Catalog Number : cca1936
Title : Developing an Outpatient Compliance Plan
Speaker : Duane Abbey

Webplay Recording Date : 11-13-2014
Webplay Price : $ 125 for two weeks viewing

Webinar Description: 

Outpatient services for hospitals represent a significant and growing percentage of services provided by hospitals. This is a high volume area with many patient encounters. The development of hospital-based or provider-based clinics has further increased hospital’s involvement in outpatient services. The Medicare payment system for hospital outpatient services is primarily APCs (Ambulatory Payment Classifications) along with the physician payment system, MPFS (Medicare Physician Fee Schedule). Both of these payment systems are quite complex and continue to evolve with changes each and every year. Making certain that a multitude of outpatient compliance issues are being addressed requires both a compliance plan and the ability to assure that compliance is being maintained.

Webinar Objectives:

• Appreciate the various requirements for all healthcare provider to have a compliance plan
• Understand the broad spectrum of compliance areas to which hospitals, systems, physicians and clinics are subjected
• Appreciate the range of outpatient services and potential compliance issues that can be encountered
• Understand the severity of current outpatient compliance issues, the auditing process, and associated penalties
• Review issues relating to RAC, OIG and Medicare audits
• Appreciate the importance of written policies and procedures for coding, billing and the Chargemaster
• Review those areas that are currently active and those that might become active
• Appreciate the need to look forward to future compliance issues including developing RAC audits
• Appreciate the need for a systematic approach to analyze, assess and take action relative to coding, billing and reimbursement issues
• Understand how an outpatient coding, billing and reimbursement program interfaces to the hospital corporate compliance plan

A few of the topics that will be covered:

• Introduction
   o Healthcare Compliance Overview
   o Importance of Understanding and Meeting Rule/Regulations
   o Statutory versus Contractual Compliance
   o Systematic Approach to Maintaining Compliance
   o Brief Review of Outpatient Services
   o OIG Audits and OIG Work Plans
   o RAC Audits
• Fraudulent Practices
   o Covered versus Non-Covered Services
   o Use of Advance Beneficiary Notices (ABNs)
   o Medical Necessity Issues
   o Proper Coding and Billing
   o Chargemaster Compliance Issues
   o Lack of Proper Physician Supervision
• Developing an Outpatient Coding, Billing and Reimbursement Compliance Program
   o Systematic Approach
   o Developing Coding and Billing Policies and Procedures
   o Establishing an Auditing Program
   o Conducting Training
• Special Areas
   o Provider-Based Clinics
   o Ambulatory Surgical Centers
   o Other
• Compliance Areas and Special Considerations
   o RAC Audit Issues
   o OIG Work Plans
   o Recent Legislation
• Case Studies

Target Audience: 

All personnel involved with coding, billing, and reimbursement activities. Chargemaster coordinators, compliance personnel, financial analysts, coding personnel, utilization review personnel, interested nursing staff, financial analysts, charge capture specialists, other interested clinical and administrative personnel. Nurses and physician are encouraged to attend

Contact Hours:

• All participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program. Completion of offering required prior to awarding certificate.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.