October 27 - 29, 2019
2019 Clinical Practice Compliance Conference
Nashville, TN, United StatesAgenda
Sunday, October 27
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08:00 AM - 09:30 AMP1: Yes, a Physician May Bill Medicare for Incident-To Services of Another Physician and Answers to Other Questions about Incident-To Policy Paul Kim, Attorney, Cole Schotz P.C. - Learn the Medicare incident-to rule as presented by the former CMS employee who drafted the 2002 regulation - Implement protocols to comprehensively and compliantly bill Medicare for incident-to services - Identify and address areas of risk before Medicare auditors doGeneral Compliance
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08:00 AM - 05:30 PMPre-Conference Session Pre-Conference Session100
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09:45 AM - 11:15 AMP2: Supporting Clinical Excellence and Co-Location Compliance Anne Daly, VP of Compliance, Samaritan Health System Tanvi Gupta, Director of Enterprise Risk Management, Ann & Robert H. Lurie Children's Hospital of Chicago Ciara Fordham, Director, Compliance Program, Ann & Robert H. Lurie Children's Hospital - Clinical integration and multidisciplinary care drive quality and efficacy in healthcare -Regulations and payor rules set limits and boundaries on what services may be billed when performed in which space and by whom - Careful consideration of clinical initiatives and the space in which they will be provided and by whom can enable collaborative, interactive care that meets billing compliance requirementsGeneral Compliance
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11:15 AM - 12:30 PMLunch Lunch on your own today.Networking
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12:30 PM - 02:00 PMP3: Patients Over Paperwork: E&M Options? Bess Ann Bredemeyer - Discuss optional documentation changes in 2019 - Review 2021 proposed changes - Consider impact of potential changes to continuity of care & paymentGeneral Compliance
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02:15 PM - 03:45 PMP4: Navigating the Compliance Pitfalls of Telemedicine C.J. Wolf, Faculty, BYUI Jay McVean, Director, UT Health - Address misconceptions among clinicians of the differences between the reality of current telemedicine delivery methods and the future possibilities of telemedicine - Discuss the compliance risk associated with IT Security, HIPAA, coding, and reimbursement - Explore how some states are approaching legislation and regulations for telemedicine, with a deeper dive into how the state of Texas is approaching telemedicine as an exampleGeneral Compliance
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04:00 PM - 05:30 PMP5: All About Appeals and Grievances: Review of the Regulations and How to Navigate Your Way through these Processes at a Medicare and Medicaid Health Plan Anthony Choe, AVP & Associate General Counsel, Inovalon, Inc. Gail Kinkead, Director, Protiviti - Review of Medicaid and Medicare Appeal and Grievance regulatory requirements, including how Plans are audited by CMS and Medicaid State Agencies on adhering to these rules - Discuss the Appeal and Grievance process and scenarios from both the Plan and Provider perspective: What are Best Practices? - Explore options after the Appeal or Grievance is denied at the Health Plan level: What happens next?General Compliance
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05:30 PM - 06:30 PMWelcome ReceptionNetworking
Monday, October 28
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08:30 AM - 09:30 AMHHS-OIG Compliance Priorities: Trends, Technology, and Takeaways Andrew VanLandingham, Senior Counselor for Medicaid Policy and Health IT, Office of Inspector General - Dep't of Health and Human Services
- OIG Update on Fiscal Year 2019
- Trends in oversight and enforcement related to the opioid epidemic, home and community-based settings, telemedicine, integrity agreements, and recent work plan additions
- Emerging compliance and enforcement issues related to health technology
- OIG’s recent Regulatory Sprint to Coordinated Care proposed rule for the anti-kickback statute
General Session -
09:30 AM - 10:30 AMEmotional Intelligence: How to Develop and Use these Skills to Build Mutual Success Adam Myers, Chief Population Health, Cleveland Clinic
- The learner will gain understanding of how to develop EI capabilities.
- The learner will learn principles of applying these skills to real world situations
- The learner will gain understanding about how to preserve their own sense of wholeness in difficult situations
General Session -
11:00 AM - 12:00 PMBreakout Sessions#101101: Preparing for the On-Site Regulatory Inspection Lela Petersen, Senior Compliance Analyst, Seattle Children's Hospital
- Completing an on-site regulatory inspection of your practice from the front door signage to the hazardous waste pick-up. A simple method to assure your practice is protected against the myriad of regulatory requirements.
- Shared lessons from the field and Bernie Madoff too! How to conduct an invasive inspection without being intrusive. Ask the right questions before the inspectors do!
- Spotting discrepancies quickly, using an on-site survey for new acquisitions and how to conduct corrective actions.
General Compliance#102102: Ensuring Medical Necessity: The Overarching Criteria of Evaluation and Management Documentation Caroline Whitlock, Sr. Compliance Consultant, Health Tx Provider Network Jennie Moody, Supervisor, Physician Coding Compliance, Health Texas/Baylor Health- Clear and Present Danger: How EMRs contribute to lack of medical necessity
- True Grit: How to have the difficult discussions when the volume of documentation is the primary influencer
- The Pursuit of Clarity: Learn key concepts that every coder should do to accurately code Medical Necessity
General Compliance -
12:00 PM - 01:00 PMNetworking Lunch Lunch providedNetworking
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01:00 PM - 02:00 PMBreakout Sessions#201201: Do the Right Thing: Leading a Federally Qualified Health Center's Response to a Medicare Targeted Probe & Educate (TPE) Audit Robyn Hoffmann, Senior Manager, BerryDunn
- How to articulate the key requirements and potential outcomes of a Medicare Targeted Probe & Educate (TPE) audit to a Federally Qualified Health Center's Administration, clinical leadership, and Board of Directors
- How to develop an inter-departmental timeline and workflow to ensure a Federally Qualified Health Center's timely response to the Medicare Administrative Contractor (MAC)
- How to address Medicare TPE Round 1 findings pertaining to treatment plan documentation in the electronic health record (EHR) and ensure that Medicare enrollees are only booked with providers that meet Medicare's "core practitioner" requirements
General Compliance#202202: Identifying Compliance Problems in Your Practice Betzaida Shands, VP Regulatory Affairs/CCO, University Physicians' Associati Jerry Willis, VP of Operations & COO, University Physicians' AssociationAssessing current workflow and compliance standards
HHS (OCR, OIG) Physician Practice Roadmap
- Compliance standard implementation and beyond
General Compliance -
02:30 PM - 03:30 PMBreakout Sessions#301301: Timed Psychotherapy under the Revised CPT Construct: Looking Back on the First Year of the New Billing Standards vs the Standard of Care David Hoffman, Chief Compliance Officer/General Counsel, Carthage Area Hospital
- The new requirement for timed billing has posed a compliance and ethical challenge for Billers and clinicians alike. In this session you will learn how to honor the therapist's obligation to the patient, and the coders duty to verify medical necessity
- Learn how to conduct chart reviews that verify adequate documentation for in-person and telemedicine encounters with patients young and old, and the caregiver's perspectives that influence treatment plans and prognosis
- The session will include a discussion of the use of experts to evaluate the indication for psychotherapy in special needs populations, and the role of "informants" in guiding the clinical judgments necessary to promote high quality care
General Compliance#302302: Physician Recruitment Agreements: the Dos and Don'ts of Income Support Cathy Bodnar, Chief Compliance and Privacy Officer (Emeritus), Cook County Health James Munz, Clinical Professor, Associate Director, MHA Program, Health Adminsitration , Governors State University- Consider the regulatory environment with a focus on Stark mandates and IRS scrutiny
- Establish oversight to avoid breach; tools and protocols for eligibility and monitoring compliance
- Solutions to remain compliant through remedies and corrective actions
General Compliance -
04:00 PM - 05:00 PMBreakout Sessions#401401: Incident-To Billing: The Convergence of Access, Documentation, and the Bottom Line Lynn Myers, Chief Medical and Quality Officer, Texas Health Physicians Group
- Review Definitions adn Requirements
- Get clear on "Incident-To" vs. Direct Billing
- Learn best documentation practices to support payment at the physician fee schedule
General Compliance#402402: Can the Provider Dismiss the Patient from their Practice? Michelle Pinter, Corp Dir Medical Group Compliance, McLaren Health Care Diana Nalett, Regional Director of Operations, McLaren Medical Group- The basics in patient dismissals
- The compliance professional's role and the role of other staff members
- How to handle patient dismissals once approved or denied
General Compliance -
05:00 PM - 06:00 PMNetworking Reception
Tuesday, October 29
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08:30 AM - 09:30 AMHHS Cybersecurity Top Threats and Best Practices Christopher Gibson, Manager, Information Security, Indiana University Health -The 405(d) task group was convened by HHS, comprised of over 150 information security officers, privacy experts, medical professionals, and industry leaders, to strengthen the healthcare and public health cybersecurity posture
-In January of 2019, the group produced applicable and voluntary guidance that seeks to cost effectively reduce cybersecurity risk
-This session will provide users with a working knowledge and resources to address the top 5 threats and 10 best practices for mitigating those threats in small, medium and large healthcare organizationsGeneral Session -
09:30 AM - 10:30 AMLessons Learned from Recent Physician Practice Enforcement Actions Anna Grizzle, Partner, Bass, Berry & Sims PLC Shannone Raybon, Managing Counsel, CareSpot - Review of recent enforcement actions, including billing/coding and compensation arrangements, as hypotheticals to understand potential issues and lessons learned from the settlements - Discussion of potential individual liability physicians and other leaders of physician practices can face and recommendations for obtaining buy-in by thought leaders on the compliance initiatives to prevent enforcement actions - Practical tips for operationalizing lessons learned into physician practice compliance programs, including suggestions for training, auditing/monitoring options, and recommendations for correcting identified issuesGeneral Session
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11:00 AM - 12:00 PMBreakout Sessions#501501: DEA Compliance Bootcamp 101 with Case Studies Dennis Wichern, Partner, Prescription Drug Consulting
- Learn what triggers a DEA audit and what investigators are seeking when they visit a hospital, medical office or pharmacy
- Recognize important and recurring opioid risk areas by a review of multiple case studies involving hospitals, pharmacies, and prescribers
- Learn practical strategies and tips to reduce opioid risk at your medical organization while complying with federal law
General Compliance#502502: CMS Audit Success: Prescriber Oversight and Documentation Strategies Michelle Rigby, Director, Life Point Health Crescent Moore, Senior Consultant, BluePeak Advisors- Overview of CMS Audits and how Prescribers are impacted
- Recent changes in Medicare Guidance: What does that mean for Prescribers and how will these changes impact Prescriber documentation and oversight?
- How should Plans and Prescribers interact to be more compliant
General Compliance -
12:00 PM - 01:00 PMNetworking Lunch Lunch providedNetworking
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01:00 PM - 02:00 PMBreakout Sessions#601601: Evolution of Monitoring Tools in Physician Practice to Identify Risk Valerie Cloud, Chief Compliance Officer, Summa Health
- Design and implement tools that monitor risk in practice
- Develop computer based training and education on data analytics
- Share lessons learned on the improved experience from the physician practice constitutes
General Compliance#602602: Identifying Unexpected and Practice-Saving Clinical Risk Exposures: A Case Study Donna Nicholson, VP Risk Management, Curi - A Medical Mutual Co.- Using insights from a recent comprehensive clinical and operational risk assessment, this session will review unexpected risks and inconsistencies identified for a multi-location and multi-specialty healthcare organization
- Learn how to identify common areas of clinical and organizational risk and changes that can help ensure compliance -Take away risk management advice and processes to consider in the ever-shifting landscape
General Compliance -
02:15 PM - 03:15 PMBreakout Sessions#701701: Integrity without Ignorance Eric Christensen, Director of Client Services, Healthcare Compliance Pros
- Learn how to educate staff in a process of honesty and accuracy with patient care, billing, coding, and with interpersonal relationships with co-workers and patients
- Understand how to address and report breaches, and how these are learning opportunities for your practice
- Educate yourself to be a leader in regard to whistleblowers and compliance hotlines
General Compliance#702702: Compliance in a time of crisis Dave Wortman Ron Pelletier, Founding Partner, Pondurance- In 2018, Hancock Health in Greenfield, IN was the victim of a cyberattack and ransom that took down their EHR, internet service, patient portal and email for four days. Two companies, Diagnotes and Pondurance, helped Hancock through the crisis
- Company founder and CEO Dave Wortman will explain why Diagnotes, a secure, HIPAA-compliant clinical communication platform, was not affected by the attack and how Hancock’s providers used Diagnotes to coordinate care and share system-wide crisis updates
- Ron Pelletier, the founder of Pondurance, will detail how his firm identified the point of entry for the attack, closed it down, worked with the FBI to help Hancock navigate the tricky Bitcoin ransom negotiations, and restored all systems
General Compliance
Agenda subject to change.
Session Levels:
All sessions have a knowledge level associated with them, these levels are just guidelines and you are free to attend sessions of any level.
Basic: Program knowledge level most beneficial to Compliance Professionals new to a skill or an attribute. These individuals are often at the staff or entry level in organizations, although such programs may also benefit a seasoned professional with limited exposure to the area.
Intermediate: Program knowledge level that builds on a basic program, most appropriate for Compliance Professionals with detailed knowledge in an area. Such persons are often at a mid-level within the organization, with operational or supervisory responsibilities, or both.
Advanced: This level focuses on the development of in-depth knowledge, a variety of skills, or a broader range of applications. Advanced level programs are often appropriate for seasoned professionals within organizations, and professionals with specialized knowledge in a subject area.