Medicare Overpayments Final Rule: Analyzing Compliance for Revenue Integrity -
Thursday, July 14, 2016
Judith L. Kares, JD, Esq.
Robert Wade, JD, Esq.
The Medicare overpayment final rule will put many hospitals at risk of noncompliance. It will test hospitals’ due diligence processes and formalize CMS’ expectations of financial transparency and efficient internal audits. Hospitals can use the final rule to analyze billing, coding, and compliance; identify chronic risk areas; and protect revenue integrity. However, the rule is complicated by the six-year lookback period, confusion about when and how CMS expects overpayments to be identified and returned, and the timing of the 60-day reporting period.
Managers and staff across compliance, health information management, and the revenue cycle must be able to identify overpayments and analyze the impact of the final rule on their hospital to ensure compliance, minimize lost revenue, and avoid penalties.
During this on-demand program, expert speakers Judith L. Kares, JD, Esq., and Robert Wade, JD, Esq., will discuss how to identify and report overpayments in a timely and acceptable manner, understand the consequences and key requirements, define staff roles and key terms so hospitals can hit the 60-day timeline, and identify acceptable options for overpayment reporting.
At the conclusion of this on-demand program, participants will be able to:
- Understand the purpose and key requirements of the Medicare overpayment final rule
- Describe the relationship of the overpayment final rule to other statutory and regulatory requirements
- Define the standard and applicable time frames for identification of an overpayment and how to report and return overpayments
- Analyze the benefits of compliance and risks of noncompliance
- Create processes to ensure compliance and reduce overpayments
- Overpayment final rule
- Define key elements and important terms
- Identify deadlines
- Analyze the impact of the six-year lookback period
- Identify overpayments
- Audit and review for potential overpayments
- Evaluate and create due diligence protocols
- The impact of deadlines on reporting time frames
- How to return overpayments
- Compare the overpayment final rule to related regulations and statutory requirements
- CMS Self-Referral Disclosure Protocol
- Section 6402(a) of the Affordable Care Act
- OIG Self-Referral Disclosure Protocol
- Section 1128J(d) of the Social Security Act
- Anti-kickback statute
- How the final rule simplifies the reporting process
- Benefits of compliance and the risks of noncompliance
- The advantage of a self-regulating system
- How the final rule improves processes and reduces administrative burden, legal risk, and financial risk
- Evaluate the consequences of noncompliance
- Processes for success
- Identify and analyze the impact on affected areas
- When to use internal or external resources
- Key staff in the compliance process
- Track and resolve high-risk areas
- Improve internal audits
- Q&A (not live)
Who Should Attend
- Compliance officers
- Financial staff
- Internal auditors
- Utilization review
- General counsel
- Physician organizational managers
(Live + On-Demand) This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. (Ability to claim CEH’s for this webcast expire on: 7/31/2017)
(Live and On-Demand) This program has been approved for 1.5 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. (Ability to claim CEU’s for this webcast expire on: 7/13/17)
Meet the Speaker
Judith L. Kares, JD, Esq., is an expert in Medicare rules and regulations and is an instructor for HCPro's Medicare Boot Camp—Hospital Version®. She spent a number of years in private law practice, representing hospitals and other healthcare clients, and then served as in-house legal counsel for two large third-party payers. For the past 20 years she has continued to provide legal and related compliance services on a consulting basis. These services include development of strategic compliance programs; establishment of baseline risk assessments; creation of appropriate compliance documents (e.g., codes of conduct, corporate policies and procedures); creation of reporting mechanisms; development of training and communication plans, including related materials; compliance reviews and audits; research and advice regarding specific risk areas; and development of corrective action plans.
Robert Wade, JD, Esq., concentrates his practice in representing healthcare clients, including large health systems, hospitals, ambulatory surgical centers, physician groups, physicians, and other medical providers. His expertise includes representing clients with respect to the Stark Act, the anti-kickback statute, the False Claims Act, and the Emergency Medical Treatment and Active Labor Act. He is nationally recognized in all aspects of healthcare compliance, including developing, monitoring, and documenting effective compliance programs. He currently serves as the compliance expert for the Board of Commissioners of Halifax Health, advising the hospital on all aspects of its Corporate Integrity Agreement.
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Internet: 56K or faster Internet connection (high-speed connection recommended)
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices
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