Healthcare Business Management Association - HBMA
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HBMA Billing: The Journal of the Healthcare Billing and Management Association

2016 HBMA Compliance Conference
Everything Old Is New Again

If there is one sentence that describes the 2016 Compliance Conference, held May 3-5 in Atlanta, it is "Pay attention, even when you think you already do." Did you know the HBMA Compliance Conference is the only conference dedicated to compliance in our industry? As such, each and every session brings fresh new ideas and key updates to critical compliance topics. This is key for compliance programs, which should be built on current issues, risk, and mitigations.

What You'll Learn
The 2016 Compliance Conference will cover crucial topics to help you and your clients remain compliant.

One topic we will address is the Office of Inspector General's (OIG) compliance guidelines. There are now 18 OIG compliance guidelines, and each one builds on lessons learned over time. What have you learned from the supplemental hospital guidance or nursing facility guidance? OIG believes new guidance serves as a roadmap for updating and refining compliance plans. If you are new to compliance, it is intended to facilitate discussions among leadership regarding the importance of compliance.

The federal sentencing guidelines have had significant changes that affect all of our compliance programs. Did you update and revise your compliance plan based on those new requirements? Are your documented risk assessments appropriately revised? In 1998, a risk assessment was considered a one-time event before you began a formal compliance program, and it was conducted under attorney/client privilege. Today, risk assessments are never-ending processes embedded in operations. Also, the federal sentencing changes placed an enormous focus on ethical behavior. How do you assess that risk? Can you teach it? Can you measure it?

Additionally, the HIPAA/HITECH audits are well underway. Where is your "take home" from the published findings? Are you confident you have all the required elements in place if you are chosen for audit? The electronic world we conduct business in has little resemblance to how our systems worked in 1998. What were effective safeguards in 1998 are inadequate now. Do you count on subcontractors or contractors to take care of your business? Do they? Have you addressed the worst case scenario adequately?

Coding has always been our biggest risk area, regardless of whether we or our clients do the coding. How has ICD-10 implementation affected that risk? Are any new mitigating actions needed? How can you use what you know to help your clients prepare for pay-for-performance models? Have any of your clients been included in the CMS profiles of physician outliers? Have any of your physicians been subject to a RAC audit? What were the findings? Do you need to take new actions? Part C RAC audits are now on the CMS agenda. Did you know there are specific scenarios when claims that are clearly incorrect were paid by Part C? How did you handle those cases?

Finally, refunds and credit balances have been the hottest topics since HBMA began offering compliance training. Have you been following the recent federal updates? What about the new case law? Are you and your clients meeting the clear expectations? We know increased focus on this area is active and growing. At the 2016 Compliance Conference, for the first time, you can participate in a full 90-minute session dedicated to credit balances that will help you understand the risks and requirements today.

Our businesses are changing, evolving, and growing in new and different ways. The future of successful companies requires new expertise and new ways to address old problems
and manage new risks. Join an expert faculty at the 2016 Compliance Conference – all of whom work in our industry every day and know the challenges we all face – and your fellow attendees to build something together. Visit to learn more.

Holly Louie, RN, CHBME, is the compliance officer for Practice Management Inc. and the 2016 HBMA president.


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