The Federal government is now aggressively working to reduce Medicare and Medicaid waste and fraud as a part of the larger healthcare reform program. Throughout the past few years, the government has identified billions of dollars improperly paid through Medicare and Medicaid programs. As a result, hospitals now face a new era of healthcare audit accountability. This era is full of a variety of Program Integrity Contractor initiatives and a veritable alphabet soup of acronyms. It is essential for hospitals to understand the roles of each group, how to deal with their findings and, when and how to appeal them. In addition, hospitals must be sure to have strong concurrent compliance programs in place to mitigate risk moving forward.

Join us for a live presentation with Dr. John Zelem, Senior Director of Audit, Compliance and Education for Executive Health Resources. Attendees of this session can take away the ability to:

  • Describe the role of MACs, RACs, PSCs, ZPICs, CERT, MIP, MIG, MICs, PERM and MIGs
  • Recognize the individual program integrity contractors’ findings and how they interrelate
  • Understand and discuss the current status of these programs
  • Identify the direct hospital and provider impact of current regulatory enforcement initiatives
  • Determine how to prioritize focus among these auditing bodies to assess the greatest threats and opportunities for ensuring revenue integrity
  • Recognize when and how to structure an appeal with each of these groups
  • Outline the appropriate steps to proactively ensure compliance

Who Should Attend

  • Healthcare Provider CFO & CEO
  • Chief Compliance Officer
  • Compliance Director
  • Chief Risk Officer
  • Director of Risk Management
  • Director of Regulatory Affairs
  • Hospital Legal/Regulatory Counsel
  • VP/Director of Revenue Cycle

About the Presenter

Dr. Zelem currently serves as a Senior Director, Audit, Compliance and Education for Executive Health Resources (EHR). At present, more than 1,900 hospital and healthcare organizations across the country are using EHR’s solutions. A Board Certified general surgeon with more than 25 years of clinical experience, Dr. Zelem is responsible for quality assessment and improvement at EHR’s client hospitals. Dr. Zelem is also a member of EHR’s physician education team and regularly visits EHR’s client hospitals to provide medical executives and staff members with ongoing education on a variety of topics including Medicare and Medicaid compliance and regulations, medical necessity, Recovery Audit Contractors, utilization review, denials management and length of stay. In addition, Dr. Zelem is a renowned industry author who has published many books and is a well-known motivational speaker and presents often to professional and public/patient audiences on health and wellness, personal development, and leadership and success.

Prior to joining EHR, Dr. Zelem practiced general surgery at Griffin Hospital, a 160-bed acute care community hospital located in Derby, Conn., and then practiced general surgery at Baptist Memorial Hospital-Booneville, a 67-bed acute care hospital located in Booneville, Miss. Dr. Zelem received his medical degree from Boston University School of Medicine and bachelor’s degree in biology from Boston College.

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About Compliance 360 for Healthcare

Compliance 360 is the leading provider of enterprise governance, risk management, compliance and audit management solutions for healthcare providers.  With these solutions, healthcare providers reduce risks, improve efficiencies and protect their brands using a single platform to address their comprehensive GRC requirements. 

The Compliance 360 solution for healthcare addresses the need for policy management, centralized regulatory management including HITECH, HIPAA, EMTALA, STARK and others, Joint Commission Accreditation, OIG corporate integrity agreements (CIA), False Claims Act (FCA) Compliance, adverse-event management, contract management, surveys, remediation projects, claims audits and denials, Medicare RAC audits, Medicaid MIC Audits, self assessments, internal audits, and enterprise risk management.  Over 225,000 active users rely on Compliance 360 everyday to manage their risk, audit and compliance programs.

To learn more about the Compliance 360 solution for healthcare, visit www.compliance360.com/healthcare.

 

Executive Health Resources (EHR)
EHR, The Physician Advisor Company™, is nationally recognized as the leading provider of real-time, point of care, expert Physician Medical Management Solutions that improve hospital revenue integrity and maintain the highest level of quality of care and regulatory compliance.  EHR's expert physicians, the EHR Physician Advisors, provide hospitals and health systems with an outsourced operational, technological, and clinical resource to achieve the hospital’s goal of effectively managing clinical care while maintaining sound financial performance.  Today, EHR's comprehensive solutions help more than 900 hospitals and health systems across the country maintain regulatory compliance and decrease costs by minimizing medical necessity denials, assisting in determining correct medical necessity status, and achieving appropriate lengths of stay. EHR's teams of Physician Advisors are an integral outsourced clinical component of EHR’s clients’ case management, utilization review, compliance, internal audit, risk management and business offices.  To learn more about EHR, please visit www.ehrdocs.com.

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