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In this session Mr. Wolfe will provide an overview of the Stark Law and its 2016 changes. He will also discuss best practices for implementing and auditing physician compensation arrangements to minimize liability exposure and penalties, including conducting compliance audits, instituting policies, and establishing ongoing monitoring and review processes.

Overview: This lesson is going to get back to the basics using multiple real life scenarios and "what if's". My goal is to make this very confusing and not well explained law easy to understand for the typical staff member. I will uncover myths versus reality as it relates to this enigmatic law based on over 1000 risk assessments performed as well as years of experience in dealing directly with the Office of Civil Rights HIPAA auditors. I will also point out multiple court cases I have been affiliated with where a staff member of a hospital or clinic has been sued or even imprisoned! I will also speak to real life audits conducted by the Federal government (I've been on both sides of these audits) what your highest risks are for being fined (some of the risk factors may surprise you). In addition this course will cover the highest risk factors for being sued for wrongful disclosures of PHI and the manner in which patients are now using state laws to sue for wrongful disclosures. Don't always believe what you read online about HIPAA, especially as it relates to encryption and IT, there are a lot of groups selling more than is necessarily required. Why should you Attend: Are you confused about HIPAA? Do you just want the basics and in plain English? Do you know there are civil and criminal penalties even for the rank and file staff member! Do you know what you can and can't do with protected health information? It is important to understand the new changes going on at Health and Human Services as it relates to enforcement of HIPAA for both covered entities and business associates as it relates to portable devices, texting, and emailing of PHI. You need to know how to avoid being low hanging fruit in terms of audit risk as well as being sued by individuals who have had their PHI wrongfully discloses due to bad IT practices. I have also been expert witness on multiple court cases where a business or medical practice is being sued for not doing their due diligence

Overview: Many medical entities are increasingly struggling to manage revenue effectively. Self pay is on the rise due to high deductibles. Bad debt is increasing. What is your plan to manage these areas? Staff trained in denial management? Variances? Are they handling these areas in a timely manner? Payers have time limits in which dollars can be salvaged. Missing those strategic times mean dollars lost. Don't leave money on the table. We will discuss multiple avenues in which strong training and timely action can equal $$$. Why should you Attend: Don't lose hard earned revenue. Learn tips to strategic follow up, when and how to manage the appeal process. Is the claim appealable? Partial payments and why? Today's industry of high dollar deductibles create the necessity to expend additional efforts on self-pay accounts. There is a significant difference in collecting small co-pays and managing large balances. Bad debt creep? What is your plan for managing these areas? Areas Covered in the Session: Hire the right staff - Then engage in ongoing education Variances and denial management Billing compliance Coding for specificity, co-existing conditions and correct modifiers Supporting medical necessity CCI edits and unbundling Productivity Claims follow up Payer processing edits Additional development requests Handling problem claims and appeals Who Will Benefit: Coders Billers Revenue cycle Physicians, mid-level providers Nurses Claims follow-up Managers Speaker Profile Dorothy D. Steed is an Independent Healthcare Consultant and Educator in Atlanta. She was a Medicare specialist for a large hospital system and a physician coding audit supervisor for another hospital system, with 38 years of experience in healthcare. Additionally, she is an instructor at a state technical college in Atlanta, provides auditing & training in both facility and physician services, and has been a speaker at several healthcare conferences. Ms. Steed has written articles for

HIPAA Survival Guide: The HIPAA Survival Guide is a set of practical help guides that seek to make compliance with HIPAA and HITECH easy for providers. This kit is some kind of checklist on what to keep in mind and implement to survive a HIPAA audit. The HIPAA Survival Guide was created as a need to comply with the HIPAA audit requirements. It evolved as a response to simplifying the HIPAA Privacy Rule and HIPAA Security Rule without its legal complexity. In other words, the framers of this Guide have developed this concept strictly as a guide, rather than as a legally enforceable set of rules. "Forest from the trees" approach: The HIPAA Survival Guide came into being in order to help users understand HIPAA and HITECH better. The approach the developers of this Guide adapted was what was called the "forest from the trees" way, because the aim was to help users navigate and wade through the complex text. It was aimed at helping them chaff and finesse the parts that required their compliance into simple terms. HIPAA Survival Guide is thus not a strict, legislative Act that lays down rules for conformity. No wonder, it was developed by the joint efforts of a Registered Nurse and an Attorney, who wanted to facilitate a greater understanding of the legislation's audit requirements. The basis on which this Guide came into existence was the HIPAA and HITECH background. It concerns itself with only the part of HIPAA and HITECH relating to a part of Covered Entities, namely providers. This is deliberate, since the aim of this Guide is to help small providers with guidelines aimed at simplifying their task. Important steps for HIPAA survival: The fundamental goal of the HIPAA Survival Guide is to equip providers with the knowledge of what needs to be kept in order and fine-tuned if they have to meet regulatory requirements. These are the thumb rules for the HIPAA Survival Guide: Documenting the provider's privacy, security and breach policies and revie

Overview: Hospital chargemasters are complex and represent a key component for the revenue cycle of hospitals. Chargemasters are intertwined with coding for services, billing for services, charging for services and even involve the cost reporting process. A myriad of decisions must be made concerning how the chargemaster is organized, impacts on coding and billing, charge structuring, cost accounting, and other processes within the revenue cycle. Whenever decisions are made, policies and procedures should be developed, approved and implemented. A proper system of billing and chargemaster policies and procedures can help to maintain an appropriate compliance stance in a world where ambiguous guidance is often the norm. The development of charges and charge structuring within the chargemaster is a major issue often referred to as transparent pricing. While even the Medicare program maintains that hospitals should charge for everything, the way in which charges are set and amalgamated at the claim level can vary significantly between hospitals. A key issue for the chargemaster is differentiating separately charging from separately reporting. The way in which hospitals make decisions about the bundling of charges at the line-item level within the chargemaster leads to many decisions, all of which need justification through proper policies and procedures. Due consideration must be given to departmental concerns about revenue generation, cost reporting implications, coding implications and any associate challenges with billing and claims filing. Why should you Attend: See Typical Questions - Here are some reworded marketing questions: Why are the chargemaster and hospital billing targets of compliance audits? How should we prioritize statutory and contractual compliance for the chargemaster and billing process? Will chargemaster and associated billing policies and procedures give us protection relative to compliance? How should we develop a system of chargemaster po

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