Registration

1:00 pm – 1:30 pm

Welcome

1:30 pm – 1:35 pm

Navigating Provider Reimbursement from Medicare Advantage Plans

Presenters will discuss recent trends in provider arrangements with Medicare Advantage (“MA”) Plans, including key terms for negotiation, the movement toward value-based models, and common reimbursement issues that arise with MA Plans.

• Negotiation of Payment Terms with MA Plans
• Trends in Payer-Provider Arrangements – Value Based Models
• Reimbursement Issues
  • Underpayments and Appeals
  • Overpayments – Whose rules apply?  MA Plan vs. Regulatory vs. State
  • In-Network vs. Out-of-Network
• Implications for other non-hospital provider types

Panel: Jonathan Buck, Polsinelli

1:35 pm – 2:35 pm

Litigation Against Medicare Advantage Plans for 340(b) Drugs

Presenters will discuss recent developments and opportunities for providers and reimbursement of 340(b) drugs from MA Plans.

• History of 340(b) Underpayments, Legal Challenge, and U.S. Supreme Court ruling
• Application of Supreme Court Ruling to MA Plans
• Current Status of Payer Response and Position
• Hospital/Clinic Strategies for Next Steps to Escalate
• State Law Intervention and Federal Pre-emption
• Other Emerging 340(b) Issues

Panel: David King, Polsinelli; Kyle Vasquez, Polsinelli

2:35 pm – 3:35 pm

BREAK

3:35 pm – 4:05 pm

Risk Adjustment Data Validation – Impacts on Reimbursement and Audits

Presenters will discuss the process for risk adjustment data validation audits performed by MA Plans as well as reimbursement opportunities available for providers.  Presenters will also discuss legal risks with collection of and reimbursement related to risk adjusted diagnosis. 

• Risk Adjustment Data Validation (“RADV”) Process and Objectives
• Reimbursement Opportunities stemming from RADV Audits
• False Claims Act Implications
• Problematic Provider Compensation Models

Panel: Ryan Morgan, Polsinelli

4:05 pm – 5:05 pm

Program Concludes

5:05 pm

Reception – office

5:30 pm

Registration and Breakfast

8:00am – 8:30am

Welcome

8:30am – 8:35am

What is the Value of A Good Audit Plan?

An experienced panel of reimbursement audits and disputes lawyers and consultants will discuss the value of a good audit plan for internal auditing, as well as outside inquiries, such as Covid-19 related inquiries by OIG, behavioral health audits by managed care organizations, and statistical samplings by recovery audit contractors.

• Internal Audits
  • Targeted or routine?
  • Probe v. statistical sample v. 100%?
  • Audit team?
• External Audits
  • CARES Act Audits
  • RACs are BACK
  • Special Audits in Behavioral Health

Panel: Kelly Loya, Pinnacle; Ross Burris, Polsinelli; Colleen Faddick, Polsinelli

8:35am – 9:35am

Homecoming: The Growth of Home-Based Clinical Care

The COVID-19 Pandemic accelerated a pre-existing trend in health care towards the utilization of home-based treatment to promote access and efficiency for all types of populations. Join leaders in home-based care for a discussion of the future of home-based care and the clinical, operational, and legal challenges these providers face as they navigate this expanding frontier.

• Discussion of clinical and reimbursement trends toward increased delivery of health care in the home setting
• Legal, operational, and clinical barriers to home-based care
• Legislative and regulatory changes to improve access to home-based care

Looking to the future – what will home-based care look like in 5 or 10 years, and how will the legal landscape and environment change to accommodate this new world?

Panel: Bill Dombi, President, National Association for Home Care & Hospice; Phil Mitchell, CMO, DispatchHealth; Ryan Thurber, Polsinelli; Kathleen Snow Sutton, Polsinelli

9:35am – 10:35am

Break

10:35am – 10:50am

Hospital and Health System Regulatory Update

A panel of experts will join Danielle Adams, a Nursing Consultant with the Centers for Medicare and Medicaid Services (CMS), to explore recent regulatory developments and future considerations as the Public Health Emergency (PHE) winds down that may impact hospital and health system operations and influence reimbursement decisions.   Topics will include matters involving hospital survey, certification and compliance, including, for example, the following:

• Hospital co-location,
• Expiring federal PHE waivers,
• Acute Hospital Care at Home,
• The new Rural Emergency Hospital conversion,
• Quality assurance under the Medicare Hospital conditions of participation, etc.

Panel: Danielle Adams, Nursing Consultant, Centers for Medicare and Medicaid Services (CMS); Colleen Faddick, Polsinelli; Ross Sallade, Polsinelli

10:50am – 11:50am

Lunch

11:50am – 12:50pm

Is it time for a Payor Engagement Audit?

In the ever-changing landscape of payor strategies and tactics, are providers optimizing reimbursement through effective revenue cycle and contracting strategies? A payor engagement audit may be in order.  In this presentation, we will discuss:

• The purpose of a payor engagement audit
• The elements
• The outputs and deliverables

Panel: Meri Gordon, Polsinelli; Jonathan Buck, Polsinelli

12:50pm – 1:50pm

State Policy Issues:  Are Providers Losing Ground?

• Addressing myths and false narratives
  • Are administrative denials appropriate in the case of medically necessary covered services?
  • Are insurers really the guardian of the realm against providers wildly out of control providing unnecessary services?
  • Are consumers OK with a doctor/hospital centric system if the quality of care is good but experience is otherwise maddening?
• Addressing payor initiatives in the state legislatures
  • Difference between reducing health care costs and reducing health care reimbursement
  • Review of Policy Initiatives addressing provider Operating Expenses
  • Payments for and beyond Professional Fees

Panel: Jennifer Evans, Polsinelli; David King, Polsinelli; Sasha Boghosian, Revive HealthCare; Jeffrey Gold, Hospital Association of NY State (HANYS); Katherine Blair Mulready, Colorado Hospital Association (CHA)

1:50pm – 2:50pm

Break

2:50pm – 3:05pm

Reimbursement for Behavioral Health: Changing Landscape in the Midst of a Mental Health Crisis

Behavioral Health has experienced a tremendous period of growth and attention.  The reimbursement framework for government and commercial payers continues to evolve as the models of care change. Keeping current on reimbursement methodologies for behavioral health, whether integrated or freestanding, will help you protect and grow your behavioral health revenue.  This experienced panel will discuss reimbursement trends across the behavioral health industry and provide key areas of focus to incorporate into your reimbursement strategy.  Topics will include the following:

• The evolving reimbursement models for behavioral health services
• Strategies for integration of behavioral health into physical health settings and across behavioral health sectors
• Reimbursement for telehealth as states and federal government wind down COVID-19 waivers

 Panel: Bragg Hemme, Polsinelli; Joelle Wilson, Polsinelli

3:05pm –4:05pm

Federal Public Policy – Thinking Outside the Box as Part of Reimbursement Strategy

President’s FY24 Budget

• The President’s Health Care Funding Priorities – General Overview
• Implications of proposed funds sequestration on Medicare Program and providers
• Implications for payment rates for hospital inpatient, outpatient, ASC settings, site-neutral payments issue

How to plan for the upcoming year in light of President’s budget

• Review of the legislative process – President’s budget provides a roadmap or blueprint for Congress
• Explain the legislative process around passing the budget

Given pressures on providers to live within packaged or bundled payments, consider advocacy as a tool to improve reimbursement framework

• If Medicare reimbursement policy doesn’t work for you, advocate to change it
• Identify similarly situated entities with whom you can partner in advocacy
• Case Study:  NO PAIN Act – creates separate payment for drug and medical devices that qualify as non-opioid alternatives under the Act
  • Discuss the process and issues to be addressed as part of an advocacy effort
  • Implementation through rulemaking once signed into law

Panel: Julius Hobson, Polsinelli, Martie Ross, PYA, P.C.

4:05pm – 5:05pm

Program Concludes

5:05pm