Conference Materials (Password Required)

This session will focus on the top “target areas” for 2023 from the OIG/CMS. We will cover the False Claims Act, Split/Shared Services, Incident-to and Evaluation & Management services. We will also discuss the importance of practices having compliance programs.

The Department of Health and Human Services, Office of Inspector General participated alongside key law enforcement partners in the 2023 Nationwide Health Care Fraud Enforcement Action. This action resulted in criminal charges brought against telemedicine platform owners, laboratory owners, durable medical equipment (DME) providers, hospice operators, and pharmacists, among others, with losses exceeding $1.1 billion. In this webinar, Sean M. Weiss, CHC, CMCO, CPMA, CMPE, CPC-P, CPC, will provide an update on key FCA trends and developments, the latest cases and their implications, and actions you can take to protect your organization in an increasingly complex and perilous environment.

Learning Objective:

• Learn about the False Claims Act
• Understand what Medical Necessity means
• Understand the benefits of compliance programs and what is mandatory
• Understand what is meant by cloning and how to avoid it
• Guidance on best practices for keeping your organization safe under today’s aggressive enforcement conditions
• Understand CMS guidelines for Split/Shared Services, Incident-to and Evaluation & Management services

Areas Covered in the Session:

• Medicare Voluntary Refund – Potential Language Change
• Continued Proposed Language Change – 2023
• The False Claims Act
• Evaluation and Management Services Prior to 2021 & 2023
• Split / Shared Services
• Compliance Programs for Physicians
• The Federal Register
• Patient Protection and Affordable Care Act of 2010 (the “Healthcare Reform Act,” or the “Act”)
• Mandatory Compliance
• Healthcare Fraud Criminal Offense
• 2023 Areas of Focus
  • Evaluation and Management Services
  • Amniotic Fluid for MSK
  • Medical Necessity
  • Cloning and Clinical Plagiarism
  • Infusion Services
  • Evaluation and Management Services and Application of 25 modifier
  • Incident-to & Split Shared Services
• Evaluation and Management Services
• Defining “Medical Necessity”
• Incident-to
• Medicaid and Medicare 72-Hour Rule
• Signature Requirements
• Cloning

Suggested Attendees:

• Medical Providers, who are Involved in the Payment Process of their Practice
• C-Level Executives
• Office Staff and Billing Managers
• Medical Billing Companies
• Hospital Revenue Cycle Staff
• Physician
• Nurses
• Physician Assistants
• Nurse Practitioners
• Medical Assistants
• Practice Manager
• Office Managers
• Billers
• Coders
• Auditors
• CDI Specialists
• Collection Staff
• Front Desk
• IT Specialists
• HIPAA Privacy and Security officers
• Compliance Officers
• Telemedicine System Vendors
• Patient Accounts Personnel
• Medical Record Supervisors
• Health Information Management Administrators and Technicians
• Other Personnel Interested in Billing Privileges with the Medicare Program

Presenter Biography:

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This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

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Purchase Order Form – Click Here to download PO form.

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Snippet From Our Previous Session