Sample Submissions

Multiple ideas may be submitted, but all ideas must be submitted through the Call For Presentation survey tool. To help plan submissions, a few tips, two examples of abstracts that were selected for presentation, and two examples that were not selected are below.

Tip 1 Give complete faculty information, including designations.
Tip 2 Make bios short and relevant. Why are you qualified to speak on this topic? If you haven't spoken for NHCAA before include the names of other organizations, conferences, or trainings where you have been faculty.
Tip 3 Objectives explain the purpose or intent of the presentation; a specific result that the faculty member aims to achieve during the presentation. Be sure to develop three concrete objectives.
Tip 4 The description gives a broader perspective on the content that will be covered during the presentation. Think through the beginning, middle, and end of the presentation, this will assist with the description creation. An introduction to what fraud is, why it exists, how many people it affects, etc. is not necessary.
Tip 5 Timing is critical at our conferences and programs. We accept 60 and 75 minute presentations. Of this time, anticipate approximately 5 minutes of Q&A. Choose the time slot that best fits presentation content.

Accepted Examples

Example 1

Objectives

  • Participants will learn about the latest "new age" or alternative medicine therapies which are considered investigational by most payers.
  • Participants will be shown how to detect these new age procedures with illustrations of typical billing patterns
  • Participants' learning will be reinforced with real case examples.

Description

The presenters will review and discuss in detail the latest "new age" or alternative medicine treatments that are popping up across the country. These therapies which are touted to prevent and restore health problems are considered investigational by health payers; however, they are slipping through the claims systems undetected. During the presentation, the participants will learn about detoxification, intravenous vitamin and mineral therapy infusions, Theragem light therapy, Nutrienergetic systems and adjunctive acupuncture treatments including cupping and moxibustion with mug wort. The investigational lab services (using blood, saliva, hair) which are performed in conjunction with the therapies will also be reviewed. The affiliated procedure codes will be provided so that the participants can return home and data mine for similar schemes.

Example 2

Objectives

  • Understand the procedure, rationale and historical context of platelet rich plasma injection therapy
  • Learn the associated CPT codes for data mining to discover F/A
  • Strategies for investigation and recovery

Description

Providers, primarily sports medicine physicians, inject Platelet Rich Plasma (PRP) into soft tissues and joints to promote the healing process of injuries. PRP injection therapy is listed as investigational by most payers including CMS. PRP was issued a HCPCS code as of July 2010 (0232T) which includes the incidental services such as ultrasound guidance (CPT 76942) and injections (CPT 2055X) that many providers also submit. In order to receive payment the providers cloak PRP by submitting a code for a tissue graft (CPT 209260). Attendees will be able to data mine, identify PRP by claims, see images of the procedure and equipment and learn a strategy for recovering paid dollars and identifying intent to misrepresent by providers.

Not Accepted Examples

Example 1

Objectives

  • Investigative techniques used to investigate Medicare false front schemes.
  • Ways to work with law enforcement

Description

"Katie" and I would discuss a case example of how to investigate the Medicare false front provider schemes. This presentation was done last year with "Company A" representatives. We could expand on it this year as the subjects have pled guilty and we could reveal more of the investigative techniques used. However, this may still be considered repetitive of last year. Let us know your thoughts.

Example 2

Objectives

  • Understand the epidemic of Drug Diversion that is attacking our society
  • Identify best practices that can assist the SIU to combat the problem
  • Take home minimum of 3

Description

Our nation is in the throes of an epidemic of controlled prescription drug abuse and addiction. It is estimated that 7% of the population abused prescription drugs in 2007. Drug diversion is like a Perfect Storm and it is growing bigger everyday. Costs are staggering not only in financial terms but more importantly in human tragedy. Today 15.1 million people admit abusing prescription drugs more than the combined number who admit abusing cocaine (5.98 million), Hallucinogens (4.0 million), inhalants (2.1 million) and heroin (.3 million) Typical doctor shoppers cost insurers $10,000-$15,000 per year. It is estimated that for every $1 spent on the prescriptions, there is $41 spent for related services. It is estimated that Drug Diversion costs insurance companies approximately 72.5 Billion dollars annually. My presentation will bring to the forefront how serious this problem is and how it affects the overall claims process. We will discuss the challenges and provide best practices for insurance companies in trying to combat this epidemic.