Is It Really Illegal? How to Avoid Unnecessary Refunds and Investigations

“But I’ve heard that’s illegal!” While the actual words may vary, this statement sums up a sentiment heard in hospitals and physician offices, and it’s often expressed by well-meaning individuals who possess little or no legal background. For example, someone believes that a particular service should not be billed because it doesn’t conform to a local coverage determinations (LCD). Or that the hospital should issue a payer refund because the physician performing a procedure lacked medical staff privileges.

All too often, these opinions are misinformed. And simply wrong. Yet healthcare decision-makers erroneously capitulate to one person’s “legal opinion,” leading to unwarranted refunds. In other instances, the opinions of these individuals are overridden, prompting them to resign and/or report the alleged infraction to the applicable external entity —potentially triggering a baseless investigation.

How can you respond more effectively to these types of situations? Better yet, how can you prevent them from happening in the first place? Join us for this RACmonitor webcast as esteemed health care attorney and popular Monitor Mondays panelist David Glaser provides guidance with navigating tricky “legal vs. illegal” questions, from tips for hiring the right compliance professionals, to strategies for ensuring that discussions are constructive and decisions are backed up by sound research. Along the way, you’ll gain valuable insights from a wealth of real-life case examples.

Why This Is Relevant:

Legally flawed decisions could easily cost your organization millions of dollars over time, especially when these mistakes occur repeatedly. Certainly, your revenue stream suffers from needlessly refunded payments. But there are other negative impacts, including the costs of preparing for, and responding to, an investigation, not to mention the human toll resulting from staff who quit because they mistakenly believe that laws have been broken. Just one hour with David Glaser could pave the way for preventing needless hits to your bottom line, while calming employees and reducing turmoil within your organization.

Learning Objectives:

• Identify improvements to the process of hiring individuals with compliance responsibilities
• Learn how to explain complicated rules and the legal hierarchy to both compliance and clinical staff
• Be able to analyze contradictory “expert opinions” and reduce the legal anxiety that can cause employees to quit and/or become external whistleblowers
• Get insights into real-life situations involving compliance professionals who correctly or incorrectly concluded something was illegal

Who Should Attend:

Chief financial officer, compliance professionals, in-house counsel, staff involved with appeals and denials, billing staff, HIM professionals, coders, clinical documentation integrity (CDI) specialists and physician advisors.