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Billing Company Contracts: Navigating Accountability & Pitfalls to Protect from Costly Penalties
$249.00 – $255.00
Even hospitals are increasingly outsourcing their billing functions as claims submission gets more complicated with new codes and increasing enrollment challenges. Many of these companies not only handle billing and collection, but enrollment and credentialing of physicians. Many billing company contracts are totally inadequate to their purposes, especially given the liability their errors can create. This session considers the allocation of responsibilities between the parties, including physician practices, performance metrics, post-termination obligations, Medicare reimbursement rules about them, what the OIG has said a lot and what happens when things go wrong. This is a must for anyone thinking of outsourcing billing, or renewing their billing company arrangements. The companies have legitimate expectations of their customers as well that should also be understood.
Learning Outcomes:
- To understand the contents of typical billing company contracts
- To appreciate the potential risks that lurk in their language
- To understand the Medicare reassignment rules
- To understand the OIG’s views of these arrangements
- To comply with the OIG compliance guidelines
- To consider issues to be negotiated before entering into them
Areas Covered in the Session:
- How did they first get created
- Compensation issues
- Percentage based
- Fixed Fee
- Being More Creative using Mix
- Performance metrics
- Allocation of responsibilities
- Data Transmission
- Company access to EMR or practice management software?
- Transmission of encounter data electronically, by paper or both
- Who does coding?
- Operational Responsibilities
- Company typically disclaims any responsibility for prior A/R which remains the responsibility of the practice
- Who collects co-pays?
- What happens post-termination?
- Company’s representation regarding maintenance of its compliance program
- Enrollment and Credentialing with Payers
- Data Management under HIPAA and OIG
- Reporting Responsibilities
- Indemnification
- Termination
- Data Transmission
- Medicare reassignment rules governing them
- What the OIG has said to them
- Model Compliance Guidance published 63 Federal Register 70138-70152
- Why the OIG cares
- 14 potential benefits of a compliance program to the billing company
- Incorporates the seven basic components the OIG recommends for all compliance programs regardless of what sector of the industry
- How troubles arise
- HIPAA
- Fraud
- Breach of Contract
- Live Q&A Session
Recommended participants:
- Healthcare Executives
- Physician Practice Managers
- Physicians and Non-Physicians Providers
- Hospital Billing Managers
- Billing Company Managers
- Medical Clinics
- Medical Practice Owners
- C-level executives
- Consultants
- Health insurance payers
- Anyone those with Financial Responsibility for Billing
- Any Health Care Entity which Contracts with a Billing Company
Presenter Biography:
Alice G. Gosfield, Esq., is a renowned attorney specializing in health law and regulatory compliance. With decades of experience advising healthcare providers on legal matters, Alice has a deep understanding of the intricacies of billing contracts and the regulatory frameworks surrounding them. She frequently advises clients on best practices for navigating complex contractual agreements to minimize risk and ensure compliance.
Ms. Gosfield served as Chairman of the Board of Directors of the National Committee for Quality Assurance, reelected to serve five terms from 1998 through 2002. She served on the Board for twelve years from1992 through 2003. In the public policy arena, she has served on four committees of the Institute of Medicine of the National Academy of Sciences studying issues involving utilization management and clinical practice guidelines and has served as an advisor to the Agency for Health Care Policy and Research in both evaluating one of their first three clinical practice guidelines and in developing methodologies to translate guidelines into medical review criteria, performance measures and standards of quality.
She has been called on by the Congressional Budget Office, the General Accounting Office, the Robert Wood Johnson Foundation, the Federal Agency for Healthcare Research and Quality, the Joint Commission, and others to advise on issues pertaining to Medicare reimbursement, medical evidence, legislation dealing with medical necessity in managed care and tort reform. Ms. Gosfield served as President of the American Health Lawyers Association (formerly the National Health Lawyers Association), from 1992-1993 and chaired their Physician and Physician Organizations Institute from 2001 through 2006.
Additional Information:
After registration, You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.
System Requirement:
- Internet Speed: Preferably above 1 MBPS
- Headset: Any decent headset and microphone which can be used to talk and hear clearly
Can’t Listen Live?
No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact: Toll-Free No: +1 800-757-9502 Email: cs@waymoreeducation.com
