Creative Arguments to Avoid and Defend Overpayments/False Claims

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Learn how to Create Counterarguments to Avoid/Defend Overpayments/False Claims

If the law is often overlooked, it leads to various common overpayment allegations. This session by David Glaser will provide some expert advice which will help you develop factual and legal arguments that may eliminate the need to make voluntary disclosures or rebut the government’s assertions of an overpayment. You will understand in this session, why documentation deficiencies or violation of certain Medicare rules do not automatically lead to Medicare overpayments. Learn how to defend yourself against overpayment assertion by individual payers in this session. Some tactical strategies will also be discussed in the session which will help you defend overpayments and make voluntary refunds whenever necessary.

Training Objective:

  • Analyze why insufficient documentation doesn't create a Medicare overpayment
  • Discuss strategies for handling audits by individual payers
  • Examine common mistakes made when making a voluntary disclosure
  • Recommend language for refund letters
  • Determining whether a purported rule is real or merely an oft-repeated legal "myth"

 Detailed agenda:

  • False Claim Act: Mistakes are not Fraud
  • Questioning Authority: how to do it rightly
  • CMS, WPS, CIGNA and other MACs what do they assert with an example
  • The Flaw: MLN: MM5613 and other scenarios
  • PPACA Requirements: Identifying and reporting Medicaìd/Medìcare requirements
  • What are the options for a Clinic?
  • What are a Hospital’s options?
  • Is using the OIG self-disclosure an option?
  • Reporting and returning overpayments
  • How do refunds affect RACs?
  • Identifying as per proposed rule
  • Audit Prevention through real case scenarios
  • What to Look for: Documentation, Code distribution pattern, Total Production, Diagnosìs codìng, Bundling etc.
  • What does OIG wants to know?
  • What is the relevant law?
  • The Role of documentation: CPT, CMS & HCFA
  • Should you quantify exposure?
  • Condition of participation: Is violation an overpayment?
  • Program integrity manual
  • Payor based rules compared to Medìcare
  • Are manuals a basis for an overpayment?
  • Medical Necessity denials
  • The “Treating Physìcian Rule”
  • The unsigned medical director agreement
  • Legal analysis of an in-patient
  • The AHA litigation
  • Calculating an overpayment
  • Sampling issues
  • The refund letter
  • Dealing with Co-Payments
  • Rebilling or refunding
  • What about prìvate Payors?
  • Real case scenarios and much more...

Who Should Attend:

The target audience would be CEOs, CFOs, Compliance officers and anyone who would deal with potential overpayments or investigations in medical facilities such as hospitals and clinics

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About Our Speaker

David Glaser - Hospital Coding Guidelines Expert

David M. Glaser is a shareholder in Fredrikson & Byron’s Health Law Group. David assists clinics, hospitals, and other healthcare entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David’s goal is to explain the government’s enforcement position, and to analyze...   More Info
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