MONDAY, OCTOBER 10
10:20 A.M. - NOON
WORKSHOP SESSIONS A - E
A
JCAHO: Compliance Implications for Auditors
This session will describe
how our internal compliance department performs focused audits
at community and tertiary hospitals to determine compliance
with the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) standards that refl ect Medicare’s conditions
of participation. Requirements such as the national patient
safety goals, emergency services, discharge planning, and
medical staff credentialing will be discussed. Audit tools
and suggestions will be provided to identify non-compliance,
track corrective actions and maintain a state of readiness.
This is a timely topic as JCAHO agreed, in July 2004, with
the proposal to develop legislative language that would make
the Joint Commission’s hospital accreditation program
specifi cally accountable to the federal government for deemed
status purposes to be a Medicare provider.
Deliverables :
1. Learn risk areas targeted for audit in JCAHO surveys.
2. Discuss documentation requirements specifi c to standards
discussed.
3. Discuss methods to audit and determine compliance with
standards.
4. Take away tool for auditing specifi c JCAHO standards that
crossover to Medicare conditions of participation.
Level: Intermediate
Instructors: Sandra L. Sessoms, RN, CPHQ,
Director, System Compliance and Robert R. Michalski, CHC,
Vice President, System Compliance, West Penn Allegheny Health
System
B
Auditing Surgical Claims
This seminar will expose the
beginning medical auditor to different methodologies for billing
surgical claims and to strategies for auditing those claims.
Deliverables :
- Review examples of various facility
surgical billing methodologies.
- Determine the compliance status of these
billing strategies.
- Learn how to audit different strategies.
- Take-away audit forms and compliance
references.
Level: Basic
Instructor: Mary Jane LaBelle, RN, CMAS,
President, L&H Associates, Sixes, OR
C
An Affair to Remember: Compliance and
Internal Audit Working Together to Audit the Revenue Cycle
The speakers will share best practices
and lessons learned from their personal experience collaborating
on revenue cycle auditing at Seattle Children’s Hospital.
Participants should have a basic knowledge of the revenue
cycle, as concepts will only be briefl y covered. Included
in the discussion will be pros and cons of the collaboration
model, techniques for overcoming communication barriers, best
practices, hands-on tools, and lessons learned.
Sessions Deliverables:
- Gain a clearer understanding of the
roles of the Corporate Compliance Auditor and the InternalAuditor
as they apply to revenue cycle auditing.
- The collaborative model of auditing
the revenue cycle will be shared. Model can be applied toother
audits, as well.
- Techniques for overcoming communication
barriers and best practices and lessons learned will be
shared.
- A sample audit tool for revenue cycle
auditing will be provided.
Level: Intermediate
Instructors: Pru Arnquist, RN, BSN, CHC,
Corporate Compliance Manager and Ann Marie Davis, CPA, Director
of Internal Audit, Children’s Hospital and Regional
Medical Center, Seattle, WA.
D
Building the Foundation of Your Internal
Audit Practice
This workshop will take the
auditor through the various steps of the auditing process
using a cash/ change fund audit as an example. The speaker
will review each step of the process in detail suffi cient
for the auditor to return to their shop and, after minimal
customization, execute the audit. In particular, the preliminary
survey, development of scope and objectives, the kickoff meeting,
audit program development, audit testing, audit reporting
and the closing meeting will be addressed. Sample documents
will be provided for each attendee.
Deliverables:
- Overview of the audit process.
- In-depth look at each step of the audit
process.
- Real-world examples to illustrate the
concepts; various “lessons learned”.
- Sample documents, including an ICQ,
an audit program, and an audit report.
Level: Basic
Instructor: Jean Lambert, BSN, Manager, Internal Audit Services,
Froedtert Hosp., Milwaukee, WI
E
Trends in Healthcare Internal Audit
KPMG will present a summary
of the results of the 2005 AHIA Survey, emphasizing the trends
and changes in internal audit management, work scope and governance
from the prior year’s survey. This session is an excellent
opportunity to learn what you should be auditing because much
of the session will be devoted to the focus areas for audit
plans.
Level: Basic
Instructors: Bill Hannah, Principal, Audit,
KPMG, Atlanta, GA and Kelly E. Styles, RN, Ph.D., Managing
Director, KPMG, Los Angeles, CA
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MONDAY, OCTOBER 10
1:20 - 3 P.M.
WORKSHOP SESSIONS F - J
F
Clinical Trails: What Are the Risks and
How Do You Audit the Risks?
Clinical trials pose signifi cant risks to your organizations.
Learn how you can help your organization ensure that human
subjects are protected; that there are appropriate fi nancial
controls to meet regulatory and accounting requirements; and
that drugs and devices provided in a clinical trial are billed
(or not billed) appropriately to Medicare and other third-party
payors. This session is designed specifically for auditors
without a clinical background.
Deliverables :
- Gain an understanding of laws and regulations designed
to protect the rights and welfare of human subjects.
- Gain an understanding of the necessary fi nancial controls
and reporting related to clinical trials.
- Gain and understanding of the laws and regulations for
billing drugs and devices provided in a clinical trial to
Medicare and other third-party payors.
- Audit tools and templates designed to assess the risk
areas listed above. Level: Intermediate
Instructors: Amy Greenhoe, Manager, Audit
Services and Mary O’Neill, Manager, Organizational Integrity,
Trinity Health, Farmington Hills, MI
G
Keeping Narcotics Safe
This session focuses on how
to keep your narcotics safe through controlled substance audits,
and monthly audits of Pyxis withdrawals to documentation on
the MAR (medication administration record). Discussion will
cover common observations, recommendations and strengthening
tools.
Deliverables :
- Audit plan for narcotics audits.
- Sample narcotic review documents.
- Monthly narcotic review record used
by nurse managers to track narcotic activity on their units.
Level: Experienced
Instructor: Diane L Stanesic RB, BSN, CORN,
Medical/Internal Auditor, Children’s Hospital of Pittsburgh,
Pittsburgh, PA
H
Documenting Revenue Cycle Processes for
Optimization and Section 404 Compliance
This session will provide a
brief overview of control frameworks and Sarbanes-Oxley Section
404 controls documentation, including a review of various
approaches available for not-for-profi t and public companies.
It will address how to leverage Section 404 year-one documentation
and testing of controls to optimize the Revenue Cycle. It
will show how COSO and CobIT work together to create process
optimization and provide tools for continuing improvement
in processes, updating documentation, and controls testing.
Deliverables:
- How to manage SOX controls and frameworks
to get more value.
- Decision criteria for choosing controls
methodology for process optimization.
- Examples of Revenue Cycle leakage reduction
using a controls approach.
- Key Revenue Cycle areas for process
improvement.
Level: Intermediate
Instructor: Lawrence, Lake, Managing Director,
Protiviti, Chicago, IL
I
Effective Communications
Diplomacy has been called the
art of telling people to go to “hell” in a way
that they actually look forward to the trip. We don’t
advocate telling your customers, suppliers, co-workers or
bosses where to go, but this workshop by Barry Maher shows
you how to diplomatically and tactfully get what you want
and have people to look forward to whatever trip you’d
like them to take.
You’ll discover:
- The single most successful strategy
for building and improving relationships.
- How to avoid costly and embarrassing
misunderstandings.
- Small difference that can make a big
difference in your communications.
Level: Basic
Instructor: Barry Maher, Barry Maher &
Associates, Helendale, CA
J
OIG Work Plan Review
This session will present
an overview of the Offi ce of Inspector General annual workplans
and associated topics such as recurring workplan issues, the
relationship between workplan issues and investigational activities,
compliance issues for the sectors of the healthcare industry,
and using the workplan to guide compliance auditing. Participants
will get a prospective “look into” the OIG 2006
Workplan issues.
Level: Basic
Instructor: Michael T. Myers, Jr., MD, MBA,
Principal, MDXcel Consulting, Boston, MA
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MONDAY, OCTOBER 10
3 - 5 P.M.
WORKSHOP SESSIONS K - O
K
The Obligation to Make
Refunds and Do Retrospective Reviews
The presentation will provide an overview of federal
and state laws and rules relating to voluntary disclosure
to third party payors (including OIG Voluntary Disclosure
Protocol). It will provide a detailed and practical analysis
of the steps that should be considered and taken when making
a refund or disclosure.
Deliverables:
- A plain English understanding of the
laws and rules that govern voluntary disclosures and refunds.
- A detailed strategy for making voluntary
disclosures and refunds, including how and when to do retrospective
reviews and how to make the actual refund.
- Identification of issues and concerns
that must be considered in deciding whether or how to do
a voluntary refund.
Level: Intermediate
Instructor: Steven J. Chananie, Partner,
Garfunkel, Wild & Travis, P.C., Great Neck, NY
L
Tuning In to Medical
Auditor Challenges
Presented in roundtable format, the session moderator
will lead an open discussion of the issues and challenges
medical auditors face every day. Some potential discussion
topics are negotiating with an outside insurance auditor,
chargemaster maintenance, coding – CDM or HIM, and improving
the bottomline. Tools (e.g., audit, chargemaster, and other
policies) applicable to the topics will be shared. Topics
of interest will be solicited from early registrants before
the conference.
Level: Basic
Instructor: Margie Ackermann, Revenue Integrity
Manager, SSM Cardinal Glennon Children’s Hospital, St.
Louis, MO
M
Outpatient Revenue
Opportunities Using CAATS
This session will focus on computer assisted auditing
techniques (CAATS) proven successful in assessing operational
departments charge capture processes and identifying potentially
missed charges. Specific operational areas addressed will
be Emergency Room, Cardiac Catherization, Electrophysiology
Lab, Interventional Radiology, Surgery, and Maternity. Additionally,
the CAAT testing used to gauge the completeness and accuracy
of the Charge Description Master (CDM) will be presented.
Discussion of initial information gathering, CAAT exception
reporting, potential exception resolution techniques, and
“success stories” will be included.
Deliverables:
- Successful techniques and real-life
experiences.
- Sample Data Request: Sample of the memorandum
that details the required data fi elds.
- Questionnaires: Documents used to gather
information about the department being tested in order to
tailor the testing.
- Charge Pairings: A document that details
testing criteria performed.
Level: Intermediate
Instructors: Terri L. Allen, CIA, Manager,
CAAT and Angelique S. Hemstreet, CIA, Manager, CAAT, CHAN
Healthcare Auditors, Little Rock, AR and Allen, TX, respectively
N
Coding 101: Basics
for Coding in the Physician Setting
Participants will learn how physicians are reimbursed
through the assignment of diagnostic ICD-9 CM codes and Evaluation
& Management CPT codes. The session will cover basics
of the coding process, including CMS mandated guidelines and
provide information on manuals, guidelines and other resources.
Deliverables:
- Most commonly used ICD-9 codes for Primary Care.
- Criteria tool for Evaluation and Management codes.
Level: Basic
Instructor: Deborah Kuehn, CPC, CRS, Senior
Corporate Coding Education Specialist, Ardent Health Services,
Nashville, TN
O
Fraud Detection and
Investigation
This workshop will discuss elements of fraud investigations
from initial notifi cation to detailed investigatory and interview
techniques to prosecution. Reference information such as fraud
“red fl ags”, the common types of fraud and how
to identify them, and specifi c audit techniques used to audit
these items will be presented. Other reference information
useful to auditing fraud such as industry web sites, professional
organizations, and the like will be reviewed. Several real-life
case studies will be discussed throughout the presentation.
Deliverables:
- ”The Red Flags of Fraud”
will identify typical “red fl ags” or indicators
that might contribute to or indicate the presence of fraud.
- ”Identifying the Various Types
of Fraud” will enumerate the common types of crimes
that fall into the broad category of fraud and will briefl
y explain each of the types.
- ”Test Your Fraud Detection Skills
– Case Studies” will present a few case study
questions (and answers) to allow the participant to have
hands-on practice in reviewing some prepared data.
Level: Intermediate
Instructors: John Pancari, Jr., Director,
Internal Audit, West Penn Allegheny Health System, Pittsburgh,
PA
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TUESDAY, OCTOBER 11
10:20 A.M. - NOON
WORKSHOPS P - T
P
How to Manage Vendor
Confl icts of Interest
With recent Pharmaceutical investigations and settlements
and the Offi ce of Inspector General’s expanded attention
in this area via the Model Compliance Guidance for Pharmaceutical
Manufacturers, many healthcare organizations are concerned
that, if their physicians are involved in “inducement”
activities with vendors, they could be “caught in an
investigative net.” This session offers compliance and
audit professionals some approaches to develop pro-active
initiatives to identify, correct, and monitor potentially
risky behaviors between the provider and vendor.
Deliverables:
- Learn how to develop a confl ict of interest
disclosure program and understand some of its limitations.
- Learn about educational tactics to get
the attention of physicians and how to use your Medical
Staff Bylaws to your advantage.
- Gain knowledge on the American Medical
Association’s opinion on Ethical Opinions/Guidelines
overview, the Pharmaceutical Research and Manufacturers
of America (PhRMA) voluntary Code on relationships with
healthcare professionals and OIG Compliance Program Guidance
for Pharmaceutical manufacturers.
- Discuss techniques available to empower
your staff to question inappropriate vendor behavior and
learn how to audit and monitor vendor relationships.
Level:
Intermediate
Instructor: Bret S. Bissey, CHE, MBA, CMPE,
Chief Compliance and Privacy Offi cer, Deborah Heart and Lung
Center, Browns Mills, NJ
Q
The Complexities of
Producing “Clean Claims”
In this session, the auditor
will develop an understanding of the billing of a claim. This
course will provide insight about why clean claims will reduce
denials, increase cash, and reduce Accounts Receivable.
Deliverables:
- Definition of a clean claim
- Identification of hospital departments
involved in the billing process and the data they supply.
- The impact of CCI and OCE edits on a
claim.
- Billing data guide for the UB92 claim
with the departmental linkage and CCI and OCE edits.
Level:
Basic
Instructor: Joanne Hollett, Director, Government
Claims and Billing, SSM Health Care, St Louis, MO
R
Non-Acute Revenue Cycle
for Dummies
This session will overview the revenue cycles for
skilled nursing facilities and home health agencies and include
general discussion of the current healthcare regulatory environment
(e.g., the impact of Sarbanes- Oxley, compliance areas) related
to these revenue cycles. Participants will gain an understanding
of the data fl ows, with a focus on fi nancial and regulatory
areas of risk, and learn about actual fi ndings from recently
completed revenue cycle reviews.
Deliverables:
- Revenue cycle fl ow charts for both
the skilled nursing facility and home health business lines.
- Understanding of the regulatory environment
impacts on these areas.
- Understanding of the major areas of
fi nancial and regulatory risk.
- Suggested control procedures designed
to mitigate risk areas.
Level:
Basic
Instructor: Patrick Trotta, Sacks, Trotta
& Koppelman, Towson, MD
S
Building an Effective
Compliance Program on a Shoe-String Budget
How do you build an effective compliance program with
almost no dedicated resources? Learn how compliance and internal
audit worked together to organize staff from high-risk areas
into a collaborative team that is the workhorse of the compliance
program. This session will describe the process and tools
used for building skills in risk assessment, control evaluation,
communication and monitoring. This approach is relevant to
small audit shops and anyone with insuffi cient audit and
compliance resources.
Deliverables:
- Sample documents: Charter to defi ne
roles and responsibilities, monthly meeting agendas
- Tools: Publicized Risks worksheet, risk-control
matrix, compliance plan template
- See the link between the OIG compliance
program guidance (seven elements) and the COSO components
of internal control
- Learn how the standards of Sarbanes-Oxley
Section 404 are being applied to compliance internal controls.
Level:
Basic
Instructors: Susan Coombes, MA, CPHQ, Director
of Regulatory Compliance, and Joyce L. Lang, CPA, CIA, Director,
Management Audit Services, Legacy Health System, Portland,
OR
T
Hot Topics In Foreign
Outsourcing: How Can My Healthcare Organization Avoid Getting
Burned?
With increased pressure to keep costs down, US healthcare
organizations are increasingly outsourcing important functions
to foreign companies. What are the pitfalls (both contractual
and regulatory) to this increasing trend? Learn about this
growing trend through an in-depth study of how such arrangements
are structured, the outsourcing contract, and how to address
issues that can burn your healthcare organization.
Deliverables:
- A sample outsourcing contract with a
foreign vendor.
- Anatomy of a foreign outsourcing contract
– We will dissect the foreign outsourcing contract
and the provisions frequently negotiated, and suggest alternatives
for a healthcare organization when entering into an outsourcing
relationship.
- Practical Pointers. We will provide
a list of pitfalls to avoid with suggested solutions and
contract language.
Level:
Experienced
Instructors: Michael F. Schaff, Esq. and
Peter Greenbaum, Esq., Attorneys. Wilentz, Goldman & Spitzer,
Woodbridge, NJ
TUESDAY, OCTOBER 11
1:20 - 3 P.M.
WORKSHOPS U - Y
U
Legal Insight: What
to do When the Government Comes Calling
What should you do when an audit letter arrives from CMS,
the OIG or your fi scal intermediary? Suppose agents show
up at your door? These actions frequently catch healthcare
providers completely by surprise. The government can cut off
or delay Medicare reimbursements, causing severe fi nancial
hardships that have resulted in providers closing their businesses
altogether. It is extremely important for providers to be
well versed in the issues and laws surrounding the issues.
Know your rights! Equally important, know what strategies
work – and which lead to trouble! Clear, practical insight
is the goal of this session.
Deliverables:
- Learn what the government is allowed
to do – and how to fight back.
- Learn what red fl ags may trigger scrutiny.
- Understand what you should do when agents
show up for an inspection or investigation.
- Understand compliance programs and other
proactive solutions.
Level: Basic
Instructor: Neil B. Caesar, President, Health
Law Center, Greenville, SC
V
Cardiac Cath and Interventional
Radiology
This session will delve into the defi nitions, rules,
hierarchies and other elements that comprise the foundation
for accurate and regulatory compliant coding in the Cardiac
Cath Lab and Interventional Radiology. Specifi c coronary
procedures, such as heart catheterization, artherectomy and
stenting, along with their unique coding challenges will be
spotlighted. Real-life clinical examples will be used throughout
the session to aid the learning process.
Deliverables:
- 2005 CPT codes for diagnostic and therapeutic radiology,
from head to lower extremity procedures.
- The proper application of evaluation and management (E&M)
codes in the cardiac cath lab and invasive radiology areas.
- Detailed guidance for proper coding of non-cardiology,
invasive radiology diagnostic and therapeutic procedures.
- Differences in coding and billing for Medicare versus
non-Medicare patients.
Level: Intermediate
Instructor: Bernie VanSomeren, BS, RT, Senior
Healthcare Consultant, Medical Learning Incorporated, St.
Paul, MN
W
Denials Management and
Auditing Managed Care Denials
Managed Care contracts contain certain and sometimes specifi
c requirements in regards to claim approval and payment. When
these terms and conditions are not followed or inappropriate
and unreasonable payor conditions exist, the healthcare provider
may note certain types of claim denials. This presentation
will take a top-level look at the contract language, policies
and procedures behind denied claims, and present an approach
to adequately audit, recover and stop inappropriate denials
from occurring. A case study review will be completed highlighting
a best-practice approach to denial management.
Deliverables:
- Audit program approach to rapid assessment and quantifi
cation of denials and denial management opportunities.
- Detailed understanding of the types of denials and plausible
causes.
- Assessment of contract language responsible for claim
denials.
- Case study from Adventist Health System.
Level: Basic
Instructor: Todd Anderson, Regional Director,
Adventist Health System and Executive Director, Adventist
Health Network, Hinsdale, IL
X
Chart Auditing 101
Healthcare billing compliance continues to be a focus on both
government and private payers. The OIG’s
Compliance Guide recommends self-audit as an important step
in ensuring proper billing and coding
practices. This workshop will discuss how to conduct a medical
record documentation audit, methodologies
for selecting the sample and results that we may expect to
fi nd.
Deliverables:
1. Evaluation and Management Audit Utilization Template.
2. Billing and Coding Policies checklist.
3. Specifi c Coding and Risk Areas Checklist.
4. Focused chart audits based on the OIG Work Plan.
Level: Basic
Instructor: Shelly Asbury, RMA, LM, CCS, CCS-P, CMRS, Senior
Corporate Coding Education Specialist,
Ardent Health, Nashville, TN
Y Tools for Managing Healthcare Change
The core tools of managing change in healthcare organizations
can help people discover what they need to
know, refi ne and digest that knowledge so that they can turn
it into judgment, turn judgment into budgets,
actions and behaviors, and share discoveries and abilities
so other people can learn from them. Knowledge
management, sense-making, competency transfer – these
are the key tools of the new millennium. This
session presents the nuts-and-bolts of knowledge management,
sense-making, and competency transfer.
Deliverables:
1. How these tools work.
2. How you can use the tools at your organization
3. What are the next steps and the key steps after that
4. What are leading healthcare organizations doing and what
works and what doesn’t
Level: Intermediate
Instructor: Janet I. Guptill, President, KM At Work, Inc.,
St. Louis, MO and Joe Flower, CEO, Imagine
What If, Inc., Ft. Bragg, CA
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