Institute on Medicare and
Medicaid Payment Issues
March 25-27, 2015
Baltimore Waterfront Marriott Hotel • Baltimore, MD
Planning Committee
Robert L. Roth, Program Chair
Jennifer L. Evans
Susan Maxson Lyons
Andrew D. Ruskin
Lawrence W. Vernaglia
PYA has provided sponsorship in
support of this program.
AMERICAN HEALTH LAWYERS ASSOCIATION
Institute on Medicare and Medicaid Payment Issues
Make plans to join us in Baltimore!
AHLA is pleased to present the Institute on Medicare and
Medicaid Payment Issues. This program is the most comprehensive program available on legal issues related to reimbursement. Leading experts, including many officials from CMS, will
present on topics such as Recent Developments in Fraud and
Abuse Enforcement, The 340B Program, Provider-Based Status, Under Arrangements, Enrollment, and Related Medicare
Requirements, Cutting Edge Stark Issues, Overpayments and
Disclosures, and many more. The committee has worked very
hard to offer an array of sessions that are of interest to those
looking for fundamentals sessions and those looking for more
intermediate/advanced sessions that will allow them to delve
into their specific areas of interest.
Learning Objectives
Attendees will learn about:
j R egulations and enforcement initiatives related to Medicare
and Medicaid reimbursement
j Th
e impact of emerging regulatory trends, recent case law,
and legislative developments on health plans and various
types of health care providers
j Reimbursement challenges faced by plans and providers
Exhibitors: AHLA would like to thank the following companies for their support of the Medicare and Medicaid program
and encourages attendees to visit their exhibit booths:
j Coding Compliance Solutions
j Dixon Hughes Goodman LLP
j EHR 2.0
j Essential Consulting LLC
j GME Solutions LLC
j Government Data Services LLC
j Healthcare Payment Specialists LLC
j HORNE LLP
j PYA
Program Materials: We will not automatically be printing
binders for everyone. All materials will be available on a website prior to the program and handed out on a flash drive at the
program. For those who still do want the binders, they will be
available for an additional fee; please order on the registration
form on page 19 or online.
Continuing Education: Participants will be given continuing
education forms at the program. Forms must be completed
and returned to AHLA staff to receive credit. AHLA is an
approved sponsor of continuing legal education credits in most
states. AHLA will apply for 19.3 continuing education credits
(including 1.0 ethics credits) based on a 60-minute hour and
23.2 credits (including 1.2 ethics credits) based on a 50-minute
hour. The number of credits approved may vary. Introductory
remarks, Keynote Addresses (in some states), breaks, and
luncheons are not approved for CLE credits.
AHLA is registered with the National Association of State
Boards of Accountancy (NASBA) as a sponsor of continuing
professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the
acceptance of individual courses for CPE credit. Complaints
regarding registered sponsors may be addressed to the National
Registry of CPE Sponsors, 150 Fourth Avenue North, Suite 700,
Nashville, TN 37219-2417. www.nasba.org. This seminar will
be worth approximately 23.0 CPE credits.
AHLA will be applying for Compliance Certification Board
(CCB) credits.
This program is designed to be an update on developments
in the area of reimbursement. There are no prerequisites or
advanced preparations required to register for this group live
program. Those seeking accounting credits should be familiar
with the basic concepts of law and terminology associated with
reimbursement in order to obtain the full educational benefit
of this program.
Hotel Reservations:
Baltimore Marriott Waterfront Hotel
700 Aliceanna Street
Baltimore, MD
Reservations: (800) 266-9432
Hotel accommodations are not included in the registration fee.
AHLA has reserved a block of rooms at the Marriott Waterfront Hotel at a discounted rate of $229. To make reservations,
please call the hotel directly at (800) 266-9432. The group rate
cutoff is March 10, 2015 and may sell out prior to this date.
Travel: Association Travel Concepts (ATC) has negotiated
discounts with United, Delta, Enterprise, Hertz Rental Car,
Enterprise, and Dollar Rent a Car to bring you special airfares
and car rental rates lower than those available to the public.
Some restrictions may apply and a service fee may apply. ATC
will also search for the lowest available fare on any airline.
Association Travel Concepts
1-800-458-9383 | email: reservations@atcmeetings.com
www.atcmeetings.com (follow the Member Travel links)
Fax: (858) 362-3153
ATC is available for reservations from 8:30 am until 8:00 pm
Eastern, Monday through Friday.
Special Needs: If you have needs requiring special assistance
or accommodations, including special dietary needs, or have
questions about accessibility issues at the program, contact our
special needs coordinator, Valerie Eshleman at (202) 833-0784
or veshleman@healthlawyers.org.
Additional information on page 18.
2
Baltimore, MD
Program Agenda
Tuesday, March 24, 2015
6:30–8:30 pm
Registration and Information
Wednesday, March 25, 2015
7:00 am–5:45 pm
Registration and Information
CONCURRENT SESSIONS
8:00–10:00 am
A. Fundamentals of Medicare and Medicaid
Reimbursement (not repeated)
Barry D. Alexander
Thomas R. Barker
Joel M. Hamme
j History and background of the Medicare and Medicaid
Programs encompassing Parts A-D
j Component Pieces of the Medicare and Medicaid Programs
j Historical and New Payment Systems deployed within the
Medicare and Medicaid systems
j Key policy and other considerations impacting Medicare
and Medicaid payment systems
B. Masters Level Session: Current Issues in Medicaid:
Start Paying Attention (not repeated)
Barbara D. A. Eyman
Mark H. Gallant
Charles A. Luband
Craig H. Smith
Megan Tinker
C. Advanced Provider Enrollment–Forewarned
is Forearmed (not repeated)
Julie Burns
Louise M. Joy
Seth A. Killingbeck
j New Medicare provider enrollment regulation regarding
enrollment denials and billing revocations
j Current status of revocations, rejections, denials,
and appeals
j Implementation of fingerprinting requirements
j Overlap of Medicaid enrollment fees/screenings
j DAB opinions
j Challenging enrollment scenarios/examples
10:00–10:10 am
Coffee Break, sponsored by PYA
GENERAL SESSION
10:10–10:30 am
Welcome and Introduction
David S. Cade, AHLA CEO
Lois Cornell, AHLA President-Elect
Robert L. Roth, Program Planning Committee Chair
10:30–11:00 am
Conference Overview: Look Back on 2014
James F. Flynn
Robert L. Roth
11:00–11:30 am
CMS Present and Future Issues
Marc Hartstein
Laurence Wilson
11:30–11:45
Updated on Office of Inspector General Initiatives
Gregory E. Demske
11:45–12:20
Learn from My Mistakes
Dennis M. Barry
12:20–1:35 pm
Lunch on your own or attend the Regulation,
Accreditation, and Payment and Health Information
Technology Practice Groups Joint Luncheon OR the
Payers, Plans, and Managed Care Practice Group and
Behavioral Health Task Force Joint Luncheon
(additional fee; limited attendance; pre-registration
required; see page 18 for more information)
CONCURRENT SESSIONS
1:45–3:15 pm Extended Sessions
D. Medicaid: The Largest Coverage Source in the United
States (not repeated)
Jennifer L. Evans
Gretchen M. Hammer
Justin Senior
Craig H. Smith
j The evolution of Medicaid and key program components
j Medicaid expansion: Is your state in or out?
j Innovative state approaches to reforming Medicaid
j Federal and state Medicaid Program Integrity efforts
j Representing clients facing Medicaid program recoupments
and sanctions
E. Fraud and Abuse Primer for the New Health Care World
(not repeated)
Troy A. Barsky
Joan P. Dailey
Vicki L. Robinson
j New to fraud and abuse law or need a refresher? Want to impress partners and clients? Interested in current enforcement
and compliance trends? This session presented by government and private experts will provide an introduction to:
–Who’s who in fraud and abuse law
–
The primary fraud and abuse statutes and regulations
every health lawyer should know
–
Practical pointers for assessing fraud and abuse risk
3
Institute on Medicare and Medicaid Payment Issues
Program Agenda
–Top trends and hot issues in the changing health care
environment
F. Medicare Physician Fee Schedule
David W. Hilgers
Christina Smith Ritter
Sidney S. Welch
j
Basic mechanisms and components of Part B reimbursement
j Implications from the Medicare Physician Fee Schedule
j Changes in the Sustainable Grown Rate
j Perspectives from the government and Part B providers
G. Meaningful Use–Stage 3 Coming, Stages 1 and 2
Compliance
Samantha Burch
James F. Flynn
Elizabeth S. Holland
j Preview of upcoming 3 Meaningful Use requirements and
a review of compliance and audit issues with Stage 1 and
Stage 2 attestations
j CMS discussion of upcoming MU requirements
j Common audit and compliance issues with Stage 1 and
Stage 2 MU requirements
j Penalties, hardship exceptions and changes of ownership
H. Recent Developments in Fraud and Abuse Prevention
and Enforcement
Kevin R. Barry
Edgar D. Bueno
Laura F. Laemmle-Weidenfeld
Janet S. Nolan
j Ongoing efforts and new trends in fraud enforcement
and prevention by CMS, HHS-OIG, and DOJ
j CMS’ recently finalized authority to deny or revoke a
provider/supplier’s Medicare enrollment
j Recent OIG fraud alerts
j Enforcement focus areas, including kickbacks, Stark Law,
quality of care, exclusion, PODs, and clinical laboratories
j Special issues arising in FCA litigation including statistical
sampling, privilege, and statutes of limitation
j Use of data and public information
J. The Medicare DSH Payment
Ing-Jye Cheng
David Hoskins
Christopher L. Keough
j The traditional DSH payment calculation
j The new DSH payment for uncompensated care
j Update on DSH litigation
3:30–4:30 pm
K. Introduction to Medical Coding for Payment Lawyers
(not repeated)
Robert A. Pelaia
j The basics of procedural (CPT) coding
j Evaluation & Management (E&M) coding overview
j General review of diagnosis (ICD-9 and ICD-10) coding
j Guidance on use of the CPT & ICD coding manuals
L. Medicare Advantage–New Developments and Key Legal
Issues
Anne W. Hance
j Policies in CMS’ annual payment notice, draft call letter,
and other guidance
j Challenges affecting plan-provider relationships, including risk-based and other payment arrangements
M. Unraveling the Knots: Stark and Medicare
Reimbursement Principles Intertwinings Elucidated
Alice G. Gosfield
j Understanding the differences between profit sharing and
productivity in a physician group
j ‘Incident to’ services and how they matter under Stark
j Supervision issues in in-office ancillary services
j How non-physician practitioners fit
j Understanding the distinctions between reassignment and
purchased services
j Understanding the distinctions in the anti-markup rule and
j Stark’s approach to independent contractor physicians
N. ICD-10 Transition: What Health Lawyers Need to Know
Julie E. Chicoine
Denise J. Hall
j What is ICD-10 and why is it important to the health care
community?
j What is the current regulatory status of ICD-10?
j Update on the organizational impact–operational and finance
j ICD-10 value in the world of new payment models
(value based purchasing and population health)
O. Update on Medicare’s Two-Midnight Rule:
Where Things Stand in 2015
Marc Hartstein
Mark D. Polston
j The two-midnight rule–in theory and in practice
j Physician order and certification requirements
j Latest guidance from CMS
j Update on MAC probe
P. The 340B Program: Overview, Compliance, and What
to Expect in the Year Ahead
Ellyn Sternfield
Barbara S. Williams
j Overview of 340B Program requirements
j Compliance issues and lessons learned from HRSA Audits
j Aftermath of PhRMA v. HHS and expectations about HRSA
j 340B guidance
j Advocacy efforts on Capitol Hill
4
Baltimore, MD
Program Agenda
M. Unraveling the Knots: Stark and Medicare Reimbursement Principles Intertwinings Elucidated (repeat)
4:45–5:45 pm
Q. Provider Audit Contractors (not repeated)
Kimberly Brandt
Mark R. Korpela
Andrew B. Wachler
j Background on provider audit contractors
j Assessment of the enforcement environment
j Review of jurisdiction and scope of review, including time
periods subject to review and types of documents
j Discussion of provider contractor approaches and tools
j Practical advice on working with provider audit contractors
and steps on reducing the likelihood of an audit
5:45–6:45 pm
Celebrating Diversity+Inclusion Reception, sponsored
by the AHLA Diversity+Inclusion Council
(all faculty and attendees are welcome; RSVP on the
registration form; see page 18 for more information)
6:45–9:30 pm
Networking Reception at the American Visionary Arts
Museum, sponsored by PYA
(attendees, faculty, children, and registered spouses and
guests welcome; transportation provided)
R. Current Issues in Medicaid Supplemental Payments
and Financing (not repeated)
Barbara D.A. Eyman
Charles A. Luband
j Medicaid disproportionate share hospital (DSH) payments
j Other Medicaid supplemental (eg UPL) payments
j Medicaid waiver payments, including delivery system
reform incentive program payments
j Medicaid financing (IGTs, CPEs, and provider taxes and
donations)
j Impact of health reform and current regulatory issues
Thursday, March 26, 2015
7:00 am–5:45 pm
Registration and Information
7:00–8:15 am
Continental Breakfast, sponsored by PYA
(attendees, faculty, children, and registered spouses and
guests welcome)
7:00–8:00 am
Medicare Legislative Update: What to Expect from
Congress
Eric Zimmerman
j Medicare Physician Payment (SGR) repeal and reform
j Hospital and post-acute payment changes
j Other anticipated Medicare payment and regulatory
changes in 2015 and beyond
S. Legal Ethics: Conflicting Laws/Conflicting Duties:
Professional Responsibility Issues when Federal and
State Laws are Inconsistent
Andrew J. Demetriou
Susan Winkler
j Ethical issues confronting lawyers who are counseling
clients in areas where federal and state laws conflict, such
as sales of marijuana, health care marketing arrangements,
and drug compounding j Appropriate scope of legal advice and services, confidentiality issues, the line between counseling clients and facilitating
potential illegal conduct, and other risks for lawyers in these
situations, including dealing with cash transactions
CONCURRENT SESSIONS
8:15–9:45 am Extended Sessions
U. Medicare Claims Appeals–Soup to Nuts (not repeated)
Thomas E. Herrmann
James P. Kelly
Donna K. Thiel
j Five appeal levels; five sets of rules
j Procedural fundamentals (RAC, ZPIC, and contractor
denials, deadlines, content of appeal petitions, evidence,
stay of recoupment, obtaining information, solving contractor process errors, CMS as a “participating” non-party, etc.)
j Advanced substantive defenses for typical appeal issues
(statistical, medical necessity, limitation on liability, waiver
of recovery, evidence missing from record, post-ALJ hearing difficulties, AdQIC protest letters to Medicare Appeals
Council, re-openings for good cause, fraud or recently
discovered material evidence, administrative remands,
federal court challenges, new ADR alternatives, etc.)
T. Recent Cost Report Appeal Issues
Leslie Demaree Goldsmith
Susan Maxson Lyons
Arthur Peabody, Jr.
j Recent decisions of PRRB and CMS Administrator and
several issues chosen by attorneys who represent providers,
Blue Cross and CMS
j Cases address myriad of issues including: IME/GME,
Nursing and Allied Health, Bad Debt, Wage Index, DSH,
SNF Cost Limits, and PRRB Jurisdiction
L. Medicare Advantage–New Developments and Key Legal
Issues (repeat)
5
Institute on Medicare and Medicaid Payment Issues
Program Agenda
j Practical tips for special problems (initiating post-victory
“recalculation,” “Section 935 Interest,” regular interest, maintaining appellant’s solvency during appeals, repetitive denials,
parallel proceedings, escalations and improvisations for
dealing with OMHA and MAC backlogs, getting help from
CMS on contractor problems, obtaining internal QIC advisor
memos, pre-hearing briefs and conferences, packaging the
evidence, dealing with ALJ “neutral” experts, etc.)
V. Fundamentals of Provider Enrollment
Emily W.G. Towey
Jeanne L. Vance
j Medicare enrollment process overview by type of filing:
Initial enrollments, revalidations, changes of information,
changes of ownership, mergers and consolidations
j Special enrollment rules for different provider types
j Recent developments in enrollment: New rules, enrollment
denials due to Medicare debts, Medicaid enrollment changes,
CMPs for false information or omissions on enrollment
forms, new forms, new MACs
j Avoiding enrollment revocations: Timely reporting of changes, preparation for enrollment site visits, understanding how
to respond to enrollment rejections, denials and revocations
j Common Medicare enrollment problems and strategies to
successfully enroll and report changes to Medicare files
W. Post-Acute Care
Edo Banach
Colin T. Roskey
j Policy objectives for 2015 and beyond
j Payment and service delivery reform agenda–the IMPACT
Act and the 114th Congress
j Demonstrations, initiatives, opportunities, and expectations
j Strategies to be successful
j Legal, operational, and implementation challenges
X. Hospital Inpatient PPS Update
John R. Hellow
Daniel Schroder
Michael Treitel (invited)
j Statutory changes to IPPS
j What is in store for the wage index, FY 2015 IPPS rule
changes, including the uncompensated care DSH and two
midnight IPPS payment reduction
j What‘s in store for IPPS with the upcoming budget changes
other significant changes
G. Meaningful Use–Stage 3 Coming, Stages 1 and 2
Compliance(repeat)
H. Recent Developments in Fraud and Abuse Prevention
and Enforcement (repeat)
10:00–11:00 am
Y. PRRB Workshop (not repeated)
Ronald S. Connelly
Paul Crofton
Arthur Peabody, Jr.
j Mediation
j PHI/non PHI
j Consolidation/case management of appeals
j Conduct of hearings
j Documentation issues
j Board exhibits
j Jurisdictional briefs
Z. Mental Health and Addiction Treatment:
Moving Forward (not repeated)
Mark Covall
j The role that Medicare and Medicaid plays in covering and
paying for mental health and substance use services
j Implications of key federal policies and laws on access, coverage, and treatment of mental and addictive disorders
j Policy initiatives to improve Medicare and Medicaid coverage
and payment for persons with mental and addictive disorders
AA. Provider-Based Status, Under Arrangements,
Enrollment, and Related Medicare Requirements
Andrew D. Ruskin
Lawrence W. Vernaglia
j Framework for analysis of compliance issues and transactions
involving the following: Provider-based status requirements;
under arrangements principle and limitations; and Medicare
enrollment requirements for provider-based entities
j Medicare coverage, payment, and compliance implications
of provider-based status compared to freestanding status
j Provider-based and related hot topics, including: Potential
for overpayments or false claims act cases associated with
provider-based status challenges; shared space arrangements; 340B drug discount program and provider-based
departments; billing non-Medicare payers for services
furnished in provider-based facilities; and joint ventures
j The future of provider-based status, including the
President’s 2016 Budget, MedPAC recommendation and
Congress considering equalizing Medicare payment
rates for ambulatory care furnished in provider-based
and freestanding settings
BB. Cutting Edge Stark Issues
S. Craig Holden
David E. Matyas
j Recent Stark case developments
j SDRP resolutions
j Due diligence challenges-the aggressive hunt for violations
j Impact of repayments on the period of disallowance
j Business courtesy issues
j Potential legislative changes
6
Baltimore, MD
Program Agenda
CC. H
ot Topics in Overpayments and Stark SelfDisclosures
Thomas S. Crane
Lisa Ohrin Wilson
Robert L. Roth
j When repayment/disclosure is not voluntary–the 60-day
report and repayment statute
j Final Rule on implementation of 60-day statute for
Medicare Parts C and D and update on Proposed Rule
for Parts A and B
j To which agency should you report a disclosure
j Distinctions between the OIG and Self-Referral Disclosure
j Protocols
j Self-Referral disclosure protocol hot topics
GG. Not Just for Geeks: Why You and Your Client’s
Executives Need to Understand Medicare’s Change of
Ownership (“CHOW”) Rules
Jan Lundelius
Claire F. Miley
j Why CHOWs are important
j CHOW situations and non-CHOWs, including the
36-month rule for Home Health Agencies
j Benefits and burdens of accepting vs. rejecting automatic
assignment of Medicare provider agreement
j Handling licensure and payment issues in CHOWprocessing period
j Obtaining a new provider agreement after rejecting automatic assignment
j Medicare filing requirements and responsible parties as a
result of CHOW
j Combining two providers under single provider agreement
j Due diligence issues to consider when entering into a
CHOW
O. Update on Medicare’s Two-Midnight Rule: Where
Things Stand in 2015 (repeat)
11:15 am–12:15 pm
DD. Primer on Researching Medicare and Medicaid Issues:
Sources and Techniques (not repeated)
Camille Blake-Fall
Anthony H. Choe
j Developing a research plan and tips to conduct research
effectively and efficiently
j Key primary and secondary sources for researching
Medicare and Medicaid coverage and payment issues
j Best practices and how to avoid pitfalls
j Real-life examples of researching Medicare and Medicaid
issues
P. The 340B Program: Overview, Compliance, and What to
Expect in the Year Ahead (repeat)
S. Legal Ethics: Conflicting Laws/Conflicting Duties:
Professional Responsibility Issues when Federal and
State Laws Are Inconsistent (repeat)
12:15–1:35 pm
Lunch on your own or attend the Accountable Care
Organization and Health Care Reform Education Task
Forces Joint Luncheon
(additional fee; limited attendance; pre-registration
required; see page 18 for more information)
EE. Medicaid Expansion (not repeated)
Eliot Fishman
Mark H. Gallant
j Updated status of state participation in Medicaid expansion
initiatives
j Gap-filling in non-expansion states through exchange
enrollments, including the King v. Burwell case and other
issues and challenges involving exchanges
j Private Option/Premium Support Sec. 1115 waiver programs and the politics and economics of expansion
j Regulatory and litigation developments impacting providers’ rights to adequate Medicaid reimbursement, the
importance of which is magnified by Medicaid expansion
FF. Standing Orders, Ordered Protocols, and Standardized
Order Sets
Timothy P. Blanchard
Joan C. Ragsdale
j Evolving policies, uncertainties and admonitions
j Developing, adopting, implementing, monitoring, and
updating
j Initiation, authentication and related documentation
j Implications for patient care, quality, efficiency, and coverage
CONCURRENT SESSIONS
1:45–2:45 pm
HH. Medicare Claims–Substantive and Sampling
(not repeated)
Steven A. Greenspan
Lester J. Perling
j A year in review of relevant federal case law and Medicare
j Common errors of law seen at ALJ prompting a request for
Appeals Council review
j Latest legal developments in statistical sampling
7
JJ. Providing and Billing for Transitional and Chronic Care
Management
Robert Jarrin
Martie Ross
j History of Medicare policy regarding care management
services
j Detailed explanation of new billing rules for TCM and
CCM and potential pitfalls
Institute on Medicare and Medicaid Payment Issues
Program Agenda
j The role of technology in providing care management
j Unique arrangements for providing centralized care
management services
KK. Medicare Litigation Update
Robert Balderston
Chris E. Rossman
j Decisions impacting payment
j Trends in advocacy and judicial decision-making
j Judicial deference policy by federal courts as it affects
Medicare litigation
j Emerging issues
Recent years have seen a substantial increase in the volume of
jurisdictional challenges filed by the MACs and a corresponding increased number of jurisdictional decisions issued by the
PRRB, many of which are now published. This session will
provide a primer on basic PRRB jurisdiction principles and
then turn to an examination of PRRB and judicial jurisdictional
decisions issued in approximately the past twelve months.
j Primer on PRRB jurisdiction
j Significant PRRB jurisdiction decisions
j Judicial decisions regarding PRRB jurisdiction
T. Recent Cost Report Appeal Issues (repeat)
N. ICD-10 Transition: What Health Lawyers Need to Know
(repeat)
AA. Provider-Based Status, Under Arrangements, Enrollment, and Related Medicare Requirements (repeat)
BB. Cutting Edge Stark Issues (repeat)
GG. Not Just for Geeks: Why You and Your Client’s
Executives Need to Understand Medicare’s Change
of Ownership (“CHOW”) Rules (repeat)
CC. Hot Topics in Overpayments and Stark SelfDisclosures (repeat)
3:00–4:00 pm
LL. PRRB Appeals–The View from the Board (not repeated)
Michael W. Harty
j Overview of the Office of Hearing and Appeals
j Division of jurisdiction and case management
j Types of cases and inventory
j Board initiatives
j Decisions
j Alert 10
MM. Calendar Year 2015 OPPS Update
Elisabeth Daniel
Twi D. Jackson
Esther B. Markowitz
Valerie Rinkle
Operational and compliance implications of the most significant OPPS payment policy changes since the payment system’s
inception in 2000, including:
j Implementation of comprehensive APCs
j Changes in reporting of device dependent edits
j New packaging policies for ancillary services and prosthetic
supplies
j Changes to pass-through payment process for skin
substitutes
j Collection of off-campus provider-based department data
NN. It Don’t Mean a Thing if It Ain’t Got Jurisdiction:
The Expanded Significance of Jurisdiction Practice
before the PRRB
Jocelyn Beer
Kenneth R. Marcus
Brendan G. Stuhan
4:15–5:45 pm Extended Sessions
OO. Medicaid Litigation Update (not repeated)
Lloyd A. Bookman
Alan S. Dorn
j Availability of private rights of action to challenge state
Medicaid decisions and HHS approvals
j Level of deference owed to state decisions and HHS approvals
j Challenges to provider rate reductions
j Challenges to coverage limits, reductions, exclusions:
Medicaid and Olmstead issues
j Third party liability issues
PP. PRRB Appeals: Current Challenges (not repeated)
Mark R. Korpela
Melanie Marolf-Fetchik
Lisa Ogilvie
Stephanie A. Webster
j Emerging jurisdictional trends
j Group appeal pitfalls
j MACs and the role of the Appeals Support Contractor
j Reopenings of appealed issues
j Avoiding procedural snafus
QQ. Emerging Administrative Enforcement Tools
Julie Burns
Judith A. Waltz
j CMS’ fraud prevention system and data analytics
j “Recalcitrant” providers/suppliers
j Medicare: Loss of billing privileges, enrollment moratoria
j Payment suspensions (recent Medicaid targets as well as
Medicare “sweeps” in HEAT cases)
j OIG CMPs–proposed rules
j Medicaid: Reciprocal terminations, suspensions
j New CMS enrollment regulations (abuse of billing
8 privileges, outstanding debts)
Baltimore, MD
Program Agenda
RR. Graduate Medical Education
Thomas W. Coons
Tim Johnson
Lori K. Mihalich-Levin
j Payment for medical education
j ACA requirements for redistribution of unused resident
slots and resident slots for closed hospitals
j New programs and CMS restrictions
j Litigation/compliance issues
j The future of GME
j The movement from paying for volume to paying for value
J. The Medicare DSH Payment (repeat)
W. Post-Acute Care (repeat)
QQ. Emerging Administrative Enforcement Tools (repeat)
and the implications for rural areas
j Recent changes in RHCs, FQHCs, CAHs, and other
Medicare programs
j New CMS and ORHP innovations and programs for rural
areas
F. Medicare Physician Fee Schedule (repeat)
V. Fundamentals of Provider Enrollment (repeat)
X. Hospital Inpatient PPS Update (repeat)
RR. Graduate Medical Education (repeat)
5:45–6:45 pm
Reception at the Baltimore Marriott Waterfront Hotel,
sponsored by PYA
(attendees, faculty, children, and registered spouses and
guests welcome)
9:45–10:45 am
TT. Making Pay-for-Performance (P4P) Pay: Opportunities
and Pitfalls of a Shifting Reimbursement Paradigm
(not repeated)
Daniel J. Hettich
Marci A. Love
Early in 2015, CMS made a “historic announcement” that it
would seek to link 85 percent of all traditional Medicare
payments to quality or value by 2016. As the paradigm for
health care reimbursement shifts from one focused on quantity of care to one focused on quality of care, the health care
industry must shift its paradigm for health care delivery to be
successful. To help hospitals align health care delivery with the
new pay for performance (P4P) paradigm, this session will:
j The key aspects of Medicare’s three P4P programs (i.e.,
the Value-Based Purchasing Program, Hospital-Acquired
Conditions program, and Hospital Readmission Reduction
program), which together will account for 6% of Medicare
reimbursement in 2015, emphasizing synergies among the
programs and ways to maximize returns on quality improvement efforts
j Practical advice for creating a top-to-bottom “culture of
quality” while highlighting potential pitfalls
7:00 pm
Life Members Networking Dinner OR Young
Professionals Networking Dinner
If you would like to go to dinner with some of your colleagues (everyone pays for their own dinner), RSVP on the
registration form; see page 18 for more information.
Friday, March 27, 2015
7:00 am–1:00 pm
Registration and Information
7:00–8:00 am
Continental Breakfast, sponsored by PYA
(attendees, faculty, children and registered spouses and
guests welcome)
7:00–7:50 am
Women’s Networking Breakfast, sponsored by the
Women’s Leadership Council
(attendees and faculty welcome; space is limited; RSVP on
the registration form; see page 18 for more information)
FF. Standing Orders, Ordered Protocols, and Standardized
Order Sets (repeat)
JJ. Providing and Billing for Transitional and Chronic Care
Management (repeat)
CONCURRENT SESSION
8:00–9:30 am Extended Sessions
SS. Current and Emerging Issues in Rural Medicare Policy
(not repeated)
Corinne Axelrod
Emily J. Cook
Aaron Fischbach
Marge Watchorn
j Medicare regulatory and payment policies and how they
affect rural providers
KK. Medicare Litigation Update (repeat)
MM. Calendar Year 2015 OPPS Update (repeat)
NN. It Don’t Mean a Thing if It Ain’t Got Jurisdiction:
The Expanded Significance of Jurisdiction Practice
Before the PRRB (repeat)
9
Institute on Medicare and Medicaid Payment Issues
Program Agenda
11:00–11:30 am
UU. Diagnostic Imaging Services
Thomas W. Greeson
j The regulatory focus on diagnostic test supervision rules
j Key imaging related issues in 2015 HOPPS and MPFS final
rules
j Latest developments on Place of Service, Date of Service
billing rules for interpretation services
j CMS payment policies for Digital Breast Tomosynthesis
and Breast Biopsy procedures
VV. Long Term Care Hospitals–Regulatory Update
Albert W. Shay
Stephen M. Sullivan
j Preparing for new LTCH-PPS Payment Criteria and Site
Neutral Payment Rules beginning October 1, 2015
–Practical tips
j The 2015 LTCH Moratorium, including the process for and
scope of an exception. j ‘‘Improving Medicare Post-Acute Care Transformation Act
of 2014’’–IMPACT
–How and when will it impact LTCHs?
WW. DMEPOS Supplier Practice Tips from Enrollment to
Payment
Jana Kolarik Anderson
j Medicare enrollment pointers
j OIG and CMS guidance affecting structure and referral
arrangements
j Licensure and documentation issues affecting payment
j Compliance safeguards
XX. Clinical Labs
Peter M. Kazon
Few providers groups have faced the types of sweeping changes
that are currently facing the clinical laboratory industry. This
session will review recent developments affecting laboratories,
including the following:
j The status of changes in the Clinical Laboratory Fee j Schedule mandated by PAMA, the Protecting Access to
Medicare Act, which requires a new market based approach
to laboratory testing
j Other recent changes in hospital outpatient reimbursement
that will affects clinical laboratory and pathology services
j Draft Guidelines issued by the FDA, which could require,
for the first time, that Laboratory Developed Tests be
subject to premarket review by the FDA
j Other areas of focus by contractors, such as Molecular
Diagnostic Testing and Drugs of Abuse testing
YY. FQHCs, RHCs, and CHCs: The Year in Review
Kathy S. Ghiladi
j Selected highlights and developments for those entities
j Aspects of ACA implementation applicable to FQHCs,
RHCs, and CHCs
11:45 am–12:15 pm
ZZ. Emergency Services
Edward R. Gaines, III
Salvatore G. Rotella, Jr.
j Review and analysis of case law addressing the scope of
EMTALA and coverage for emergency services
j Developments in payment rates for out-of-network
emergency services
j 5 Emergency Medicine (EM) Payment challenges and
strategies in 15 minutes:
–
Converting the rural hospital ED into a free standing ED
(FSED), in states with no Medicaid expansion
–Medical debt is skyrocketing and the impacts of the
TCPA and FDCPA, respectively, on collecting patient cost
sharing
–
Medicare provider charge and payment data is now
searchable on Internet—what are the implications for EM
providers?
–How should EM providers adopt/react to tele-medicine?
–
Out of network (OON) services and balance billing (BB)
are under assault in state legislatures—what does it mean
to EM?
AAA. Home Health and Hospice Update
William A. Dombi
j 2015 Medicare home health and hospice payment changes
j Hospice annual cap reporting requirements
j New Medicare home health face-to-face physician
encounter compliance changes
j Value-based Purchasing in Medicare home health
j Medicaid home care moves to managed care
UU. Diagnostic Imaging Services (repeat)
XX. Clinical Labs (repeat)
YY. FQHCs, RHCs, and CHCs: The Year in Review (repeat)
12:30–1:00 pm
VV. Long Term Care Hospitals–Regulatory Update (repeat)
WW. DMEPOS Supplier Practice Tips from Enrollment to
Payment (repeat)
ZZ. Emergency Services (repeat)
AAA. Home Health and Hospice Update (repeat)
Adjournment
10
Baltimore, MD
Program Faculty
PLANNING COMMITTEE
Robert L. Roth, Program Chair
Hooper Lundy & Bookman PC
Washington, DC
Jennifer L. Evans
Polsinelli PC
Denver, CO
Susan Maxson Lyons
Deputy Associate General Counsel for
Litigation
US Department of Health and Human
Services
Office of the General Counsel CMS Division
Washington, DC
Andrew D. Ruskin
Morgan Lewis & Bockius LLP
Washington, DC
Lawrence W. Vernaglia
Foley & Lardner LLP
Boston, MA
_______________________________________
Barry D. Alexander
Nelson Mullins Riley & Scarborough LLP
Raleigh, NC
Jana Kolarik Anderson
Foley & Lardner LLP
Jacksonville, FL
Corinne Axelrod
Health Insurance Specialist
Hospital and Ambulatory Policy Group, CMS
US Department of Health and Human
Services
Baltimore, MD
Robert Balderston
Office of General Counsel
US Department of Health and Human
Services
Washington, DC
Kevin R. Barry
Office of the Inspector General
US Department of Health and Human
Services
Washington, DC
Troy A. Barsky
Crowell & Moring LLP
Washington, DC
Jocelyn Beer
Office of the General Counsel
US Department of Health and Human
Services
Washington, DC
Camille J. Blake-Fall
Office of the General Counsel
US Department of Health and Human
Services
Washington, DC
Timothy P. Blanchard
Blanchard Manning LLP
Orcas, WA
Lloyd A. Bookman
Hooper Lundy & Bookman PC
Los Angeles, CA
Kimberly Brandt
Chief Oversight Counsel
US Senate Finance Committee
Washington, DC
Edgar D. Bueno
Assistant United States Attorney, Civil
Chief and Affirmative Civil Enforcement
Coordinator
US Attorney’s Office for the Southern District
of Georgia
Savannah, GA
Samantha Burch
Vice President of Health and IT
Federation of American Hospitals
Washington, DC
Edo Banach
Senior Advisor, Acting Director
Division of Program Alignment MedicareMedicaid Coordination Office
Windsor Mill, MD
Julie Burns
Office of the General Counsel
US Department of Health and Human
Services, CMS Division
Baltimore, MD
Thomas R. Barker
Foley Hoag LLP
Washington, DC
Ing-Jye Cheng
Deputy Director, Division of Acute Care
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Dennis M. Barry
King & Spalding LLP (Ret.)
Washington, DC
Julie E. Chicoine
Senior Assistant General Counsel
Ohio State University Wexner Medical
Center
Columbus, OH
11
Anthony H. Choe
Morgan Lewis & Bockius LLP
Washington, DC
Ronald S. Connelly
Powers Pyles Sutter & Verville PC
Washington, DC
Emily J. Cook
McDermott Will & Emery LLP
Los Angeles, CA
Thomas W. Coons
OBER | KALER
Baltimore, MD
Mark Covall
Executive Director
National Association of Psychiatric Health
Systems
Washington, DC
Thomas S. Crane
Mintz Levin Cohn Ferris Glovsky & Popeo PC
Boston, MA
Paul Crofton
Director, Division of Hearing and Decisions
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Joan P. Dailey
Senior Attorney
Office of the General Counsel
US Department of Health and Human
Services
Washington, DC
Elisabeth Daniel
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Andrew J. Demetriou
Lamb & Kawakami LLP
Los Angeles, CA
Gregory E. Demske
Chief Counsel
Office of the Inspector General
US Department of Health and Human
Services
Washington, DC
William A. Dombi
Vice President for Law
National Association for Home Care &
Hospice
Washington, DC
Alan S. Dorn
Chief Counsel, Region V
Office of General Counsel
US Department of Health and Human
Services
Chicago, IL
Institute on Medicare and Medicaid Payment Issues
Program Faculty
Barbara D. A. Eyman
Eyman Associates PC
Washington, DC
Anne W. Hance
McDermott Will & Emery LLP
Washington, DC
Peter M. Kazon
Alston & Bird LLP
Washington, DC
Aaron Fischbach
Policy Coordinator
Federal Office of Rural Health Policy, HRSA
US Department of Health and Human
Services
Rockville, MD
Marc Hartstein
Director, Hospital and Ambulatory Policy
Group
Centers for Medicare and Medicaid Services
Windsor Mill, MD
James P. Kelly
Kelly Law Firm PC
Atlanta, GA
Eliot Fishman
Centers for Medicare and Medicaid Services
Windsor Hill, MD
James F. Flynn
Bricker & Eckler LLP
Columbus, OH
Edward R. Gaines, III
Chief Compliance Officer
Medical Management Professionals, Inc.
Greensboro, NC
Michael W. Harty
PRRB Board Member, Office of Hearings/
PRRB
Centers for Medicare and Medicaid Services
Windsor Mill, MD
John R. Hellow
Hooper Lundy & Bookman PC
Los Angeles, CA
Thomas E. Herrmann
Strategic Management Services LLC
Alexandria, VA
Mark H. Gallant
Cozen O’Connor PC
Philadelphia, PA
Daniel J. Hettich
King & Spalding LLP
Washington, DC
Kathy S. Ghiladi
Feldesman Tucker Leifer Fidell LLP
Washington, DC
David W. Hilgers
Husch Blackwell LLP
Austin, TX
Leslie Demaree Goldsmith
OBER | KALER
Baltimore, MD
S. Craig Holden
OBER | KALER
Baltimore, MD
Alice G. Gosfield
Alice G. Gosfield & Associates PC
Philadelphia, PA
Elizabeth S. Holland
Director, HIT Initiatives Group
Office of E-Health Standards and Services
Center for Medicare and Medicaid Services
Windsor Mill, MD
Steven A. Greenspan
Vice President, Regulatory Affairs
Executive Health Resources
Newtown Square, PA
Thomas W. Greeson
Reed Smith LLP
Falls Church, VA
Denise J. Hall
PYA
Atlanta, GA
Gretchen M. Hammer
Medicaid Director
Colorado Dept. of Health Care Policy and
Financing
Denver, CO
Joel M. Hamme
Powers Pyles Sutter & Verville PC
Washington, DC
Christopher L. Keough
Akin Gump
Washington, DC
Seth A. Killingbeck
HCA
Nashville, TN
Mark R. Korpela
Director, Division of Provider Audit
Operations, Office of Financial Management/
Financial Services Group
Centers for Medicare and Medicaid Services
Baltimore, MD
Laura F. Laemmle-Weidenfeld
Jones Day
Washington, DC
Marci A. Love
Office of General Counsel
US Department of Health and Human
Services
Washington, DC
David Hoskins
Office of General Counsel
US Department of Health and Human
Services
Washington, DC
Twi D. Jackson
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Robert Jarrin
Senior Director, Government Affairs
Qualcomm, Inc.
Washington, DC
Tim Johnson
Greater New York Hospital Association
New York, NY
Louise M. Joy
Joy & Young LLP
Austin, TX
12
Charles A. Luband
Dentons US LLP
New York, NY
Jan Lundelius
Assistant Regional Counsel, Office of Chief
Counsel
Office of the General Counsel
US Department of Health and Human
Services
Philadelphia, PA
Kenneth R. Marcus
Honigman Miller Schwartz and Cohn LLP
Detroit, MI
Esther B. Markowitz
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Melanie Marolf-Fetchik
Centers for Medicare and Medicaid Services
Windsor Mill, MD
David E. Matyas
Epstein Becker & Green PC
Washington, DC
Baltimore, MD
Program Faculty
Lori K. Mihalich-Levin
Director, Hospital and GME Payment
Policies, Health Care Affairs
Association of American Medical Colleges
Washington, DC
Claire F. Miley
Bass Berry & Sims PLC
Nashville, TN
Janet S. Nolan
Deputy Associate General Counsel for
Program Integrity
US Department of Health and Human
Services
Washington, DC
Lisa Ogilvie
Director, Division of Jurisdiction and Case
Management-PRRB
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Arthur Peabody, Jr.
Lead Medicare Counsel
Blue Cross Blue Shield Association
Washington, DC
Robert A. Pelaia
Senior University Counsel
University of Florida
Jacksonville, FL
Lester J. Perling
Broad and Cassel
Fort Lauderdale, FL
Mark D. Polston
King & Spalding LLP
Washington, DC
Joan C. Ragsdale
CEO
MedManagement LLC
Birmingham, AL
Valerie Rinkle
Associate Director
Navigant Consulting
Seattle, WA
Colin T. Roskey
Alston & Bird LLP
Washington, DC
Michael Treitel (invited)
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Martie Ross
PYA
Overland Park, KS
Jeanne L. Vance
Salem & Green PC
Sacramento, CA
Chris E. Rossman
Foley & Lardner LLP
Detroit, MI
Andrew B. Wachler
Wachler & Associates PC
Royal Oak, MI
Salvatore G. Rotella, Jr.
Reed Smith LLP
Philadelphia, PA
Judith A. Waltz
Foley & Lardner LLP
San Francisco, CA
Daniel Schroder
Health Insurance Specialist
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Marge Watchorn
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Justin Senior
Medicaid Director
Florida Agency for Health Care
Administration
Tallahassee, FL
Albert W. Shay
Morgan Lewis & Bockius LLP
Washington, DC
Craig H. Smith
Hogan Lovells LLP
Miami, FL
Elllyn Sternfield
Mintz Levin Cohn Ferris Glovsky & Popeo PC
Washington, DC
Brendan G. Stuhan
Senior Associate Counsel
Blue Cross Blue Shield Association
Washington, DC
Stephen M. Sullivan
Sullivan Stolier Knight LC
Lafayette, LA
Donna K. Thiel
King & Spalding LLP
Washington, DC
Christina Smith Ritter, PhD
Deputy Director
Hospital & Ambulatory Policy Group,
Center for Medicare
Centers for Medicare and Medicaid Services
Windsor Hill, MC
Megan Tinker
Senior Counsel
Office of the Inspector General
US Department of Health and Human
Services
Washington, DC
Vicki L. Robinson
Senior Counselor to the Inspector General
Office of the Inspector General
US Department of Health and Human
Services
Washington, DC
Emily W. G. Towey
Hancock Daniel Johnson & Nagle PC
Richmond, VA
13
Stephanie A. Webster
Akin Gump Strauss Hauer & Feld LLP
Washington, DC
Sidney S. Welch
Kilpatrick Townsend & Stockton LLP
Atlanta, GA
Barbara S. Williams
Powers Pyles Sutter & Verville PC
Washington, DC
Laurence Wilson
Chronic Care Policy Group
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Lisa Ohrin Wilson
Senior Technical Advisor
Centers for Medicare and Medicaid Services
Windsor Mill, MD
Susan Winkler
Assistant US Attorney
US Attorney’s Office
Boston, MA
Eric Zimmerman
McDermott Will & Emery LLP
Washington, DC
Institute on Medicare and Medicaid Payment Issues
Program at a Glance
Tuesday, March 24, 2015
Registration and Information
6:30–
8:30 pm
Wednesday, March 25, 2015
7:00 am–
5:45 pm
8:00–
10:00 am
Registration and Information
A. Fundamentals of Medicare and
Medicaid Reimbursement
(not repeated)
C. Advanced Provider and Supplier
Enrollment
(not repeated)
B. Masters Level Session: Current
Issues in Medicaid: Start Paying
Attention
(not repeated)
Eyman
Gallant
Luband
Smith
Tinker
Alexander
Barker
Hamme
Burns
Joy
Killingbeck
10:00–
10:10 am
Coffee Break sponsored by PYA
10:10 am–
12:20 pm
GENERAL SESSION
10:10–10:30 am
Welcome and Introduction
Cade, Cornell, Pavarini, Roth
10:30–11:00 am
Conference Overview: Look Back on 2014
Flynn, Roth
11:00–11:30 am
CMS Present and Future Issues
Hartstein, Wilson
11:30–11:45
Update on Office of Inspector General Initiatives
Demske
11:45–12:20
Learn from My Mistakes
D. Barry
12:20–
1:35 pm
1:45–
3:15 pm
Extended
Sessions
Lunch on your own or attend the Regulation, Accreditation, and Payment and Health Information Technology Practice
Groups Joint Luncheon OR the Payers, Plans, and Managed Care Practice Group
and Behavioral Health Task Force Joint Luncheon
(additional fee; limited attendance; pre-registration required; see page 18 for more information)
E. Fraud and Abuse
D. Medicaid
Expansion and Primer for the New
Health Care World
Maintenance:
(not repeated)
A View from the
States
(not repeated)
Evans
Hammer
Smith
Senior
Barsky
Dailey
Robinson
F. Medicare
Physician Fee
Schedule
G. Meaningful Use– H. Recent Developments
in Fraud and Abuse
Stage 3 Coming,
Prevention and
Stages 1 and 2
Enforcement
Compliance
Burch
Flynn
Holland
Hilgers
Smith Ritter
Welch
14
Barry
Bueno
Laemmle-Weidenfeld
Nolan
J. The Medicare
DSH Payment
Cheng
Hoskins
Keough
Baltimore, MD
Program at a Glance
Wednesday, March 25, 2015 (continued)
3:30–
4:30 pm
4:45–
5:45 pm
K. Introduction
to Medical
Coding for
Payment
Lawyers
(not repeated)
L. Medicare
Advantage–New
Developments
and Key Legal
Issues
M. Unraveling
the Knots: Stark
and Medicare
Reimbursement Principles
Intertwinings
Elucidated
Pelaia
Hance
Gosfield
Q. Provider
Audit
Contractors
(not repeated)
R. Current Issues in Medicaid
Supplemental
Payments and
Financing
(not repeated)
S. Legal Ethics:
Conflicting Laws/
Conflicting Duties: Professional
Responsibility Issues when
Federal and State
Laws Are
Inconsistent
Eyman
Luband
Demetriou
Winkler
Brandt
Korpela
Wachler
N. ICD-10
Transition: What
Health Lawyers
Need to Know
O. Update on
Medicare’s
Two-Midnight
Rule: Where
Things Stand
in 2015
P. The 340B
Program:
Overview,
Compliance, and
What to Expect in
the Year Ahead
Chicoine
Hall
Hartstein
Polston
Sternfield
Williams
T. Recent Cost
Report Appeal
Issues
L. Medicare
Advantage–New
Developments
and Key Legal
Issues
(repeat)
M. Unraveling
the Knots: Stark
and Medicare
Reimbursement
Principles
Intertwinings
Elucidated
(repeat)
Hance
Gosfield
Goldsmith
Lyons
Peabody
5:45–
6:45 pm
Celebrating Diversity+Inclusion Reception, sponsored by the AHLA Diversity+Inclusion Council
(all faculty and attendees are welcome)
6:45–
9:30 pm
Networking Reception at the American Visionary Arts Museum, sponsored by PYA
(attendees, faculty, children, and registered spouses and guests welcome; transportation will be provided)
Thursday, March 26, 2015
Registration and Information
7:00 am–
5:45 pm
7:00–
8:15 am
Continental Breakfast, sponsored by PYA
(attendees, faculty, children, and registered spouses and guests welcome)
7:00–
8:00 am
Medicare Legislative Update: What to Expect from Congress
Zimmerman
8:15–
9:45 am
Extended
Sessions
U. Medicare
Claims
Appeals–Soup
to Nuts
(not repeated)
Herrmann
Kelly
Thiel
10:0011:00 am
Y. PRRB
Workshop
(not repeated)
Connelly
Crofton
Peabody
V. Fundamentals of Provider
Enrollment
W. Post-Acute
Care
X. Hospital
Inpatient PPS
Update
G. Meaningful
Use–Stage 3
Coming, Stages 1
and 2 Compliance
(repeat)
H. Recent Developments in Fraud and
Abuse Prevention
and Enforcement
(repeat)
Hellow
Schroder
Treitel (invited)
Burch
Flynn
Holland
K. Barry
Bueno
Laemmle-Weidenfeld
Nolan
CC. Hot Topics
in Overpayments
and Stark
Self-Disclosures
Towey
Vance
Banach
Roskey
Z. Mental and
Addiction
Treatment:
Moving
Forward
(not repeated)
AA. ProviderBased Status,
Under
Arrangements,
Enrollment, and
Related Medicare
Requirements
BB. Cutting Edge
Stark Issues
Ruskin
Vernaglia
Holden
Matyas
Covall
15
Crane
Ohrin Wilson
Roth
O. Update on
Medicare’s
Two-Midnight
Rule: Where Things
Stand in 2015
(repeat)
Hartstein
Polston
Institute on Medicare and Medicaid Payment Issues
Program at a Glance
Thursday, March 26, 2015 (continued)
11:15 am–
12:15 pm
DD. Primer on
Researching
Medicare and
Medicaid Issues:
Sources and
Techniques
(not repeated)
EE. Medicaid
Expansion
(not repeated)
FF. Standing
Orders, Ordered
Protocols, and
Standardized
Order Sets
GG. Not Just for
Geeks: Why You
and Your Client’s
Executives Need
to Understand
Medicare’s
Change of
Ownership
(“CHOW”) Rules
P. The 340B
Program:
Overview,
Compliance, and
What to Expect in
the Year Ahead
(repeat)
S. Legal Ethics:
Conflicting Laws/
Conflicting Duties:
Professional
Responsibility
Issues when Federal
and State Laws Are
Inconsistent
(repeat)
Blake-Fall
Choe
Fishman
Gallant
Blanchard
Ragsdale
Lundelius
Miley
Sternfield
Williams
Demetriou
Winkler
Lunch on your own or attend the Accountable Care Organization and
Healthcare Reform Education Task Forces Joint Luncheon
(additional fee; limited attendance; pre-registration required; see page 18 for more information)
12:15–
1:35 pm
1:45–
2:45 pm
3:00–
4:00 pm
HH. Medicare
Claims–
Substantive
and Sampling
(not repeated)
JJ. Providing
and Billing for
Transitional
and
Chronic Care
Management
KK. Medicare
Litigation Update
N. ICD-10
Transition: What
Health Lawyers
Need to Know
(repeat)
BB. Cutting Edge
Stark Issues
(repeat)
Greenspan
Perling
Jarrin
Ross
Balderston
Rossman
Chicoine
Hall
Holden
Matyas
LL. PRRB
Appeals–The
View from the
Board
(not repeated)
MM. Calendar Year 2015
OPPS Update
NN. It Don’t
Mean a Thing
if It Ain’t Got
Jurisdiction: The
Expanded Significance of Jurisdiction Practice
Before the PRRB
T. Recent Cost
Report Appeal
Issues
(repeat)
AA. ProviderBased Status,
Under
Arrangements,
Enrollment, and
Related Medicare
Requirements
(repeat)
Beer
Marcus
Stuhan
Goldsmith
Lyons
Peabody
GG. Not Just for
Geeks: Why You
and Your Client’s
Executives Need
to Understand
Medicare’s Change
of Ownership
(“CHOW”) Rules
(repeat)
Ruskin
Vernaglia
Lundelius
Miley
QQ. Emerging
Administrative
Enforcement
Tools
RR. Graduate
Medical Education
J. The Medicare
DSH Payment
(repeat)
X. Hospital
Inpatient PPS
Update
(repeat)
Coons
Johnson
Mihalich-Levin
Cheng
Hoskins
Keough
Hellow
Schroder
Treitel (invited)
Daniel
Jackson
Markowitz
Rinkle
Harty
4:15–
5:45 pm
Extended
Sessions
OO. Medicaid
Litigation
Update
(not repeated)
Bookman
Dorn
PP. PRRB
Appeals:
Current
Challenges
(not repeated)
Korpela
Marolf-Fetchik
Ogilvie
Webster
Burns
Waltz
CC. Hot Topics in
Overpayments and
Stark SelfDisclosures
(repeat)
Crane
Ohrin Wilson
Roth
5:45–
6:45 pm
Reception at the Baltimore Marriott Waterfront Hotel, sponsored by PYA
(attendees, faculty, children, and registered spouses and guests welcome)
7:00 pm
Life Members Networking Dinner OR Young Professionals Networking Dinner
If you would like to go to dinner with some of your colleagues (everyone pays for their own dinner).
See page 18 for more information; RSVP on the registration form.
16
Baltimore, MD
Program at a Glance
Friday, March 27, 2015
Registration and Information
7:00 am–
1:00 pm
7:00–
8:00 am
Continental Breakfast, sponsored by PYA
(attendees, faculty, children and registered spouses and guests welcome)
7:00–
7:50 am
Women’s Networking Breakfast, sponsored by the Women’s Leadership Council
(attendees and faculty welcome; RSVP on the registration form; see page 18 for more information)
8:00–
9:30 am
Extended
Sessions
SS. Current
and Emerging
Issues in Rural
Medicare Policy
(not repeated)
Axelrod
Cook
Fischbach
Watchorn
9:45–
10:45 am
TT. Making Payfor-Performance
(P4P) Pay:
Opportunities
and Pitfalls
of a Shifting
Reimbursement
Paradigm
(not repeated)
Hettich
Love
11:00–
11:30 am
UU. Diagnostic
Imaging Services
F. Medicare
Physician Fee
Schedule
(repeat)
V. Fundamentals
of Provider
Enrollment
(repeat)
W. Post-Acute
Care
(repeat)
QQ. Emerging
Administrative
Enforcement
Tools
(repeat)
Hilgers
Welch
Towey
Vance
Banach
Roskey
Burns
Waltz
FF. Standing
Orders, Ordered
Protocols, and
Standardized
Order Sets
(repeat)
JJ. Providing
and Billing for
Transitional and
Chronic Care
Management
(repeat)
KK. Medicare
Litigation
Update
(repeat)
MM. Calendar
Year 2015 OPPS
Update
(repeat)
Balderston
Rossman
Daniel
Jackson
Markowitz
Rinkle
Blanchard
Ragsdale
ZZ. Emergency
Services
Gaines
Rotella
12:30–
1:00 pm
NN. It Don’t
Mean a Thing
if It Ain’t Got
Jurisdiction:
The Expanded
Significance
of Jurisdiction
Practice Before
the PRRB
(repeat)
Beer
Marcus
Stuhan
XX. Clinical Labs
YY. FQHCs, RHCs, and
CHCs: The Year in Review
Kolarik Anderson
Kazon
Ghiladi
AAA. Home
Health and
Hospice Update
UU. Diagnostic
Imaging Services
(repeat)
XX. Clinical Labs
(repeat)
YY. FQHCs, RHCs, and
CHCs: The Year in Review
(repeat)
Dombi
Greeson
Kazon
Ghiladi
Shay
Sullivan
VV. Long Term Care Hospitals–
Regulatory Update
(repeat)
Shay
Sullivan
Coons
Johnson
Mihalich-Levin
WW. DMEPOS
Supplier Practice
Tips from
Enrollment to
Payment
VV. Long Term
Care Hospitals–
Regulatory Update
Greeson
11:45 am–
12:15 pm
Jarrin
Ross
RR. Graduate
Medical
Education
(repeat)
WW. DMEPOS Supplier
Practice Tips from
Enrollment to Payment
(repeat)
Kolarik Anderson
17
ZZ. Emergency Services
(repeat)
Gaines
Rotella
AAA. Home Health and
Hospice Update
(repeat)
Dombi
Institute on Medicare and Medicaid Payment Issues
Additional Program Information
NETWORKING OPPORTUNITIES
Dennis Smith, McKenna Long & Aldridge LLP, Washington, DC
Thursday, March 26, 12:15–1:35 pm
Accountable Care Organizations and the Health Care
Reform Education Task Forces (joint luncheon)
The Medicare Shared Savings Program—Lessons from
the Past, for the Present, and into the Future
Dr. Terri Postma, Medical Officer of the Centers for Medicare
and Medicaid Services, Windsor Mill, MD
Dr. Dennis Weaver, Chief Medical Officer and Executive Vice
President of The Advisory Board Company, Vernon Hills, IL
Wednesday, March 25, 5:45–6:45 pm
Celebrating Diversity+Inclusion Reception, sponsored by
AHLA’s Diversity+Inclusion Council
Celebrate, connect with one another, learn what AHLA is
doing to integrate diversity throughout the Association,
share, learn, network, and enjoy together. Attendees and
faculty welcome; RSVP on the registration form on page 19.
Practice Group Luncheons
There is an additional fee, pre-registration is required, and
space is limited for both of these luncheons. Register on
page 19.
Thursday, March 26, 7:00 pm
Young Professionals Networking Dinner OR Life
Member Networking Dinner
Calling all young professionals OR life members! We are
hosting groups for dinner together at area restaurants.
Dinner will be on your own dime, but the time spent with
your colleagues and AHLA leaders will be priceless. RSVP
on the registration form on page 19.
Wednesday, March 25, 12:20–1:35 pm
Regulation, Accreditation, and Payment and Health
Information and Technology Practice Group
(joint luncheon)
The Ever-Changing Legislative and Reimbursement
Landscape that is Telemedicine
Alexis Gilroy, Jones Day, Washington, DC (Moderator)
Gary Capistrant, Chief Policy Officer, American
Telemedicine Association, Washington, DC
Jordan See, Communications Director and Chief Health Care
Policy Advisor to Congressman Gregg Harper, Washington, DC
Congressman Gregg Harper (Invited, R-MS), Washington, DC
Friday, March 27, 7:00–7:50 am
Women’s Networking Breakfast, sponsored by the
Women’s Leadership Council
Join us for breakfast and hear a panel of experts share their
tips, advice, and takeaways on leadership, executive presence, and more. Prior to and after the panel discussion, you
will have the opportunity to speak with members of the
Women’s Leadership Council. There will be time to network
with one another. Attendees and faculty welcome; limited
space; RSVP on registration form on page 19.
Payers, Plans, and Managed Care Practice Group and
Behavioral Health Task Force (joint luncheon)
The Changing Landscape of Medicaid Coverage of
Behavioral Health
Suzanne J. Scrutton, Vorys Sater Seymour and Pease LLP,
Columbus, OH
REGISTRATION INFORMATION
Registration Fees:
Postmarked and paid by March 10, 2015
$855 for the first AHLA Member
$780 for each additional AHLA Member from the same
organization/firm
$1095 Non-Members
Postmarked and paid between March 11–March 17, 2015*
$980 for the first AHLA Member
$905 for each additional AHLA Member from the same
organization/firm
$1220 Non-Members
Printed Course Materials: $90
*Registration Fees increase $100 after this date.
Membership: Dues are $200 for those admitted to the Bar/
graduated from college within the last four years; $320 for
those admitted/graduated between four and eight years ago;
and $365 for those admitted/graduated eight or more years
ago. Dues are $100 for government employees and full-time
academicians; $85 for paralegals, $100 for public interest
professionals and $25 for fulltime law school students. Include
the applicable membership fee with your registration form and
take advantage of the program registration fee for members.
Cancellations/Substitutions: Cancellations must be
received in writing no later than March 16, 2015. Refunds will
not be issued for cancellations received after this date. Registration fees, less a $125 administrative fee, will be refunded
approximately 3-4 weeks following the program. If you wish to
send a substitute or need more information regarding refund,
complaint and program cancellation policies, please call (202)
833-1100, prompt #5. Please note that registration fees are
based on the AHLA membership status of the individual who
actually attends the program.
18
Baltimore, MD
Registration Form
3
To register: Remit payment and completed registration form by mail to the American Health Lawyers Association • P.O. Box 79340 • Baltimore, MD
21279-0340 or fax with credit card information to (202) 775-2482. To register by phone call (202) 833-1100, prompt #2. If any program is over-subscribed, only AHLA members will be placed on a waiting list. On-site registrations will be accepted on a space-available basis only.
Name:__________________________________________________________________ Member ID #:________________________________________________
First Name for Badge (if different than above):____________________________________________________________________________________________
Title:_______________________________________________________________________________________________________________________________
Organization:________________________________________________________________________________________________________________________
Address:____________________________________________________________________________________________________________________________
City:___________________________________________________________ State:__________________ ZIP+ 4:_____________________________________
Telephone: (______)__________________________________________________ Fax: (______)____________________________________________________
E-Mail:_____________________________________________________________________________________________________________________________
Spouse/Guest _______________________________________________________________________________________________________________________
REGISTRATION INFORMATION
Early Registration Fees (Postmarked and paid on or before March 10, 2015):
AHLA Members: N $855
Non-Members: N $1095
Group Members: N $780 each additional member registering from same organization at same time on the same check or credit card payment
Registration fees (Postmarked and paid on or before March 11-March 17, 2015):
AHLA Members: N $980Non-Members: N $1220
Group Members: N $905 each additional member registering from same organization at same time on the same check or credit card payment
I plan to attend:
N Celebrating Diversity+Inclusion Reception, Wednesday, March 25, 5:45-6:45 pm
N Young Professionals Networking Dinners, Thursday, March 26, 7:00-9:00 pm
N Life Members Dinner, Thursday, March 26, 7:00-9:00 pm
N Women’s Networking Breakfast, Friday, March 27, 7:00-7:50 am
I will require: N Audio
N Visual
N Mobility
N Other assistance_______________
N I have special dietary needs
REGISTRATION INFORMATION
Please fill in applicable amount: (Sorry! Registrations cannot be processed unless accompanied by payment.)
$______________ Registration Fee
$______________ RAP/HIT Practice Group Luncheon OR PPMC/Behavioral Health Task Force Practice Group Joint Luncheon–March 25
($35 for PG Members/$45 for Non-Members)
$______________ Accountable Care Organizations and Health Care Reform Education Task Forces Joint Luncheon –March 26
($35 for AHLA Members/$45 for Non-Members)
$______________ Printed Course Materials ($90) (all attendees will receive an electronic version of the course materials. Attendees may purchase the
binder for an additional fee)
$______________ Membership Dues (Date admitted to the bar/graduated: N N/ N N/ N N)
$______________ Spouse/Guest Fee ($75) Name____________________________________
$______________ Total Enclosed
N Check enclosed (Make checks payable to American Health Lawyers Association)
Bill my credit card:
N Á
N Ò
N Å
N ¸
N Diners Club
Number: _________________________________________________________________________
Exp. Date: N N/N N
Name of Cardholder:_________________________________________________________________________________________________________________
Signature of Cardholder:______________________________________________________________________________________________________________
ZIP Code of Cardholder’s Billing Address _______________________________________________________________________________________________
Please Note: Should your credit card total be miscalculated, AHLA will charge your credit card for the correct amount. To receive a refund of the registration fee paid minus $125, cancellation notice must be received in writing by March 16, 2015.
Fed ID No. 23-7333380
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For updates and to register, go to
www.healthlawyers.org/programs
March 25-27, 2015
Baltimore Waterfront
Marriott Hotel •
Baltimore, MD
1620 Eye Street, NW
6th Floor
Washington, DC 20006-4010
Presorted
Permit No. 4841
Suburban, MD
U.S. Postage Paid
First-Class Mail