|Seminar: Special Investigations Unit (SIU) - What to Know in a Commercial Payer Audit|
When: April 13, 2017 at 11:00 AM - 1:30 PM (Seminar/Lunch Included)
Where: Nelson Hardiman Conference Facilities
Pricing: $75 for Non-Members / $50 for AATA Members
What’s your reaction when you hear the word AUDIT?
It’s the one word that can send staff into a panic.
No one likes an audit but comprehensive reviews are becoming common in the addiction treatment and recovery industry. With heightened attention toward billing practices, providers need to be proactive in preventing and eliminating accusations of fraud or abuse.
Most large insurance companies have special investigations units (SIU) that routinely identify, investigate, and expose fraudulent practices. There are best practices to handle an audit that will benefit your recovery program or addiction treatment center. There are also best practices to avoid being audited.
Why is a provider the target of an investigation? Red-flagged!
There are red flags for fraud detection as the SIU’s are employed to look for anything that resembles fraudulent practices. One red flag can trigger an investigation or audit, which results in a full review of a provider’s insurance methods, billing practices, referrals, marketing practices, medical and billing records, spreadsheets, claim information, and supporting documentation. Enforcement actions may result from an investigation by the SIU. That can include freezing all payments until the investigation is complete, accusations of fraud, or a court case.
Any provider billing an insurance company runs the risk of an audit, which can have severe consequences for both finances and workflow. As the behavioral health field expands to better meet the needs of a national addiction crisis, payers are putting more attention on the industry, and subjecting providers to significantly more scrutiny.
This seminar, co-sponsored by Infinity Behavioral Health Services, Nelson Hardiman, and AATA, will give an overview of the commercial payer SIU process, provide lessons learned for surviving an audit, and offer some tips for how to avoid being flagged in the first place.
Industry experts will walk you through an audit from start to finish and go through the possible outcomes. They will also discuss the issues most frequently addressed by payers, how to address them in an audit, and how to make the changes to your practice today to lower the chance of being audited.
Avoid an audit and be informed!
*NOTE: Members must be logged into the AATA website for discount pricing.
See lunch options on the registration page.
Frank Brady is Director of West Coast Operations for Infinity Behavioral Health Services, a revenue cycle management company that specializes solely in behavioral healthcare. Frank joined Infinity shortly after the company’s inception in 2011 and has since filled a number of roles, which have been integral to Infinity’s growth and development. Since launching Infinity’s Los Angeles office, Frank has consulted for a wide variety of behavioral healthcare providers in all corners of the United States and has been instrumental in furthering Infinity’s understanding of treatment culture in the west. Like many other members of Infinity’s executive team, Frank’s previous experience is in direct patient care.
Zach Rothenberg is a partner at Nelson Hardiman with nearly 15 years of experience litigating business disputes in federal and state courts and in arbitration. Zach’s practice focuses primarily on litigating healthcare industry business disputes. Zach regularly represents healthcare clients in cases involving breach of contract, fraud, unfair competition, and misuse of trade secrets, among others. Zach also has deep experience litigating employment-related cases, on behalf of both employers and employees, and litigating payment disputes involving managed care entities. Zach’s healthcare clients have ranged from individual doctors, nurses, and other individual healthcare providers, to ambulatory surgery centers, pharmacies, and drug rehabilitation facilities, to hospitals and Independent Practice Associations (“IPAs”).
Max Sirianni is General Counsel and Chief Compliance Officer for Infinity Behavioral Health Services. As in-house counsel for Infinity, Max provides comprehensive internal representation for Infinity including keeping Infinity ahead of an ever-changing legal landscape for behavioral healthcare, developing strategic partnerships for growth, and directing activities to limit risk and maintain compliance. Max graduated from Georgetown University Law School in 2013, and is admitted to practice in Florida and Colorado. Prior to his position at Infinity, Max worked as a Public Defender in Colorado where he represented defendants in many jury trials and hundreds of contested judicial hearings.
Nelson Hardiman Conference Facilities
11835 W. Olympic Blvd.
Los Angeles, CA 90064
Infinity Behavioral Health Services
Since 2011, Infinity Behavioral Health Services has been providing unparalleled revenue cycle management services to behavioral healthcare providers. As a result of our operational experience, we deeply understand the day-to-day issues that arise in attempting to navigate managed care companies. Our goal is to help you enhance your quality of service, while increasing revenue and maintaining compliance with industry and managed care standards.