Medical Necessity - Primer on Key Legal Principles and Operational Compliance

Why Should You Attend:

'Medical Necessity' principles are a fundamental component of health care delivery and payment for both government and private health plans. Moreover, both individual and organizational providers face undesirable consequences if they do not learn and follow these principles. The consequences range from mere ‘warning notices’ to possible criminal charges.

The objective of this 90-minute webinar is to provide a solid frame of reference for those who must deal with ‘medical necessity’ issues as part of their core job responsibilities.

The session designed to provide historical and legal context that will help attendees understand the social and payment policies related to medical necessity determinations, as applied in our health care industry. The webinar also will analyze specific statutory and regulatory authorities that are the sources of most interpretive differences of what is or is not a ‘medically necessary’ item or service. Several, specific examples of clinical services will be discussed.

Areas Covered in the Webinar:

• Legal Overview
• Examples of how payment reforms relate to ‘medical necessity’
• Enforcement techniques and related sanctions
• Suggestions for reducing risks of denials, repayment obligations and other legal penalties
• Methods to educate and train providers and support personnel on ‘medical necessity’

Who will benefit:

The following personnel in medical offices, hospitals, medical centers and clinics will benefit:

• Clinical Service Administrators
• Process Improvement Teams, especially Revenue Cycle and Patient Accounts
• Clinicians
• Compliance Professionals
• Financial Officers
• Physicians

It will also benefit business associates providing accounting and billing services.

Instructor Profile:

John E. Steiner, Jr., Esq., CHC, CCEP, is the Chief Compliance and Privacy Officer and Associate General Counsel for Cancer Treatment Centers of America (CTCA), based in Schaumburg, Illinois. He is a member of the Executive Team and responsible for the design, implementation and administration of an enterprise compliance program. He is a national speaker on health law and compliance topics. He also is a nationally recognized author and editor of a variety of health care and compliance publications.

Prior to his current position, Mr. Steiner served as the Chief Compliance Officer for UK HealthCare of the University of Kentucky, Lexington, Kentucky, where he was responsible for the enterprise wide compliance program. Mr. Steiner previously served as the Chief Compliance and Privacy Officer for the Cleveland Clinic Health System, an international referral center and multi-specialty, academic medical center in Cleveland, Ohio, and Florida. He was the first compliance officer in the history of the Cleveland Clinic and designed, implemented and administered the corporate compliance program for the health care system.

Mr. Steiner also was Senior Counsel for the American Hospital Association, where he served as an attorney and advocate for this national trade association and its 5,000 member hospitals. He obtained his BA from the Johns Hopkins University, his Certificate from the Johns Hopkins University Nitze School of Advanced International Studies, and his JD, with honors, from Chicago-Kent College of Law in Chicago, Illinois. He is the Vice Chairman of the American Bar Association Health Law Committee, a former board member of the Health Care Compliance Association and former chairman of the American Medical Group Association’s Council of Compliance Officers.

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