AUDIOCONFERENCE ON TAPE OR CD
Sponsored by Compliance Officer's Handbook
presented on January 31, 2007
CMS is serious when it comes to outlier payment abuse.
In 2006 alone, healthcare providers paid more than $1 billion to settle civil false claims cases related to Medicare outlier payments. What’s more, outpatient outlier payments are included in the 2007 OIG Work Plan—reinforcing that outpatient outlier payments represent a critical area for compliance review.
Listen to OIG’s former Director of Program Investigations Jim Kopf and Medicare billing expert and healthcare lawyer Hugh Aaron for our 90-minute audioconference Outpatient Outliers: Strategies to Ensure Compliant Payments.
Our experts will explore the practical implications of the recent outlier case settlements, explain the types of charging, billing and cost-reporting practices that can result in allegations of outlier abuse, and provide recommendations on how hospitals can avoid becoming the target of an enforcement action relating to outlier payments.
TAKE A LOOK AT OUR AGENDA
- Presentations
- What are outpatient outliers and how do they differ from inpatient outliers?
- CMS’s outpatient outlier payment methodology
- How outlier payments are calculated
- How the hospital’s charge structure and cost-to-charge ratio affects outpatient outlier payments
- How packaged charges affect the outpatient outlier calculation
- Recent inpatient outlier cases and the impact of those cases on outpatient outlier compliance
- The 2007 OIG Work Plan—Why is the OIG looking at outpatient outliers and what is the OIG looking for?
- Strategies for obtaining appropriate outpatient outlier payments while remaining in compliance with CMS/OIG requirements applicable to outpatient outliers
- Performing an outpatient “cost-to-charge review” for your hospital
- Performing an outpatient “outlier payment percentage review” for your hospital
- Techniques for minimizing allegations of inappropriate charge levels
- Techniques for ensuring the accuracy of your hospital’s outpatient cost-to-charge ratio
- How time-based charges (and other “surgical package” charging methodologies) could result in inappropriate outlier payments
II.Q&A
LEARNING OBJECTIVES
At the end of this program, you will:
- understand how to set charges in a way that minimizes allegations of inappropriate charge levels
- understand how to avoid inaccuracies in your hospital’s outpatient cost-to-charge ratio that could result in inappropriate outpatient outlier payments
- understand how to perform an outpatient “cost-to-charge review” and an outpatient “outlier payment percentage review” to identify potentially inappropriate outpatient outlier payments
- understand why your hospital may want to transition from time-based/surgical package charges to procedure-based charges in order to minimize potential outpatient outlier overpayments
FEATURED SPEAKERS
Hugh E. Aaron, MHA, JD, CPC, CPC-H, is the Senior Vice President for Compliance and Regulatory Affairs/Regulatory Counsel with HCPro, Inc. Prior to joining HCPro, Mr. Aaron practiced health law for approximately 13 years. He was also the founder and president of HRAI Coding Specialists, LLC, a national coding and billing training firm. Mr. Aaron's work focuses primarily on coding and billing accuracy with a particular emphasis on Medicare billing compliance. He has also held a variety of management positions within the health care industry. Mr. Aaron was the original developer of the Certified Coder Boot Camp® – Original Version, the Medicare Boot Camp® – Hospital Version, and the Medicare Boot Camp® – Professional Services Version courses, now offered by HCPro.
James Kopf is the President of Healthcare Oversight, Inc., a solution-driven company concentrating on health care issues and problems confronting both the public and private sector of the health care community. Mr. Kopf's prior experience includes 26 years as a Federal law enforcement officer with the Office of Inspector General, U.S. Department of Health and Human Services, and the Federal Bureau of Investigation. Mr. Kopf was Director of the Program Investigations Branch for the Office of Investigations, Office of Inspector General.
BONUS MATERIAL INCLUDED IN YOUR MATERIALS PACKET!
In addition to the expertise and advice presented during this audioconference, you'll also receive a slide presentation of the program materials and tools, relevant CMS guidance documents and copies of the actual Department of Justice settlement documents from the Tenant and St. Barnabas Cases. These materials are provided with PDF links.
WHO SHOULD LISTEN?
- Compliance Managers/Staff
- Revenue Cycle Managers/Staff
- Chargemaster Managers/Staff
- Billing Managers/Staff
- Auditors
- Finance and Reimbursement Managers/Staff
- HIM Managers/Staff
- CFOs and Legal Counsel
Purchase a tape or CD of the program and listen when you can. It's a perfect training tool for new staff or as a refresher for veteran staff.
Save money when you purchase multiple copies! Ask your customer service representative about money-saving
discounts and bulk orders. Call toll free 800-650-6787 or e-mail
customerservice@hcpro.com.
