Monday, October 12

8:15–9:15 am GENERAL SESSION:

Clinical Documentation Improvement Programs and Physician Advisors: Working Together to Improve Effectiveness

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

Handout

Evaluation Survey

• Importance of CDI to Physician Practices within the Inpatient and Office Settings
• Overview of goals & mission of CDI Programs
• Overview of Compliance requirements by Medicare regarding the documentation of severity-of-illness and medical necessity within the medical record
  

9:30–10:30 am GENERAL SESSION:

Medicaid Enforcement

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

Handout

Evaluation Survey

11:00 am–12:00 pm (Concurrent Breakouts)

101 ICD-10-CM: Just the Basics for the Physician Office

Judy B. Breuker, CPC, CCS-P, CHBME, ACS, PCS, CPC-E/M, CHC, President, Medical Education Services, LLC

Handout, Handout 2

Evaluation Survey

• Where can I find current and accurate information?
• Why the need for change?
• What are the differences between ICD-9-CM and ICD-10-CM?

102 The Lighter Side of Documentation

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

Handout 1, Handout 2, Handout 3, Handout 4

Evaluation Survey

• Looking at the “lighter” side of provider documentation issues
• Real life documentation Real life documentation “Mad Libs“Mad Libs”
• A laugh a day could keep the OIG away!

1:00–2:00 pm (Concurrent Breakouts)

201 Auditing & Monitoring Compliance: Taking the“Vital Signs” of Your Compliance Program

Jason Caron, Attorney, Epstein Becker & Green, PC
Robin Barton, Corporate Compliance Officer, Sheridan Healthcare, Inc.

Handout

Evaluation Survey

• The importance of auditing and monitoring in the face of the government’s heightened scrutiny: “Kicking the tires” before it is too late
• What are the What are the “high risk” areas that I should be focusing on? What are my peers concerned about? Where is the government focusing?
• Practical tips for efficiently targeting your efforts, protecting your findings and implementing appropriate corrective actions

202 Surviving a Government Investigation: A Collaborative Effort

Vicki L. Dwyer, MN, ARNP, CPC, ACS-EM, Chief Compliance Officer, Galichia Medical Group, P.A.
Nancy Kennedy, RHIT, CPC, Associate Compliance Officer, Galichia Medical Group

Handout, Handout 2, Handout 3

Evaluation Survey

• Key elements to have in place
• What to do when government agents walk in the door
• Responding to warrants, subpoenas, investigative demands, etc.
  

2:30–3:30 pm (Concurrent Breakouts)

301 Ancillary Services: A Practical Approach to
Navigating Through Stark Law Requirements and the Medicare Billing Rules

Hayden S. Wool, Partner/Director, Garfunkel, Wild & Travis, P.C.

Handout 1, Handout 2, Handout 3

Evaluation Survey

• Review of pertinent Stark Regulations, including the in-office ancillary rules, and recent amendments to Stark
• Medicare Medicare’’s new Anti-markup provisions
• Practical suggestions for reviewing arrangements and bringing them into compliance with the billing rules and Stark  requirements, when necessary

302 Avoiding the Median Coding Phenomenon for
Routine E/M Codes

Michael Calahan, Director, Coding & Compliance, Associates Physicians Practice Development
Mary E. Wood, CPC, President, Marsalisi, Inc

Handout 1, Handout 2

Evaluation Survey

• What is the “median coding” phenomenon?
• Review of protocols for appropriate E/M code assignment for office visits, consultations and inpatient hospital visits (CMS audit tool provided)
• How to avoid median coding patterns in your practice quickly, efficiently and within accepted compliance standards

4:00–5:00 pm (Concurrent Breakouts)

401 Why Physicians Should Care About Never Events

Henry C. Fader, Partner, Pepper Hamilton LLP

Handout

Evaluation Survey

• Review definitions and history of “never events” and discuss the emerging conflicts
• Discussion of patient safety issues generally including infections
• Impact on professional liability

402 Alternative Practitioners: From “Incident To” to Locum Tenens; How to Ensure Compliance with Federal Regulations, Get Paid, and KEEP IT!

Kim Heibel, CPC, Manager, Professional Services Coding
Assurance, Compliance Department, WellStar Health System
Sheryl Spohn, RHIA, CHC, Executive Director of Coding Assurance, Compliance Department, WellStar Health System

Handout

Evaluation Survey

• PAs/NPs: How can we get the most of their services in the office?
• Biggest bang for your buck in the hospital setting: state laws, hospital bylaws, Medicare/Medicaid/managed care, shared visits, consults
• Substitute physicians: Medicare/Medicaid, hospital credentialing,
  temporary need, long term coverage, employed or agency

Tuesday, October 13

8:15–9:15 am GENERAL SESSION:

Hot Topics from the Center for Medicare and Medicaid Services

Jean Stone, Director, New York Field Office, OFM Program Integrity Group, Centers for Medicare & Medicaid Services

Handout

Evaluation Survey

9:30–10:30 am GENERAL SESSION:

OIG Hot Topics

David M. Blank, Senior Counsel, Office of Counsel to the
Inspector General, Administrative and Civil Remedies Branch
Division, Department of Health and Human Services
Tony Maida, Deputy Chief, US Dept of Health & Human Services

Handout 1, Handout 2

Evaluation Survey

11:00 am–12:00 pm (Concurrent Breakouts)

501 De-Nile Ain’t Just A River in Egypt

Susan Welsh, MHA, CPC, CPC-I, PCS, Compliance Manager, HMA

Handout

Evaluation Survey

• Identifying your hit list of denials
• How to How to ‘root cause’‘root cause’ your denials
• Improving the process to eliminate the denials

502 Theories of Liability and Defenses under the False Claims Act

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

Handout

Evaluation Survey

• A review of cases involving claims for services not provided, but claimed; claims not provided as claimed and quality of care theories of liability and evidentiary proof in these types of false claims cases
• A review of issues arising in a false claims case premised on a violation of the Anti-Kickback Statute and/or the Stark Law
• A review of recent amendments to the False Claims Act and the impact on physicians and other providers of health care service

1:00–2:00 pm (Concurrent Breakouts)

601 When to Hold Your Tongue: The Benefits and
Risks of Self-Disclosure

Michael F. Schaff, Esq., LLM, MBA, Chair, Corporate &
Healthcare Departments, Wilentz, Goldman & Spitzer, PA
Alyson M. Leone, Esq., Associate, Wilentz, Goldman & Spitzer, PA

Handout 1, Handout 2

Evaluation Survey

• Overview of OIG’s Provider Self-Disclosure Protocol, including recent changes to protocol
• Why Self-Disclose? What are the benefits? Why hold your tongue? What are the risks?
• How are other physicians implementing the Self-Disclosure Protocol?

602 Identity Theft Prevention: The FTC’s Red Flags Rules and Health Care Providers

Rebekah A.Z. Monson, Senior Attorney, Pepper Hamilton LLP

Handout

Evaluation Survey

• A discussion of Medical Identity Theft and the FTC’s Red Flags Rules
• Exploring who must comply with the Red Flags Rules and where health care providers fit in
• Establishing an identity theft prevention program, including the FTCs Guidelines on Developing and Implementing a Written Program

2:30–3:30 pm (Concurrent Breakouts)

701 Risky Business: Physical Therapy in the Physician Office

Sheila K. Nicholson, Esq., MBA, MA, PT, Partner, Quintairos, Prieto, Wood & Boyer, P.A.
Nancy Beckley, MS, MBA, CHA, President, Bloomingdale Consulting Group, Inc.

Handout

Evaluation Survey

• Analyzing: why rehab and therapy services offered “incident-to” are being targeted for compliance audits and overpayment recovery
• Accountability: in delivery and billing for therapy services
• Improving: internal controls for compliance in therapy services
• Documentation: do your therapy forms facilitate compliance proactively?

702 Does Coding Affect Compliance?

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

Handout

Evaluation Survey

• Coding accurately and responsibly
• Coding and Compliance go hand-in-hand
• Why is the OIG motivated?