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You are here : Resources  >  Resource Overview  >  Past Conference Handouts  >  Compliance Institute  >  CI2018  >  sunday
2018 Compliance Institute presentations and handouts

Sunday

Conference session handouts are organized by the day they were presented and sorted sequentially:

Sunday   |   Monday   |   Tuesday   |   Wednesday

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* selected documents contain over 25 pages. Printing will be disabled during the institute, you will be able to print them before and after the conference.

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Track color key

General Compliance and Hot Topics

Long-Term Care

Privacy & Security

Physician Compliance

Compliance Lawyer

Auditing & Monitoring

Internal Audit

How to Succeed as a Compliance Professional

Quality of Care

Advanced Discussion Groups

Industry Immersion

Session

Title/Description

Speakers

Pre Conference Morning Breakout Sessions | 9:00 am - 12:00 pm


P1

Industry Immersion

Large Hospital Systems

  • Learn how to benchmark your program against other large hospitals and health systems through use of polling software
  • Understand challenges relevant to large hospitals and large health systems
  • Engage in dialogue with your colleagues regarding operational solutions and best practices for large hospitals and health systems

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

Suzie Draper, VP Business Ethics and Compliance, Intermountain Healthcare

Margaret Hambleton, VP Corporate Compliance, Dignity Healthcare

Kimberly Otte, Chief Compliance Officer, Mayo Clinic


P2

General Compliance and Hot Topics

Compliance Program Start Up: What Are the Basics Needed for Your Infrastructure?

  • Describe the fundamental elements of a compliance program
  • Identify ways to leverage current resources
  • Provide tips on getting organization buy in

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

Debbie Troklus, Managing Director, Aegis Compliance & Ethics Center LLP

Sheryl Vacca, Chief Risk Officer, Providence St Joseph Health


P3

Long-Term Care

Hey, Therapy Provider! The Government and Private Insurers Have Therapy in Focus—Do You?

  • Therapy focus explained: JIMMO, Probes, Targeted Medical Reviews, Supplemental Reviews, OIG reports and findings, Investigations, Therapy Related Civil Monetary Penalties
  • Understand and implement the who, what, how and why of auditing therapy Conditions for Coverage, Conditions of Participation, and Conditions of Payment
  • Take away an audit tool to ensure your focus on compliance with therapy technical and medical necessity requirements for restorative and maintenance therapy (JIMMO)

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

Shawn Halcsik, Corporate Compliance Officer, Encore Rehabilitation

Nancy Beckley, President, Nancy Beckley & Associates LLC

 



P4

Privacy & Security

Designing an Effective Privacy Program

Presentation 1 (2 slides/page)
Presentation 1 (3 slides/page)

Christopher Terrell, Deputy Chief Compliance Officer & Privacy Officer, Encompass Health

Adam Greene, Partner, Davis Wright Tremaine, LLP

David Behinfar, Chief Privacy Officer, University of North Carolina Health

Katherine Georger, Associate Compliance Officer, Duke University Health System



P5

Physician Compliance

Physician and APP Coding Workshop

  • Coding basics for compliance professionals—knowing where to find the code information, defining the sources for definitive guidance—how to educate your providers and audit-proof your coding and billing
  • Understanding the gray areas of evaluation and management coding, appropriately applying modifiers, and documenting to support the medical necessity of all services
  • Defining and maximizing the role of advanced practice providers, aka non-physician practitioners, in the practice and compliantly billing for their services

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

Kimberly G. Huey, President, KGG Coding & Reimbursement Consulting

Sandra K. Giangreco Brown, Coding Compliance Audit Sr Manager, CHAN Healthcare



P6

Compliance Lawyer

False Claims Act Developments

  • Understand the fundamentals of liability, damages and procedure under the FCA
  • Review critical recent court interpretations of the Supreme Court’s Escobar decision
  • Discuss recent decisions on determining “falsity” in medical necessity cases

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

Handout 1 * will not print on site

John T. Boese, Counsel, Fried Frank Harris Shriver & Jacobson LLP

Michael D. Granston, Director, Commercial Litigation Branch, Fraud Section, Civil Division, US Department of Justice

Gary W. Eiland, Partner, King & Spalding LLP

Michael Morse, Partner, Pietragallo Gordon Alfano Bosick & Raspanti, LLP



P7

Auditing & Monitoring

The Great Internal Audit-Compliance Mystery

  • Guests will observe and identify, or even become party to, the ultimate compliance mystery/conspiracy
  • Attendees will assist in identifying acts of noncompliance and network with the cast and other guests to determine what wrongdoing occurred, why and define an appropriate response to the wrongdoing
  • Attendees will utilize strategies to help define compliance program weaknesses and what safeguards may have prevented an identified behavior

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

Handout 1

Kristen R. Taylor, Managing Director, Pinnacle Enterprise Risk Consulting Services

Kelly C. Loya, Managing Director, Pinnacle Enterprise Risk Consulting Services



P8

Internal Audit

Top IT and Cyber Risks to Include in Your Audit Plan

  • Learn about key IT and Cyber risks
  • Learn trending IT governance best practices
  • Discuss IT audit challenges in an evolving IT risk environment

Presentation

Johan Lidros, President, Eminere Group



P9

How to Succeed as a Compliance Professional

Try Your Luck: Solve a Complex Compliance Case Study

  • Walk through a complex compliance case study in this interactive session and try your luck on making complex decisions to solve the case
  • Learn tips on how to investigate and document complex matters, spot coding and billing issues, interview witnesses, develop a corrective action/mitigation plan, and communicate sensitive matters to senior leadership and your board
  • Understand considerations for self-disclosure, attorney-client privilege and when to use it, and the Yates memo

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

Handout 1 (docx)

Melissa J. McCarthy, AVP, Deputy Chief Corporate Compliance Officer, Northwell Health

Greg Radinsky, SVP, Chief Corporate Compliance Officer, Northwell Health



P10

Quality of Care

Why In The World Is the Compliance Officer Asking about Quality?

  • Attendees will define compliance and quality, explore CMS’ value-based reimbursement model, evaluate the alignment of quality care with reimbursement, and examine work models requiring synergy between compliance and quality to meet CMS requirements
  • Attendees will be introduced to key programs related to value-based reimbursement, examine the implications for the receipt of quality-based reimbursement, and discuss the compliance professionals’ role in monitoring compliance with CMS regulations
  • Attendees will learn effective techniques to monitor and share data, and study effective tools to aide collaboration between senior leadership and the medical staff regarding operations, finances, and clinical outcomes for value-based reimbursement

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

Eugena A. White, Compliance Officer, Medical West, an affiliate of the UAB Health System

Deborah F. Grimes, Chief Diversity Officer, UAB Hospital



P11

General Compliance and Hot Topics

Due Diligence for Acquisition and Partnerships

  • Outline and discuss the strategy, analyis and due diligence necessary for determining fit, aligning appropriate resources and implementing a successful transition for acquisition or partnership with another practice
  • Discuss common goals, areas of compromise and deliverables in order to navigate logistical hurdles and contractual negotiations
  • Share lessons learned and provide practical tips to ensure thorough due diligence from beginning to go-live and thereafter

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

Catherine I. Masoud, Compliance and Privacy Manager for External Affairs, University of Kentucky, UK HealthCare

John Allen, Chief Administrative Officer, University of Kentucky, UK HealthCare



P12

General Compliance and Hot Topics

Navigating Therapy Compliance Requirements Across the Continuum of Care

  • “Medical Necessity” is the key concept to justify Medicare payment for services, but how is medical necessity evaluated in the outpatient, inpatient rehab, home health and SNF settings?
  • Documentation requirements for Medicare payment vary significantly between the OP/IRF/HH and SNF settings. You will learn the documentation commonalities but also the key differences between the settings to better audit and monitor compliance
  • What are the challenges and best practices for compliance training and monitoring for therapists who provide services in multiple settings?

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

Catherine Gill, Director of Quality, Compliance Officer, Franciscan VNS

Kay Hashagen, Senior Consultant, LW Consulting, Inc.



P13

Industry Immersion

Laboratory Compliance: Maintaining Compliance in an Uncertain and Changing Environment

  • Compliance issues facing today’s laboratories include medical necessity, marketing arrangements, network participation issues, toxicology testing, pathology date of service issues, legal actions initiated by insurers, actions under Medicare enrollment authorities, and repayments
  • What you should know about CLIA and the avoidance of commonly identified citations. Presenters will look at proficiency testing requirements, proficiency testing referral safeguards, the overlap between CLIA regulations and billing considerations, and other current certification and accreditation topics
  • Practices that can result in imposition of sanctions, and use of general laboratory auditing plans and other steps to minimize legal and regulatory risk

Presentation 1 (2 slides/page)
Presentation 1 (3 slides/page)

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

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

Presentation 4 (2 slides/page)
Presentation 4 (3 slides/page)

Handout 1
Handout 2
Handout 3
Handout 4
Handout 5

Robert E. Mazer, Shareholder, Baker Donelson

Tim Murray, National Director Laboratory Compliance, Corporate Responsibility, Catholic Health Initiatives

Barbara Senters, Chief Compliance & Ethics Officer, Ameritox

Kathy Nucifora, Director of Accreditation, COLA



P14

Industry Immersion

Managed Care Organizations and Measuring Compliance Program Effectiveness: Review the Tools Used by Hospitals, Health Plans and Providers to Measure Effectiveness and See How They Work!

  • Discuss what tools may best fit your organization for measuring compliance effectiveness regardless of whether you are a Hospital, Health Plan, or Provider
  • Review actual examples of these tools from various organizations and see their effectiveness by examining associated results
  • Share ideas regarding the CMS 2017 three new audit elements of Prevention, Detection, and Correction and consider the similarities and differences (if any) from using the seven elements of an Effective Compliance Program

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

Caron Cullen, President, Positive Compliance Outcomes, Inc.

Kelsey C. Brodsho, Chief Compliance Officer, North Memorial Health Care


Did you miss a session you wanted to attend? Get a recording of a session you missed.

Attendee prices: Each session only $20 or get the whole conference for $499

(Online recordings, Attendee prices)




Pre Conference Afternoon Breakout Sessions | 1:30 pm - 4:30 pm



P15

Industry Immersion

Tactics for Maintaining Expected Levels of Performance in an Increasingly Complex Regulatory Environment

  • Application of proven Quality Management methods to systematically identify, measure, and monitor key performance metrics and generate targeted, informed responses when deviations occur
  • Orchestrate the efforts of operations, compliance, and specialized teams across the enterprise to make, manage, and sustain change
  • Strategies for effective and sustainable quality improvement: project selection, team engagement, and building a culture of continuous improvement

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

Kristine Koontz,Vice President of Quality & Clinical Services, Keystone Human Services Inc.

Amy Short, Administrative Director, Center for Improvement Science

Victoria Hoshower, Quality and Performance Manager



P16

General Compliance and Hot Topics

Conflict of Interest 2.0: Beyond Data Collection

  • Join us while we review the intricacies of COI policy evolution
  • We’ll discuss updates and advancements in CMS’ Open Payments Database
  • We’ll provide useful skills and tools to help you conduct investigations and implement conflict management plans

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

Rebecca M. Scott, Compliance/Privacy Manager, University of Kentucky

C.J. Wolf, Senior Compliance Executive, Healthicity

Andrew Hill, Compliance Analyst/Auditor, UK HealthCare Office of Corporate Compliance



P17

Long-Term Care

Post-Acute Compliance Officers: How Do You Prepare for Constant Change and the Unknown of the Regulatory Environment

  • Join our Compliance Officer Roundtable
  • Does your company invest in compliance without a CIA?
  • Is there a best practice for structuring an effective program and have you tested it?
  • Do you have a seat at the decision maker table?
  • Can you afford to be proactive or just reactive?

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

Handout 1
Handout 2

Karla Dreisbach, VP Ccompliance, Friends Services for the Aging

Betsy Wade, Corporate Compliance Officer, Signature HealthCARE

Jeramy Kuhn, Corporate Compliance Officer, Care Initiatives

Barbara Duffy, Shareholder, Lane Powell



P18

Privacy & Security

What Do Carnegie Hall and Good Security Incident Response Plans Have In Common: To Get There You Must Practice, Practice, Practice!

  • Discussion of the purpose of and process around table top exercises
  • Discussion of the goals of the exercise and pre-table top exercises to dos
  • Performance of a mock table top exercise with audience participation and role assignments and identification of terms used

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

Marti Arvin, Vice President, Audit Strategy, CynergisTek, Inc.

Joseph Dickinson, Partner, Smith Anderson



P19

Physician Compliance

Benchmarking and Coding Outlier Workshop

  • Discuss the critical elements needed in building a risk-based audit process from scratch.
  • Outline and demonstrate how to conduct the needed benchmarking analytics that will support a comprehensive provider risk scorecard. (Above and beyond just a generic E/M bell-curve)
  • Explore strategies to interpret and incorporate the outlier analysis results in a functional day-to-day internal audit process. Discuss current and future risk areas related to professional service billing including the use of Advanced Practice Providers, Hierarchal Condition Categories, and the Electronic Health Record

Presentation (2 slides/page)
Presentation (4 slides/page)

Jared Krawczyk, Mathematician, Nektar Analytics

Andrei M. Costantino, VP of Integrity & Compliance, Trinity Health



P20

Compliance Lawyer

Anatomy of a False Claims Act Case: Investigation, Litigation, Negotiation, Resolution

  • The Investigation Phase: subpoenas, witness interviews and more
  • The Litigation Phase: Discovery and Motions Practice
  • The Resolution Phase: Settlements, CIAs and Relator issues

Handout (docx)

Rick Robinson (Moderator), Global Co-Head of Life Sciences and Healthcare, Norton Rose Fulbright US LLP, Washington, DC

Lisa Re, Assistant Inspector General for Legal Affairs, Office of Inspector General, Department of Health & Human Services

Daniel C. Gerhan, Director and Senior Litigation Counsel, Boston Scientific Corp.

Amy Easton, Partner, Phillips and Cohen LLP



P21

Auditing & Monitoring

340B Compliance Monitoring Utilizing Data Analytics

  • Utilizing data analytics to monitor the 340B Drug Discount Program allows healthcare systems to ensure compliance with the 340B Program and maximizes cost-saving opportunities afforded by the 340B Program
  • KPIs allow for granular analysis of high risk area related to diversion, duplicate discounts, the GPO prohibition, and provide insights into missed cost- saving opportunities where split-billing software limitations and/or poor master data come into play
  • Reduce risk of fines and sanctions by regulators and protection against reputational damage; Improve risk management from automated continuous monitoring for 100% of transactions; Reduce number of FTEs used to maintain compliance with 340B program

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

Tim Krzeminski, Healthcare Compliance Director, PwC

Ryan Hayden, Partner, PricewaterhouseCoopers



P22

Internal Audit

Three Keys to Rock Your Auditing and Monitoring Plan

  • Review the importance of pre-audit preparation and decisions—including what to audit and what to monitor
  • Cover tips on the value of collaboration, clarity of accountability, what to do with incidental findings and more
  • Provide sample tools and the three key concepts that will help you get the job done

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

Handout 1 (xlsx)
Handout 2 (docx)
Handout 3 (xlsx)
Handout 4 (doc)
Handout 5 (docx)
Handout 6 (xlsx)
Handout 7 (xls)

Ruth Krueger, Lead Compliance Program Administrator, Sanford Health

Cindy J. Matson, Sr Executive Director, Compliance, Sanford Health

Mary Jo Henne, Director of Compliance, Sanford Health



P23

How to Succeed as a Compliance Professional

Collaboration between Compliance, Internal Audit and Coding Operations

  • Effective Collaboration between Compliance, Internal Audit and Coding Operations can have a positive impact on the bottom line of your organization
  • Policy and Procedure of the organization impacts all levels and areas, how to help ensure policies and procedures are value-add
  • Insights on collaborative efforts within our organizations with focus on the positives and negatives

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

Kenneth M. Jenkins, Hospital Compliance Officer, Vanderbilt University Medical Center

Colleen A. King-Dennis, Associate Vice President of Compliance Billing & Education, University of Louisville-Physicians



P24

Quality of Care

Three Blind Mice: Achieve a Shared Vision for Compliance, Risk, and Quality

  • Obstacles to creating a unified approach to healthcare compliance, risk, and quality initiatives
  • Achieving integration through the development of shared goals
  • Leveraging technology and data to break down communication silos

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

Jessica L. Smith, Vice President, Compliance Partners, LLC

Jonathan Brouk, Director, Compliance & Privacy Officer, Children’s Hospital New Orleans

Sandra A. Keller, VP Compliance & Regulatory, Lafayette General Medical Center



P25

General Compliance and Hot Topics

Significant Regulatory Changes and OMHA Initiatives Impacting the Medicare Appeals Process

  • Significant reforms to the Medicare appeals process, including recent HHS rulemaking aimed at reducing the backlog of pending appeals and encouraging resolution of cases earlier in the appeals process
  • Key OMHA initiatives taking place at the ALJ appeal level, including the new Statistical Sampling Initiative, implementation of attorney adjudicators, and expansions to the Settlement Conference Facilitation program
  • Understand the impact these reforms and OMHA initiatives will have on providers, and learn strategic approaches and practical tips to consider and implement when appealing overpayment demands and claim denials through the Medicare appeals process

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

Andrew B. Wachler, Partner, Wachler & Associates, P.C.

Nancy Griswold, Chief Administrative Law Judge, Department of Health and Human Services, Office of Medicare Hearings and Appeals



P26

Industry Immersion

The Ups and Downs of DME

  • Identify industry trends and current legislative activity related to audits, appeals, and compliance for DME suppliers, including some positive news for suppliers
  • Identify common legal issues related to providing DME in current regulatory environment
  • Identify current products being targeted for audits and common denial reasons

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

Wayne H. van Halem, CFE, AHFI, President The van Halem Group – A Division of VGM Group, Inc.

Joshua Skora, Attorney, K & L Gates, LLP

Kelly Grahovac, Sr. Consultant The van Halem Group



P27

Industry Immersion

Issues in Academic Medical Compliance: Bridging the Great Divide

  • Working with FDA Surveyors, Clinical Research Billing, and Audits: Using the process and results to improve and augment your compliance program
  • Conflicts of Interest across the medical center, campus, and community environments: Managing and mitigating
  • Physician Hospital Contracting and Reimbursement Challenges in Academic Medical Centers: The compliance role in negotiations, review, and advisement for new and ongoing arrangements

Presentation 1 (2 slides/page)
Presentation 1 (3 slides/page)

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

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

Valerie Dixon, Deputy Compliance Officer, University of California-Irvine

Kim Bixenstine, Chief Compliance Officer, University Hospitals

David Lane, Chief Compliance Officer, Providence St. Joseph Health



P28

Industry Immersion

What’s New and Exciting in Research Compliance: Exploring New Laws, Regulations and Government Guidance

  • Overview of new laws, regulations, and government guidance from NIH, OHRP, ORI, FDA, WHO and more
  • Review of recent enforcement initiatives related to the life sciences and research from DOJ, OIG, CMS
  • Best practices for oversight of research programs and ongoing compliance

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

Lisa Murtha, Senior Managing Director, Ankura Consulting Group, LLC

Ryan Meade, Dir Regulatory Compliance Studies, Loyola University Chicago School of Law


Did you miss a session you wanted to attend? Get a recording of a session you missed.

Attendee prices: Each session only $20 or get the whole conference for $499

(Online recordings, Attendee prices)