This seminar is designed for attorneys, business and office managers, nurses, health care providers, billing managers, CEOs, administrators, accountants and compliance officers.
The federal and state government and third party payors are concentrating significant resources on the prosecution of health care fraud. Health care providers and their representatives must understand the regulatory framework and the industry’s rules and policies under which they operate, as medicare and medicaid are rapidly transitioning to managed care.
Areas to be discussed include the following:
• Fraud And Abuse Overview And Update
• Compliance Programs And Risk Management
• New Jersey Regulation Of Health Care Services
• HIPAA Privacy/Security, Code Sets/Transaction Standards
8:30 a.m. - 8:40 a.m.
I. Welcome And Overview
8:40 a.m. - 10:10 a.m.
II. Fraud And Abuse Overview And Update
A. Anti-Kickback Statute
B. Stark Law
C. False Claims Act
D. New Jersey Codey Law
E. Other Federal And State Laws, Initiatives And Priorities
10:10 a.m. - 10:20 a.m.
10:20 a.m. - 11:10 a.m.
III. Compliance Programs And Risk Management Strategies
A. Development And Design
B. Compliance Audits And Operational Issues
C. Industry Specific Compliance Guidance
D. Advisory Opinions
E. Dealing With Audits And Internal Investigations
F. Voluntary Disclosure
G. Practical Issues Facing Compliance Officers
11:10 a.m. - 12:00 p.m.
IV. New Jersey Regulation Of Health Care Services
A. Certificate Of Need
B. Licensing Of Facilities And Providers
C. HMOs And Other Third Party Payors And Networks
D. Prompt Pay Legislation
12:00 p.m. - 1:00 p.m.
Lunch (On Your Own)
1:00 p.m. - 2:20 p.m.
IV. New Jersey Regulation Of Health Care Services (Continued)
E. Contractual Constraints
F. Coordination Of Benefit Issues
G. Medical Screening And Diagnostic Testing Offices
H. Surgical/Anesthesia Standards For Medical Offices
I. Corporate Medical Practice And Fee-Splitting
J. New Jersey Medical Records Issues
2:20 p.m. - 2:30 p.m.
2:30 p.m. - 4:30 p.m.
V. HIPAA Privacy/Security, Code Sets/Transaction Standards
A. HIPAA Privacy Overview
B. HIPAA Security Overview
C. HIPAA Code Sets And Transaction Standards Overview
D. Frequently Asked Questions And Government Guidance
E. The HIPAA Privacy Deadline Has Passed: Now What?
F. Practical Considerations And Advice