With over 2800 registrants this year, the conference was more vibrant than ever before. Overall the agenda was great with some very good keynote sessions and there were a wide variety of breakout sessions to select from.
If you missed this year’s HCCA National Conference, don’t you worry–we were there and have summarized some of the main topics and subject areas addressed regarding regulations, standards, and compliance.
Regulations and Standards
Nancy Griswold, Chief Administrative Judge with the Department of Health and Human Services’ (DHHS), Office of Medicare Hearings and Appeals, gave us a look into some of the important initiatives at the appeal level. For example:
- Settlement Conference Facilitation (SCF) which allows providers to have open settlement discussions with the Centers for Medicare and Medicaid Services (CMS). She informed the group that 10,838 such appeals have been resolved since June 2014. Additionally, she discussed major reforms in the Medicare Appeals process – changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures (82 FR 4974).
- Another key regulatory area covered was the CMS’s Final Rule on Reform of Requirements for Long Term Care Facilities. The presentation centered around the new Requirements of Participation (ROPs), examining, among other things, the themes of the rule (person-centered care, quality of care and quality of life, changing patient population etc.) and its alignment with the HHS’ priorities (reducing unnecessary hospitalizations, improving behavioral healthcare, reducing incidences of healthcare acquired infections/adverse events etc.).
Compliance, of course, was a big focus and many aspects were addressed, including:
- How best to start your compliance program,
- How to build an effective compliance program,
- How to conduct an effective and compliant internal investigation,
- How to build your resume as a Compliance Professional, and
- How to combat stress and burnout on the job.
One of the topics that stood out the most for us however, was on HIPAA compliance, where the speakers delved into understanding the latest industry trends and the potential for a government audit, and how to use the seven (7) elements of a compliance program combined with the HIPAA audit tool as a basis for compliance with HIPAA.
Another topic of importance was on maintaining laboratory compliance in an environment that is changing and uncertain. Here the discussion surrounded various compliance issues that laboratories must handle inclusive of marketing arrangements and reporting requirements under the Protecting Access to Medicare Act (PAMA); initiatives regarding enforcement of legal and regulatory authorities such as failure to return overpayments, proceedings against referring physicians and laboratory executives, and using private contractors. The presenters also expounded on practices that lead to laboratories being sanctioned and ways to mitigate resulting legal and regulatory risks.
OIG’s Resource Guide on Measuring Compliance Program Effectiveness
A major takeaway from the conference in the area of compliance was an update from the Office of Inspector General (OIG), where the Inspector General informed the group that the OIG, working with compliance professionals, developed and have released a resource guide for measuring the effectiveness of compliance programs. This document, Measuring Compliance Program Effectiveness: A Resource Guide, provides metrics for evaluating all seven (7) elements of a compliance program separated into what to measure and how to measure it. The audience was cautioned that this document should not be used as a standard or for certification purposes and no one should aim to implement all or even most of the metrics covered in the guide. Instead, individual organizations should select metrics that are appropriate for them based on their size, risk areas, industry segment etc.
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