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Handouts - 2017 - Regional - Kansas City

Kansas City Regional Conference
Monday, September 25, 2017
Kansas City, KS

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Chair Update – Year in Review

Brian Bewley, Shareholder, Polsinelli PC

  • Overview of recent enforcement activity
  • Notable settlements
  • Key litigated cases and decisions
  • Perspectives going forward under new administration

Presentation (2 slides/page)
Presentation (3 slides/page)

Key Practices in Prevention of Medical Necessity Denials and Recoupments

Denise Hall-Gaulin, Principal, PYA
Richelle Marting, JD, MHSA, RHIA, CPC, CEMC, CPMA, CPC-I, Attorney, Forbes Law Group, LLC

  • A discussion of medical necessity – what it means and what it affects
  • Details regarding the types of medical necessity determinations and the criteria for determining medical necessity
  • An explanation of categorically excluded services
  • Admission criteria [to include Skilled Nursing Facilities (SNF) and Inpatient Rehabilitation Facilities (IRF)]
  • The use of Advanced Beneficiary Notification (ABN) and Hospital Issued Notice of Non-Coverage (HINN), and the outcomes and penalties for not using ABNs or HINNs

Presentation (2 slides/page)
Presentation (3 slides/page)

Compliance in the Managed Care World: Key Lessons for Providers

Anthony H. Choe, Counsel, Polsinelli PC
Rodney K. Miller, JD, Associate Counsel, Mosaic Life Care

  • Compliance obligations for providers
  • Oversight activities of payers
  • Common pitfalls and best practices

Presentation (2 slides/page)
Presentation (3 slides/page)

Stark Wars: The Government Strikes Back

Megan Phillips, Attorney, Husch Blackwell LLP
​​​​​​​Cori Casey Turner, Partner, Husch Blackwell LLP

  • A general overview of the Stark Law, including key requirements of many regulatory exceptions
  • Update on recent developments, including new exceptions, guidance, and self-disclosure protocol procedures
  • Discussion of enforcement trends, including recent case law and settlements
  • Lessons learned from a recent Stark voluntary self-disclosure

Presentation (2 slides/page)
Presentation (3 slides/page)

Coding and CDI Compliance Programs (What Compliance Officers need to know or should know under Auditing and Monitoring Guidelines)

Diana Adams, RHIA, Consultant, RRA, Inc.

  • Discovering who are the healthcare industry watchdogs for coding and CDI programs
  • Understand the history of Clinical Documentation Improvement (CDI) programs
  • Getting involved with the CDI and coding teams from the compliance standpoint
  • Ensuring the coding and CDI reflect an accurate picture of clinical care being given under compliance-audit and monitoring

Presentation (2 slides/page)
Presentation (3 slides/page)

What Every Compliance Officer Needs in Their Toolkit

Bret Bissey, MBA, FACHE, CHC, CMPE, Healthcare Compliance Executive Consultant, MediTract

  • Learn of the resources needed to develop an effective compliance program
  • The obstacles that will be present, challenges that will need to be overcome
  • Potential strategies to achieve success

Presentation (2 slides/page)
Presentation (3 slides/page)

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