Monday

• The seven essential elements of an effective compliance program
• Organizational steps necessary to implement a successful compliance program
• The laws, rules, and regulations pertinent to healthcare compliance
• Challenges confronting compliance officers

• Understand the importance of structure vs. operations
• The components of an effective compliance infrastructure
• Implementation of a compliance program, selection of qualified staff, and budgeting for program

• The importance of have a Standard of Conduct to provide the ethical culture of the organization.

• Compliance-related policies, which are current to regulatory requirements and organizational expectations, are the cornerstone of an effective compliance program

• The differences between policy and procedures
• The essential components of compliance policies
• Developing, implementing, and evaluating the adequacy of compliance program policies

HIPAA Privacy and Security

• An overview of the HIPAA Privacy and Security regulations
• A breakdown of these regulations in an easy to understand format
• Understanding how to apply the Privacy and Security Regulations to their daily compliance activities

Tuesday

Risk Assessment and Internal Controls

• What is risk and how can it be assessed?
• Who should be involved in risk assessments?
• What is the risk assessment process and how does it differ for non-profits and publicly traded for-profits?
• What are ways to identify risk areas?
• How do you rank and prioritize risks?
• How does risk assessment relate to auditing and monitoring?
• What do you with the results of a risk assessment?
• How does risk assessment relate to compliance effectiveness?
• Tools to implement a risk assessment process

Routine Auditing and Monitoring

• The basic components of auditing and monitoring including different considerations for developing an audit
• Examples of reporting formats to communicate auditing and monitoring results
• Developing a compliance audit plan and soliciting management’s involvement in that plan

Education and Training

• Understanding how adults learn
• Adult learning techniques, effective teaching styles, topics of interest, and evaluation of the educational programs
• The adequate length of sessions, who should be included, and how often training should be held
• The difference between general and focused/targeted education

Organizational Ethics

• 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?

Wednesday

Conflicts, Discipline, and Incentives

• The nature of conflicts of interest in health care, including regulatory oversight, industry guidance, and other documents that impact compliance professionals’ oversight of this area
• A practical approach to implementing a Conflicts of Interest process and how it differs for non-profits and publicly traded for profits
• How Conflicts of Interest relates to Auditing and Monitoring and Compliance Program Effectiveness
• How discipline and incentives should be integrated into the compliance program
• How discipline and incentives relate to Auditing and Monitoring and Compliance Program Effectiveness

Stark and Anti-Kickback

• Severe civil and even criminal penalties can result from compliance failures involving these important healthcare legal requirements

• An overview of each law
• Discussion of recent enforcement actions, similarities and differences in the two laws, and strategies that can be implemented to promote compliance

Enterprise-Wide Billing and Reimbursement

• Basic compliance terminology as it relates to Health Care Services
• Information on billing and reimbursement risk areas that have been identified by Governing Authorities
• Controls and mitigating activities to address billing and reimbursement risk areas and healthcare fraud and abuse

Internal and External Investigations

• Government agencies that can be involved in an investigation of a healthcare provider
• The many factors that compliance professionals and their organizations must consider before, during, and after an internal investigation
• The use of experts and consultants
• Details about the attorney-client privilege and attorney work product doctrine
• Practical advice on how to conduct investigations

Thursday

Legal Risks and Self-Disclosure

• The legal risks associated with health care compliance
•  Self Disclosure of Non-compliant Activity and Government Expectations
• The considerations that compliance professionals must address when designing, implementing and administering compliance programs.

Effectiveness and Evaluation

• A historical review of what various government agencies consider when determining what makes a compliance program effective
• Industry research and best practices related to effectiveness and evaluation
• Methodologies for evaluating and measuring the effectiveness of a compliance program