Agenda:

Monday

Introduction to Compliance Practices: Abbreviated Compliance 101

Introduction to Compliance Practice provides a basic introduction to health care compliance and compliance programs. It covers the seven essential elements of a compliance program and reviews the organizational steps necessary to implement a successful compliance program. The laws, rules and regulations pertinent to compliance programs are introduced. Challenges confronting compliance officers are discussed.

Quality and Compliance Strategies for Making Your Program a Success

This is an introductory session designed to introduce the relationship between quality and compliance and the necessity for compliance professionals to monitor quality activities. During this session, we will discuss monitoring quality, identifying clinical champions, using quality tools and examine how quality issues can also be compliance issues.

Risk Assessment

If there were an eighth key element of compliance program guidance, risk assessment would be it. In this session, participants will learn what risk is and how it can be assessed, who should be involved in risk assessments, ways to identify risk areas, and what to do with the results of a risk assessment.

Compliance Infrastructure

This course is designed to help compliance professionals understand the components of an effective compliance infrastructure. Discussed is implementation of a compliance program, selection of qualified staff, budgeting for compliance and the overall structure of the office. Time is spent discussing the various positions needed and the qualifications for each. The auditing position along with qualifications (coding credentials) is discussed. A compliance professional should be able to use what is taught in this course to design an adequate structure to facilitate an effective compliance program.

Organizational Ethics

The HCCA Code of Ethics sets an important standard for those doing compliance and ethics work in the healthcare field. In this class you willlearn about such points as:

• What are the duties we, as professionals, owe to the public, our clients and the profession?
• What do we do when confronted with misconduct?
• What is our duty to keep the board informed?
• How do we deal with limits placed on our professional judgment?

Tuesday

Certification Discussion

Corporate Responsibility

This session covers the governing bodies’ role in the oversight of the organizations compliance program, as well as, a review of the kinds of questions boards should be asking about the compliances’ program operations. There is a discussion of the role of the Compliance Officer in providing the board with reports on operational activities and how to address the necessary ongoing educational needs of the board about compliance issues and regulatory changes. In addition, there is a review and discussion of the responsibilities of senior management, department director, and supervisors with regard to compliance within their individual areas of responsibility. Sample Board Agendas, report forms and other related documents are discussed in the session.

Education and Training

This course is designed to aid the participant in understanding adult learning techniques, effective teaching styles, topics of interest, and evaluation of the educational programs. An indepth discussion centers on adult learning and how to design the classroom for retention. Also discussed is the adequate length of sessions, who should be included, physicians working with coders, and how often training should be held. The class designs and participates in skits demonstrating effective training techniques focusing on compliance-related topics.

Routine Auditing and Monitoring

Auditing and Monitoring is a critical element in any compliance program. In this session, participants will learn about the basic components of Auditing and Monitoring including different considerations for developing an audit, examples of reporting formats to communicate auditing and monitoring results and developing a compliance audit plan and soliciting management’s involvement in that plan.

Effectiveness and Evaluation

Since the early 1990s government agencies have indicated that credit would be given in the context of criminal and civil law enforcement actions, to organizations that operate effective compliance programs. This session provides a historical review of what various government agencies consider when determining what makes a compliance program effective, reviews industry research and best practices related to effectiveness and evaluation, and discusses methodologies for evaluating and measuring the effectiveness of a compliance program.

Wednesday

Enterprise-Wide Billing—Reimbursement Compliance Risks

The healthcare business continues to become more complex with its many rules and regulations as health care costs continue to climb. The enterprise-wide billing reimbursement across the continuum curriculum provides compliance officers with a basic understanding of Medicare and Medicaid services and health care claims submission. The class covers basic compliance terminology as it relates to Evaluation and Management (E & M) code selection and billing terms; presents information on compliance billing risk areas that have been identified by the Office of Inspector General (OIG); and provides an overview of government activities to combat health care fraud and abuse.

Stark and Anti-Kickback

The Anti-Kickback and Stark laws are at the heart of every health care organization’s compliance program—severe civil and even criminal penalties can result from compliance failures involving these important health care legal requirements. This session provides an overview of each law including discussion of recent enforcement actions, discusses similarities and differences in the two laws, and discusses strategies that can be implemented to promote compliance.

Internal & External Investigations

This session identifies the many government agencies that can be involved in an investigation of a healthcare provider. It also provides in-depth discussion of the many factors that compliance professionals and their organizations must consider before, during, and after an internal investigation. It addresses the use of experts and consultants, and provides details about the attorney-client privilege and attorney work product doctrine. It offers practical advice on how to conduct investigations.

Conflicts of Interest

The discussion will focus on the nature of conflicts of interest and the various healthcare areas where conflicts of interest are of particular interest, including regulatory oversight, industry guidance, and other documents that impact the compliance professionals’ oversight of this area.

Thursday

Legal Issues, Risk Factors and Disclosure Issues

This session focuses on the legal risks involved in compliance functions (in the circumstances of doing the right thing, and not doing so.) It also addresses voluntary disclosures and the government’s expectations when providers identify instances of non-compliance. The session is practical and oriented toward addressing the many considerations that compliance professionals must address when designing, implementing, and practicing compliance functions, policies, and procedures.

HIPAA Privacy & Security

This session is a detailed review of the HIPAA Privacy and Security regulations. The discussion is focused on the primary components of each set of regulations so the audience will have a basic understanding of these regulations and be able to apply this knowledge to their daily compliance activities.

12:15 pm – 1:15 pm

Lunch: Q & A Review Panel

Friday

9:00 am – 11:00 am

Certified in Healthcare Compliance Examination

The CHC exam is optional. You must be preregistered to sit for the exam. Visit www.hcca-info.org for more information and the registration form.

Please note: agenda and/or speakers may vary slightly for each Academy.