|Workshop: Risk Reality and Preventative Solutions In The Commercial Payer Landscape|
When: September 7, 2018 at 10:00 am - 1:00 pm CST
Where: Lin and Patel Conference Facilities, Chicago
Pricing: $75 for Non-Members / $50 for BHAP Members
Register by phone at (888) 958-2282
The only Risky Business we like is that movie with Tom Cruise ... and to be fair, we don't like it that much anymore -- it hasn't aged well.
But there is one thing in our space that never gets old: a provider billing an insurance company runs the risk of an audit.No one likes an audit, but comprehensive reviews are a reality 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.
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.
There are red flags for fraud detection as the payers employ investigators 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.
Audits 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 workshop, co-sponsored by Infinity Behavioral Health Services, Lin and Patel LLC, Nelson Hardiman, and BHAP, will provide lessons learned for surviving an audit, offer some tips for how to avoid being flagged in the first place, and give an overview of the commercial payer SIU process.
Some of the workshop's highlights:
Industry experts will 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.
*NOTE: Members must be logged into the BHAP website for discount pricing.
Register by phone at (888) 958-2282
Lee Arian is a former Assistant United States Attorney and current Partner at Nelson Hardiman. Lee has dedicated his career fighting for integrity within the American healthcare system. He spent nearly eight years in the U.S. Attorney's Office's Criminal Division Public Corruption and Government Fraud section where he served as the health care fraud coordinator, investigating and prosecuting fraud involving health care, as well as fraud against other government programs, banks, securities and taxes. Sixteen years of litigation and government enforcement experience in both criminal and civil cases has positioned him as a prominent thought leader among Fortune 50 companies. He also served as Vice President for Optum's advisory services team and as Staff Vice President at Anthem, where he oversaw the enterprise fraud and abuse audit efforts, implementing cutting edge tools to ensure regulatory compliance with all federal and state laws relating to recovery. Lee graduated magna cum laude from Georgetown University and earned a Juris Doctor degree from UCLA School of Law.
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.
Michelle E. Lin, Esq.
Michelle E. Lin is a founding Principal with Lin and Patel, LLC. Michelle strategically guides health care providers through the continually-changing regulatory environment. She concentrates her practices in several areas, including payor audits, payment issues, compliance with statutes and regulations, and the sale and purchase of provider practices. Michelle focuses her practice on defending providers against pre- and post-payment audits resulting in overpayments, and has successfully defended clients at all levels of the Medicare appeals process and against other auditing agencies. She also regularly counsels providers regarding corporate and employment related matters.
Amee V. Patel, Esq.
Amee V. Patel, Esq. is a founding Principal with Lin and Patel, LLC. Amy counsels a variety of corporate clients and clients seeking counsel on the establishment, financing, and delivery of health care. She practices in all areas of healthcare law, with a focus on all transactional and coporate aspects of the business, reimbursement issues including payor audits, compliance with both federal and state regulations with a focus on fraud and abuse and general counsel to several corporations. Amy believes every issue she confronts should be viewed through a legal, business and practical lens, a belief that evolved from her past roles as government counsel, private counsel, and general counsel.
Behavioral Health Association of Providers
11835 W Olympic Blvd
Los Angeles, CA 90064
Nelson Hardiman represents healthcare providers, including hospitals, physician organizations, long-term and behavioral care providers, and other healthcare-related organizations, in business litigation, transactions, and regulatory matters. Although we are based in California, our attorneys are routinely asked to advise business organizations that are national in scope. For more than 20 years, our lawyers have focused on regulatory compliance, litigation, and transactions specific to the healthcare industry. We combine specialized experience in a wide range of healthcare sectors with a proactive and attentive approach, making us the most effective choice for healthcare legal matters.
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.
Since 2011, Lin and Patel, LLC. was started as a response to client needs for healthcare legal services from an in-house perspective. Having worked at both firms and in-house at healthcare providers, the firm is able to effectively serve the increasing needs of our clients with the business perspective of an insider. With a concentration in healthcare, our Firm is able to provide tailored services to the specialty area of our clients in an efficient, effective and timely manner.