2019 Compliance Institute (CI)

  1. HCCAS and Providers: Get Paid for What You Do

    2019 Compliance Institute (CI)  | Presenter(s): D. Scott Jones  | April 09, 2019 

    • Hierarchial Coding Conditions (HCCs) capture the complexity of patient care and ensure maximum reimbursement. Are you getting paid for what you are doing?

    • CMS Risk Adjustment shifts reimbursement risk to healthcare providers through Risk Adjustment Factors and HCC capture. As Medicare plan enrollment increases, providers must meet the challenges of provider education and documentation

    • Join us to learn how Risk Adjustment, HCCs, RAFs, and the CMS Annual Miracle Cure will impact future provider, institution, and health plan compliance and reimbursement

  2. Home Health and Hospice: Enforcement Trends and Compliance

    2019 Compliance Institute (CI)  | Presenter(s): Jennifer Kildea Dewane, Kathleen McDermott, Kenny Kraft  | April 09, 2019 

    • Home health and hospice enforcement trends: Key areas of focus for audits, investigations and enforcement by the federal government

    • Behaviors that can lead to investigation and enforcement: Physician and facility relationships, marketing, sales, billing, and medical record documentation

  3. Fraud and Abuse Regulation, Compliance, and Value-Based Purchasing: The Search for Greater Alignment

    2019 Compliance Institute (CI)  | Presenter(s): Jane Hyatt Thorpe, Elizabeth Gray  | April 09, 2019 

    • Healthcare stakeholders are developing new care delivery and payment models using financial incentives to encourage healthcare stakeholders to work together to integrate care between and among providers and other healthcare organizations

    • The current legal framework was designed for fee-for-service payments where financial arrangements between and among healthcare stakeholders could encourage the overutilization of resources and inappropriately influence provider decision-making

    • This session will address potential changes to the framework that would support new care delivery and payment models while still protecting against fraud and abuse; and guidance for compliance professionals navigating this new terrain

  4. HIPAA Privacy and Social Media: How to Create a Culture of Confidentiality

    2019 Compliance Institute (CI)  | Presenter(s): Carlos Cruz, Melissa Mitchell  | April 09, 2019 

    • Attendees will hear how the explosion of social media (and smart phones) has led to increased HIPAA privacy risks. Presenters will share real world examples of breaches at other organizations originating from social media posts by employees

    • Presenters will share tactics used to create cultures of confidentiality within their respective organizations

    • Presenters will share how proactive monitoring of social media accounts has led to mitigation of potential privacy breaches and educational opportunities

  5. Labs, Recovery Homes, and Treatment Centers, Oh My! Follow Us Down the EKRA Brick Road

    2019 Compliance Institute (CI)  | Presenter(s): Tony Maida, James Cannatti  | April 09, 2019 

    • In-depth analysis of the new all-payor kickback statute, Eliminating Kickbacks in Recovery Act of 2018 (EKRA)

    • Comparison of EKRA to the federal anti-kickback statute

    • Tips for compliance strategies and risk assessment

  6. Hands On Keys Computer Lab: Computer Tips, Tricks, and Internet Hacks to Make You a More Efficient and Effective Compliance Professional

    2019 Compliance Institute (CI)  | Presenter(s): Frank Ruelas, Rachel Buchanan  | April 09, 2019 

    • How to unlock some of the unused potential of your computer using functions and tools that you may not be aware of and how these functions can increase your effectiveness in your time management efforts

    • Learn how to identify daily processes and workflows so as to identify if they may present opportunities for you to automate various tasks while also increasing the overall accuracy of your work product

    • Participate in hands on exercises during the session to make your use of the internet more productive while also learning how to maximize the use of Internet-based resources

  7. Home Health Agency: Audit Strategies and Common Red Flag Findings

    2019 Compliance Institute (CI)  | Presenter(s): Shawn Stevison  | April 09, 2019 

    • Understand types of HHA internal audits

    • Define methodology for conducting the internal audit

    • Discuss common findings

  8. How Vendor Oversight Should Lead the Charge for Contracting with a New FDR

    2019 Compliance Institute (CI)  | Presenter(s): Jennifer Justine Phillips, Tammy Sanchez  | April 09, 2019 

    • Assessing Internal Risk: Gauging similar vendors, specific needs, and breakdown of oversight program and responsibilities between the functional areas and vendor oversight and establishing oversight workflows

    • Exposure Risk of Vendor: How the risk assessment shapes your program. Involving functional areas in understanding what the vendor does (and doesn't do) for your organization and how past, present, and potential risks affect oversight responsibilities

    • Ongoing Risk: Talk. Oversee. Audit. All aspects contribute to managing successful relationships. Grooves are great, but don't let it become a rut you can't get out of. Being comprehensive without surprises

  9. Internal Audit's and Compliance's Role in Addressing Enterprise Risk: Behavioral Health

    2019 Compliance Institute (CI)  | Presenter(s): Kimberly Jordan, Lorrie Ghose  | April 09, 2019 

    • ERM Risk Identification: explanation of the process for identification and ownership of enterprise risk (includes risk assessment tools and heat maps)

    • Key Areas of Focus and Process Improvement: Collaboration with clinical, executive and front-line leadership to implement identified improvements—restraint/seclusion, face-to-face assessments, ligature risks, status individual observation, and safety

    • Governance, Execution and Sustainability: Engagement of the board in risk identification, monitoring and sustainability, redundant leadership, metrics, continuous monitoring (includes LEAN tools such as A3)

  10. Internal Investigations: Refining Your Interviewing Skills

    2019 Compliance Institute (CI)  | Presenter(s): Melissa Edson, Jackie Stemwedel, Jacki Waltman  | April 09, 2019 

    • Interviewing questions, skills, and processes

    • Investigation documentation

    • Mock interviews

  11. Investigational Device Exemption (IDE) and Humanitarian Device Exemption (HDE) Device Coverage & Billing: Compliance Insights

    2019 Compliance Institute (CI)  | Presenter(s): John Dortero  | April 09, 2019 

    • The key FDA and CMS regulations affecting IDE and HDE device use and coverage, and the corresponding roles and the responsibilities across a health system - including Compliance, Providers, IRB, Clinical Trials Office, Supply Chain, and Billing

    • Tips for how Compliance departments can promote collaboration and successful partnerships across a health system (such as education and outreach, task forces, and policy review) to reduce regulatory risk and promote system-wide compliance

    • Sample process for analyzing IDE and HDE devices as they enter a health system to help ensure compliant device usage and billing

  12. It's Time For a Revolution: Assessing the Effectiveness of Your Code of Conduct

    2019 Compliance Institute (CI)  | Presenter(s): Darrell Contreras  | April 09, 2019 

    • Review the Guidance and Effectiveness Measures related to the Code of Conduct to establish the requirements and goals for the Code of Conduct

    • Bring your Code of Conduct (or follow along) to draft new standards that provide meaningful guidance that can be remembered and recalled by employees

    • Discuss mechanisms to publicize the new standards for guidance, high visibility, and reinforcement for employees

  13. Managed Care Fraud: Enforcement and Compliance

    2019 Compliance Institute (CI)  | Presenter(s): Megan Tinker, Banjamin D. Singer  | April 09, 2019 

    • Mental Health Parity: Managing Compliance Across Commercial, Medicaid, and Duals Products

      2019 Compliance Institute (CI)  | Presenter(s): Helaine Fingold  | April 09, 2019 

      • Learn about Mental Health Parity requirements, including the most recent guidance from federal regulators, and how the rules differ for commercial, Medicaid and dual products

      • Gain insight into federal and state parity enforcement initiatives and oversight efforts

      • Discuss key issues in assessing parity, such as: Who is responsible for the parity assessment, how to address behavioral health carve outs and correctly identifying non-quantitative treatment limits

    • Navigating Privacy Requirements When Integrating Mental Health, Substance Use Disorder and Primary Care Services

      2019 Compliance Institute (CI)  | Presenter(s): Elizabeth Winchell, Kristine Preston  | April 09, 2019 

      • Successfully providing co-located and integrated services depends on timely sharing of patient information—but there is no “one size fits all” approach

      • Understanding state and federal privacy laws is key when developing an integration program for mental health, substance use, and primary care services

      • The presenters will highlight key privacy issues and share practical lessons learned from their first-hand experience with integrated services

    • Only Take a Calculated Risk: Empowering Leaders to Make Risk-Informed Decisions with a Modern Enterprise Risk Management Program

      2019 Compliance Institute (CI)  | Presenter(s): Stephen Mackey, Ashley Ferdinand  | April 09, 2019 

      • Discover the critical components for a successful Enterprise Risk Management program. These steps include crafting your charter, identifying ERM champions across your organization, and aligning with organizational strategy

      • Acquire new methods for uncovering, aggregating, and reporting on enterprise risks, your organizations's risk tolerance, and key risk indicators

      • Gain tools for evaluating the effectiveness of your Enterprise Risk Management program. Program will include lessons learned from building and implementing our ERM program. Learn from our mistakes so you don't have to make them!

    • Patient Incentives or Inducements? Avoiding Pitfalls and Managing Risks

      2019 Compliance Institute (CI)  | Presenter(s): Catie Heindel, Rita Isnar  | April 09, 2019 

      • Overview of regulatory guidance particularly in the accountable care organization/provider and managed care setting

      • Discuss operational objectives and practical considerations in administering beneficiary incentives

      • Provide examples of how to design beneficiary incentives and avoid design flaws

    • Physician Practice Enforcement Actions: Could You Be Next Year's News?

      2019 Compliance Institute (CI)  | Presenter(s): Sarah Couture, Glena Jarboe  | April 09, 2019 

      • Lessons learned from a twelve-month summary of published enforcement actions against providers and physician practices

      • Simplified approach to a risk assessment for your practice, large or small

      • Practical compliance plan development based on your risk assessment

    • Physician Relationships in the Academic Medical Center Context: Anti-Kickback and Stark Law Issues

      2019 Compliance Institute (CI)  | Presenter(s): Amy Joseph, Christopher Collins  | April 09, 2019 

      • Discuss application of kickback and physician self-referral (Stark) laws to academic medical centers in the clinical care context and beyond, including with respect to engagement in medical education and research

      • Review recent developments in anti-kickback and Stark laws and apply evolving legal standards to various hypotheticals

      • Identify practical strategies to mitigate risk, including tips for preparing physician agreements, monitoring and auditing compliance with agreements and applicable policies, and addressing fair market value and commercial reasonableness

    • Protecting the Bottom-line: Defending Claims with Policies & Procedures

      2019 Compliance Institute (CI)  | Presenter(s): Renee Blomme  | April 09, 2019 

      • Risk and claim management evolve through claims identification, investigation, discovery, mediation, and resolution. Learn how to achieve excellence by establishing standard policies, protocols, and procedures to guide your claims management process

      • Discover how modernizing your policy and procedure management platform enables the ability to verify staff have reviewed the most current policies, helps you easily and effectively defend claims and aids accreditation with easy access to approved policies

      • Learn how to eliminate liabilities by streamlining your healthcare claims management activities and reducing operational spending with digital policies and procedures easily accessible to all staff and dynamic workflows enable easy policy maintenance

    • Real-World Strategies for Identifying, Measuring, and Reporting Risk

      2019 Compliance Institute (CI)  | Presenter(s): Betsy Wade  | April 09, 2019 

      • Learn how to refine your risk management process so it not only involves the right people, information, and implementation, but also conveys the importance and impact to your business decision makers

      • Discuss how to quantify business risk exposure and think like your CEO so you can get buy-in from your leadership team

      • Understand common barriers to success and how to overcome them

    • Responding to Government Investigations and Compliance Matters

      2019 Compliance Institute (CI)  | Presenter(s): Lauren Marziani, Kirk OGrosky  | April 09, 2019 

      • Learn what investigative tools are used by DOJ and HHS-OIG to initiate different types of investigations

      • Understand the obligations of legal and compliance officers throughout an investigation

      • Best practices for addressing governmental investigations from hold notices document collection and production, internal investigations, and resolution

    • The Spyware Nightmare

      2019 Compliance Institute (CI)  | Presenter(s): Regina Verde, Erin Trost  | April 09, 2019 

      • A spyware incident revealed itself when the FBI notified us of suspicious criminal activity. How would you respond if one of your providers was accessing your health system, unaware of the presence of malware?

      • We will inform attendees on the activation of data breach response procedures, the investigation and forensic review, analysis of patient data at risk, public breach notification and communications, and corrective actions taken

      • At end we will discuss steps a healthcare organization should take once a malware breach is suspected or has been determined, and how to protect your organization from these types of attacks. We will also reveal our most beneficial lessons learned

    • The CI Is Over: Now What?

      2019 Compliance Institute (CI)  | Presenter(s): Frank Ruelas  | April 09, 2019 

      • Attendees will perform a self assessment using the 5WH1 model to identify next steps on actions to take once they arrive back at their own organizations

      • Compliance professionals will share with one another what they see as the most effective options to exercise within their organizations to show that their time and resources spent in attending the Compliance Institute was a sound investment

      • Strategies will be discussed and those interested will have a chance to participate in an ongoing support group to help them stick to their action plans that are based on what they learned while attending the Compliance Institute

    • Telehealth or TeleHELL? Understanding the Complexities of Telehealth Beyond the Initial Set Up

      2019 Compliance Institute (CI)  | Presenter(s): Tonja Wise  | April 09, 2019 

      • We know what the basic rules are. Now what?? Understanding the complexities of consents, record sharing and more!

      • State Lines: Dare I cross them? Understanding more about how Telehealth is impacted by state borders

      • Is it okay if we... A comprehensive look at some of the strangest questions and answers for Telehealth operations!