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Live Webinar

90-minute live streaming program
  • January 6
  • 1:00 - 2:30 pm EST

Communicating Medical Necessity to Insurance Companies

January 6

Learn to properly communicate medical necessity to insurance companies.

This topic will help you acquire an understanding of how to respond to insurance companies, auditors, and other entities (e.g. Pharmacy benefit managers) regarding medical necessity. At the conclusion of the material, you will gain valuable guidance concerning medical necessity audits; how to overcome rejections and/or appeal an unfavorable decision regarding medical necessity; and how disprove unfavorable medical necessity determinations.

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Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Medical Necessity – What It Is and Who Is Asking

How to Demonstrate Medical Necessity to Auditors, Payors (Private and Government), and Other Regulators

Using Guidance Documents, Regulations, Law, Lcds, and Other Items to Prove Medical Necessity

The Growing Culture of Rejections and Denials and How to Overcome a Rejection

How the Aseracare Decision From the 11th Circuit May Be Used to Demonstrate Medical Necessity

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Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

Live Webinar Registration

  • ACHE 1.5
     
  • The American College of Healthcare Executives no longer pre-approves courses or organizations. Participants in this program wishing to have the continuing education hours applied toward ACHE Qualified Education credit should indicate their attendance when submitting an application to the American College of Healthcare Executives for advancement or recertification. ACHE Qualified Education credit must be related to healthcare management (i.e., it cannot be clinical, inspirational, or specific to the sponsoring organization). It can be earned through educational programs conducted or sponsored by any organization qualified to provide educational programming in healthcare management. Programs may be sponsored by ACHE, chapters or other qualified sources, whether the programming is face-to-face or distance offerings (webinars, online seminars, self-study courses, etc.).
     
  • AHIMA (Pending)
     
  • AL CLE 1.5
     
  • This course or a portion thereof has been approved by the Alabama State Mandatory Continuing Legal Education Commission for a maximum of 1.5 hours credit.
     
  • AR CLE 1.5
     
  • This course has been approved for 1.5 hours of CLE by the Arkansas CLE Board.
     
  • Arizona CLE 1.5
     
  • The State Bar of Arizona does not approve or accredit CLE activities for the Mandatory Continuing Legal Education requirement. This activity may qualify for up to 1.5 hours toward your annual CLE requirement for the State Bar of Arizona.
     
  • CA MCLE 1.5
     
  • Lorman Business Center, Inc. is a State Bar of California approved MCLE sponsor and this course qualifies for 1.5 CLE hours of participatory credit.
     
  • CT CLE 1.5
     
  • Neither the Connecticut Judicial Branch nor the Commission on Minimum Continuing Legal Education approve or accredit CLE providers or activities. This course has been approved for CLE credit in jurisdictions aside from CT and therefore it automatically meets the content and delivery requirements in Connecticut. Credit is based on a 60 minute credit hour and shall be awarded as follows: 1.5 CLE credit(s).
     
  • GA CLE 1.5
     
  • This program has been approved by the Georgia Commission on Continuing Lawyer Competency for 1.5 CLE hours.
     
  • HI CLE 1.5
     
  • This program was approved by the Hawaii State Board of Continuing Legal Education for 1.5 CLE credit hours.
     
  • IL CLE 1.5
     
  • This course was approved for a total of 1.5 hours of MCLE Credit by the Illinois MCLE Board.
     
  • ME CLE 1.5
     
  • This course has been approved by the State of Maine Board of Overseers of the Bar. Lawyers who complete this course shall receive 1.5 hours of CLE credit under M. Bar R. 12.
     
  • MS CLE 1.5 (Pending)
     
  • This program has been submitted to the Mississippi Commission on Continuing Legal Education. Approval pending.
     
  • MT CLE 1.5
     
  • This program has been approved by the Montana Commission of Continuing Legal Education for a total of 1.5 CLE credits.
     
  • NH MCLE 1.5
     
  • NH MCLE does not approve or accredit CLE activities for the NH Minimum CLE requirement. Lorman Education Services believes this course meets the requirement of NH Supreme Court Rule 53 and may qualify for CLE credit(s). Program Length: 90 Minutes.
     
  • NJ CLE 1.8
     
  • This program has been approved by the Board on Continuing Legal Education of the Supreme Court of New Jersey for 1.8 hours of total CLE credit.
     
  • NV CLE 1.5
     
  • This program has been approved by the Nevada Board of Continuing Legal Education for 1.5 CLE hours.
     
  • PA CLE 1.5
     
  • This Distance Learning program has been approved by the Pennsylvania Continuing Legal Education Board for 1.5 hours of substantive law, practice and procedure CLE credit.
     
  • RI CLE 1.5
     
  • This program has been approved by the Rhode Island Mandatory Continuing Legal Education Commission for 1.5 hours of CLE credit.
     
  • TN CLE 1.5
     
  • This program has been approved as a distance learning format by the Tennessee Commission on Continuing Legal Education for a maximum of 1.5 hours of credit.
     
  • VT CLE 1.5
     
  • This program has been approved by the Mandatory Continuing Legal Education Board of Vermont for 1.5 hours of CLE credit.
     
  • WA CLE 1.5
     
  • This program has been approved by the Washington State Board of Continuing Legal Education for 1.5 hours of Law & Legal Procedure credit.
     
  • WI CLE 1.5
     
  • This program has been approved by the Board of Bar Examiners for 1.5 hours for use toward the Wisconsin Mandatory CLE requirement.
     
  • WV MCLE 1.8
     
  • This program has been approved by the West Virginia State Bar MCLE Commission for 1.8 MCLE hours.
     
  • HFMA 1.5
     
  • This course is approved by HFMA for certification maintenance of continuous educational points and will equal 1.5 points of classroom instruction.
     

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

Who should attend?

This live webinar is designed for medical records directors, health information managers, privacy officers, IT professionals, hospital and clinic administrators, coders, compliance officers, finance managers, security officers and attorneys.

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Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Andrew S. Feldman

Feldman Firm PLLC

Andrew S. Feldman is the founder of Feldman Firm PLLC. Mr. Feldman has represented individuals in white collar criminal cases involving health care fraud, insurance fraud, controlled substances and pharmaceutical diversion, misbranding, violations of the Federal Anti-Kickback statute, securities fraud, bribery, campaign finance violations, violations of the Endangered Species Act, criminal tax cases, and other economic crimes.

Mr. Feldman has also defended individuals in grand jury investigations and in connection with IRS investigations related to unreported foreign (FBAR investigations) and domestic income, ZPIC inspections and Drug Enforcement Administration administrative inspections. Mr. Feldman also has experience in a variety of civil litigation matters including False Claims Act litigation, tax cases and controversies, civil RICO, tax refund litigation, fraudulent transfer litigation, and Section 1983 litigation.

Prior to founding the Feldman Firm, PLLC, Mr. Feldman worked for a nationally renowned white collar defense attorney and former president of the National Association of Criminal Defense Lawyers and at a large regional firm. During that time Mr. Feldman represented individuals and small businesses in a wide variety of government investigations and enforcement actions. While in law school at the University of Miami, Mr. Feldman also clerked at various U.S. Attorney¡¦s Offices working closely with federal prosecutors.

Mr. Feldman is a frequent speaker on health care fraud and abuse issues and is a member of the ABA Health Law Section¡¦s Fraud and Compliance Committee and has served as a co-chair to the ABA¡¦s White Collar Crime Committee for more than five years.

PUBLICATIONS

„h The Federal Anti-Kickback Statute: Have Prosecutors and Relators Ignored the Potential Benefits of Using the Second Provision of the Anti-Kickback Statute? ABA Health Law Section, Health Lawyer (pending Fall 2015 publication)

„h Responding to Civil Investigative Demands, Materials for ABA¡¦s Annual National Institute on Health Care Fraud, Miami Beach, FL (May 15, 2015)

„h Medical Necessity in Health Care Fraud Prosecutions: An Analysis of Past, Present, and Future Prosecutions, Materials for ABA White Collar Criminal Conference (March 2015)

„h ¡§Worthless Services: Is it a Worthless Theory?¡¨ Materials for Significant White Collar Prosecutions and Investigations: Health Care Fraud & False Claims Act, ABA White Collar Criminal Committee, (November 2014)

„h ¡§Should Hedge Funds be Concerned with Government Enforcement of the FPCA in 2014?¡¨ Materials for Significant White Collar Prosecutions and Investigations: Foreign Corrupt Practices Act & Anti-Corruption Compliance, ABA White Collar Criminal Committee, (November 2014)

„h ¡§United States v. Esquenazi, The Eleventh Circuit Becomes the First Circuit Court of Appeals to Decide What Constitutes an ¡§Instrumentality¡¨ of a Foreign Government,¡¨ Materials for Significant White Collar

Prosecutions and Investigations: Foreign Corrupt Practices Act & Anti-Corruption Compliance, ABA

White Collar Criminal Committee, (November 2014)

„h Responding to a Search Warrant in White Collar Criminal Prosecutions, NACDL, The Champion (November

2014)

„h State False Claims Acts: A Practitioner¡¦s Guide to the False Claims Acts of the Various States, ABA

Publishing 2014 (selected chapters).

„h Responding to ZPIC Inspections: How Practices Can Manage the Process, Chicago Medical Society (August

2014)

„h Responding to ZPIC Inspections, ABA Health Care Law E-Source Publication, (June 2014)

„h Potential Pitfalls in the Execution of a Search Warrant of a Corporation, ABA White Collar Criminal

Conference Materials, (March 2014)

PRESENTATIONS

„h Panelist, Concerns over Patient Access to Controlled Substances, Florida Academy of Pain Medicine

Annual Meeting, Orlando, Florida (June 28, 2015)

„h Presenter, Significant Developments in Health Care Fraud and Abuse in 2015 Part II: What to Anticipate?,

ABA Health Law Section, Member Benefit Webinar (June 24, 2015)

„h Presenter, Significant Developments in Health Care Fraud and Abuse in 2015 Part I: What to Anticipate?,

ABA Health Law Section, Member Benefit Webinar (May 21, 2015)

„h Panelist, Looking Ahead in 2015: Health Care Fraud and the False Claims Act, ABA National Institute on

Health Care Fraud (May 2015)

„h Panelist, Health Care Fraud and Abuse, ABA White Collar Criminal Conference, New Orleans (March

2015)

„h Moderator, Significant White Collar Prosecutions and Investigations: Health Care Fraud & False Claims

Act, ABA White Collar Criminal Committee, (November 2014)

„h Moderator, Significant White Collar Prosecutions and Investigations: Foreign Corrupt Practices Act & Anti-

Corruption Compliance, ABA White Collar Criminal Committee, (November 2014)

„h Presenter, White Collar Crime and Trends in Government Enforcement of Securities Laws: Looking Ahead

in 2014-2015, Trinity College (CT) Reunion Weekend (June 2014)

„h Panelist, Current Trends in White Collar Crime Investigations and Prosecutions (South Region), ABA White

Collar Crime Committee Annual Meeting, Miami Beach, FL (March 2014)

„h Moderator, Responding to Search Warrants, ABA White Collar Crime Committee Annual Meeting,

Miami Beach, FL (March 2014)

„h Presenter, What Employers Should Know- How to Prepare for an Audit of Conflict Minerals Compliance,

Ohio Association of Corporate Counsel, Toledo, Ohio (September 2013)

RECOGNITION

Florida Super Lawyers, Rising Stars (2013-2015 edition)

Martindale Hubbel AV-Rated Preeminent (2014)

EDUCATION

„h University of Miami Law School, Coral Gables, FL, J.D., (May 2008)

„h Trinity College, Hartford, CT, B.A., International Relations and Spanish, (May 2004)

„h Universitat De Pompeu Fabra, Barcelona, Spain, (January 2003-May 2003)

LANGUAGES

Spanish

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Why Lorman?

Over 32 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

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Product ID: 406583
Published 2020
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