Thursday, October 2

8:15 – 9:30 am

General Session: Can Compliance Programs Help Physicians Improve Quality of Care?

Rory Jaffe, MD, MBA, CHC, President, HCCA Board of Directors

• Systems and culture
• The new coding rules
• Terms of engagement

Document 1         Evaluation

9:30 – 10:45 am

General Session: How Compliance Efforts Can Help Avoid Enforcement Actions

Sean R. McKenna, Assistant U.S. Attorney, Department of Justice

• Physician risk areas that could result in fraud investigations
• How the government evaluates the merits of referrals
• How the government investigates such allegations
• Compliance activities that can assist physicians during fraud investigations
• Compliance efforts that could reduce or minimize the adverse effects of fraud investigations

Document 1         Evaluation

11:00 am – 12:00 pm

101 Internal Investigations and Voluntary Disclosure

Gabriel Imperato, Esq., CHC, Managing Partner, Broad & Cassel

• Determining the scope of the internal • investigation, the
  methodology of an investigation and accountability and reporting authority between the law firm directing the investigation and the consultants conducting the investigation
• Application of the attorney-client, work product and self-evaluative privileges during the internal investigation and issues arising with respect to matters that are privileged, especially when taking into consideration parallel criminal and/or civil litigation or disclosure by public companies
• Discussion of the methodology for the investigation, including, but not limited to, interview techniques, document review and cooperation of the client organization
• Alternatives for documenting the results of the investigation and issues of voluntary disclosure and waiver of the privilege
• The risks and rewards of voluntary disclosure of misconduct and the who, what, why and where of such disclosures
• The obligation of returning known overpayments to Federal health programs

Document 1         Evaluation

102 Outpatient Billing and Coding: Is Your Revenue Washing Down the Drain?

Teresa Bivens, CPC, CHC, Deputy Compliance Officer
University of Louisville/HSC

• Whether your organization is small or large, piping together a structure and process for the accurate coding and billing patient claims is imperative to a continuous flow of revenue
• You have a revenue process in place, but are you catching all your potential revenue? Where to stop the leaks…
• Those nasty clogs—what they are and how to plunge them
  away!

Document 1, Document 2         Evaluation

1:30 – 2:30 pm

201 Compliance & Clinical Documentation
Improvement: Are You Ready for the RACs?

Betty Bibbins, MD, CHC, C-CDI Spec, CPEHR, CPHIT
President & Chief Medical Officer, DocuComp LLC

• Importance of Clinical Documentation Improvement Specialists within the inpatient environment
• Give examples of appropriate documentation of severity of illness that justifies consumption of resources
• What Recovery Audit Contractors are and how they are and will be impacting healthcare
• Methods in responding & appealing denials regarding quality of care issues that may be raised by third-party payers

Document 1, Document 2         Evaluation

202 Advanced Stark: How to Operationalize Stark
and Assess Stark Compliance in a Physician Organization

Bob Wade, Partner, Baker & Daniels LLP
Janis Anfossi, JD, MPH, RN, Associate General Counsel
Rush University Medical Center

• Brief overview of Stark Act and Physician Practice exceptions
• Detailed analysis and operational issues involving:
  • Rental of office space
    
  • Rental of equipment
    
  • Bona fide employment relationships
    
  • Personal services
    
  • Group Practice Definition
    
  • In-office ancillary exception
    
  • Stand In the Shoes/Physician Organizations
    
  • Physician recruitment
    
  • Indirect compensation and ownership arrangements
    
  • Gifts and benefits: Non-monetary compensation up to $329 and medical staff incidental benefits
• Fair market value
• How to perform a Stark Compliance Assessment
• Tools and processes for implementing Stark compliance
• How to conduct periodic audits of your Stark processes

Document 1, Document 2, Document 3, Document 4,
Document 5, Document 6, Document 7         Evaluation

2:45 – 3:45 pm

301 Identifying and Analyzing Compliance Issues

John Falcetano, CHC, CIA, MA, Chief Audit /Compliance Officer, University Health Systems of Eastern Carolina

• Selecting the team
• Reviewing the documentation
• Identifying the issues
• Implementing corrective action
• Monitoring the results

Document 1         Evaluation

302 HIPAA Security for the Un-Geek

Tom Ealey, Associate Professor, Alma College

• Laptop, laptop, who’s got the laptop? Smaller, faster, more
  dangerous
• The joys of technology: phishing and social engineering
• Helping identity thieves—Trojans, worms, mal-ware, spy-ware, and wireless surfers
• Steal your employees’ passwords before someone else does: security in the era of sticky notes
• Document protection: paper and digital
• Fire, flood, lighting, theft, earthquake—the joys of paranoia

Document 1         Evaluation

4:00 – 5:00 pm

401 The Dark Side of EMR

Schawn Pedersen, CPC-E/M, Manager, Moss Adams LLP

• Identify where EMR provides the ability for complete and
  accurate documentation and quality patient care
• Identify where risk is associated with specific functions in an electronic medical record
• Consider appropriate policies and procedures to support
  documentation and reduce organization’s risk

Document 1         Evaluation

402 Quality In Physician Practices: Practical Tools for Assessment and Implementation

D. Scott Jones, CHC, LHRM Vice President, Corporate Compliance and Risk Management, American Healthcare Providers Insurance Services

• Why the work we do is the same: The real roles of Compliance Officers, Risk Managers, and Quality Leaders in Physician Practices
• The Top Quality and Compliance issues that generate
  professional liability lawsuits: An analysis of the nations’ leading database of medical malpractice claims against doctors
  
• Administrative support systems that foster quality in medical
  practices
• Medical Records documentation assessments for quality and defensibility of documentation
• Facility assessments for quality and patient safety
• Effective assessment of compliance, quality and risk for Physician Practices
  

Document 1, Document 2, Document 3         Evaluation

Friday, October 3

8:15 – 9:15 am

General Session: Medicaid Enforcement

James Sheehan, Medicaid Inspector General
New York State Office of the Medicaid Inspector General

Document 1         Evaluation

9:15 – 10:30 am

General Session: Physician Practice Enforcement Initiatives

Laura Ellis, Senior Counsel
U.S. Department of Health & Human Services
Office of Counsel & Office of the Inspector General

• Relationships with Drug and Device Manufacturers
• Relationships with Hospitals
• False Claims for Physicians: Billing, Upcoding, Unbundling,
  and Other Pitfalls
• Research and Education Grants
• A Potential Remedy: The Provider Self-Disclosure Protocol

Document 1         Evaluation

10:30 – 10:45 am

501 Meshing Compliance Education for Physician and Hospital

Ronda Tews, CPC, CHC, CCP-P
Corporate Compliance Project Manager Education
St. John’s Health System

• Why is compliance education needed in the physician’s practice?
• How can this education be rolled out to the physician?
• How can compliance education be rolled out to other
  coworkers?
• How can you mesh hospital compliance education with the
  physician practice compliance education?

Document 1         Evaluation

502 From Dictation to Clinical Data: Achieving Documentation Compliance

Nick van Terheyden, MD, Chief Medical Officer, M Modal

• By converting speech recognized text into structured data it is easier to achieve documentation compliance and generate higher quality documentation
• Accurate, detailed and complete clinical information is
  semantically interoperable between electronic health records systems and used to provide a wealth of decision support at the point of care

Document 1         Evaluation

1:15 – 2:15 pm

601 Audit Plan for Medicare’s Shared Visit Rule

Elin Baklid-Kunz, MBA, CPC, CCS
Director of Physician Services, Halifax Health

• Risk Areas and regulations for shared visit
• Relationship to “incident-to” and scribing
• Documentation and billing requirements
• Private payer difference
• Workplan for the actual audit
• Implementing self audit tools for department to use for follow up

Document 1, Document 2         Evaluation

602 How to Develop and Use Physician Scorecards to Audit/Monitor Physician Compliance

Andrei Costantino, CHC, MHA, CPC, CPC-H
Director of Organizational Integrity, Trinity Health

• Develop individual physician scorecards
• Implement an effective auditing and monitoring strategy for
  large physician’s practices or multiple physician networks
• Using external (CMS) and internal (provider) data to develop compliance tools
• Monitoring Risk
• Sampling designs based on data
• Framework of reporting results and findings

Document 1         Evaluation

2:30 – 3:30 pm

701 Conflict of Interest

John Falcetano

Document 1         Evaluation

702 An Inconvenient Truth-Coding: The Risk Areas

Amy Bailey Muckler, CHC, CPC, CPC-H, CCS-P, PCS, FCS
Healthcare Consulting Manager, Hooper Cornell, PLLC
Sarah Spry, CHC, CPC, PCS, Healthcare Consultant Hooper Cornell, PLLC

• Identify the most common risk areas pertinent to coding
• Discuss proper documentation and coding for known risk areas
• Interactive review of case examples
• Explore easy resources to identify aberrant coding patterns

Document 1         Evaluation