC, CCP, Corporate Compliance Project Manager–
Education, St. John’s Health System
Document 1
- Online compliance education ideas
- Examples of promotional items to get the message out
- How to measure the effectiveness of your education
702: Risk Assessments
Lori Laubach, Partner, Moss Adams LLP
John Falcetano, Chief Audit & Compliance Officer,
University Health Systems of Eastern Carolina
Document 1
- How to conduct risk assessments in physician practices
- Identifying universal risks and the things that affect risk
- How to conduct controlled self-assessments
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