Policy Management

Webinar Replay - What Are the Experts Saying: Delay, Deregulate, Derail — Health Care Roiled by Actions of Trump and Congress

Since January, both President Trump and Republican leaders in Congress have talked about a three-step process for repealing and replacing the Patient Protection and Affordable Care Act (ACA). While the first six months of the Trump administration has seen mixed results, its efforts to reign in or hold back regulations, combined with its delay in filling lower-level agency roles, has impacted regulatory review and issuance of new regulations. So, despite Congress’ inability to pass legislation to change parts of the ACA, there is still plenty for providers to be concerned about.

Claims Adjudication and Payer Rules under ICD-10

Rayellen Kishbach's picture

Because we process thousands of LCDs updates weekly for our Coding Suite, we often get some insights that we can share. With the implementation of ICD-10, a significant drop off in the number of local coverage determinations (LCDs) and coverage articles published by the Medicare Administrative Contractors (MACs) has occurred. (See table in the white paper link below). While this may be partly due to MAC consolidation, it has left providers with less guidance than before about the proper coding and billing of covered services.

How health care economics teams communicate with payers (and other healthcare entities)

Rayellen Kishbach's picture

In January 2017, the FDA released draft guidance specifying the nature of communications between manufacturers and payers: The first draft guidance, entitled “Drug and Device Manufacturer Communications with Payers, Formulary Committees, and Similar Entities--Questions and Answers,” provides answers to common questions regarding communications of health care economic information (HCEI) about their approved prescription drugs to payers.

Webinar Replay-Compliance Accountability: Lessons Learned from Implementing Corporate Integrity Agreements

Corporate Integrity Agreements (CIAs) are among the most important means used by DHHS OIG for promoting compliance in the healthcare industry. Recent CIAs also provide an up-to-date perspective on the OIG’s priorities and concerns in a particular industry sector, as well as important insights into what the OIG believes to be effective oversight and operational controls for healthcare organizations. At any given time there are more than 300 CIAs in place with three or four on average being added monthly.

Webinar Replay: 2017 OIG Work Plan—A Continuum of Risk

The OIG’s introduction of a mid-year update to its Work Plan now requires healthcare organizations to view the Work Plan as an ongoing, continuous process. Organizations not only need to review and act upon the areas introduced in the fall with the Work Plan’s traditional release, but also must now pivot and respond to new or revised areas of focus introduced with the mid-year update in the spring.

Webinar Replay-Compliance Basics for the Skilled Nursing Facility

A Corporate Compliance Program is the Long Term Care provider's formalized and proactive approach towards detecting fraud, abuse, and waste of precious company resources. This live webinar will cover the historic perspective of compliance, the seven elements of a compliance program, and describe the changing landscape of compliance enforcement to help providers address risk.

LEARNING OBJECTIVES:

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