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Regulation, Accreditation, and Payment

 
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The Regulation, Accreditation, and Payment (RAP) Practice Group addresses issues related to reimbursement and coverage, including Medicare and other government payer laws, regulations, and instructions, as well as issues related to health care organizational accreditation such as The Joint Commission and other accrediting entity standards.

Now More Than Ever, You Need the RAP Practice Group  

Summaries of the Office of Inspector General (OIG) Advisory Opinions are provided by the Advisory Opinions Task Force of the Fraud and Abuse Practice Group. The Task Force aids Practice Group members in keeping abreast of new Advisory Opinions. For each new opinion issued by the OIG, a summary is released via an email alert and posted on several Practice Groups' websites.

You may access this content by joining AHLA and enrolling in Regulation, Accreditation, and Payment Practice Group.


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You may access this content by enrolling in Regulation, Accreditation, and Payment Practice Group.

You may access this content by Renewing your membership for Regulation, Accreditation, and Payment

Member Briefings, prepared by members of Practice Groups, are a useful practice tool to facilitate your understanding of the most recent health law issues and to assist you and your clients with implementing those issues.

You may access this content by joining AHLA and enrolling in Regulation, Accreditation, and Payment Practice Group.


Already a member? Sign in

You may access this content by enrolling in Regulation, Accreditation, and Payment Practice Group.

You may access this content by Renewing your membership for Regulation, Accreditation, and Payment

Executive Summaries, prepared by members of Practice Groups, are a useful practice tool to facilitate your understanding of the most recent health law issues as they develop.
Newsletters offer articles on the most recent issues facing health law attorneys within their practice area. They also provide news of recent Practice Group events and highlight opportunities to get involved in the Association.

Interested in writing an article? Please submit your article proposal to the Practice Group staff including the title/topic and a short summary, and indicate which Practice Group(s) you would like to submit it to.
The RAP Sheet - November 2014​
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The following toolkits are made available to members of the Regulation, Accreditation, and Payment Practice Group. If you have any comments or suggestions on existing or potential toolkits, please email the Practice Groups staff

EMTALA Toolkit - Published on March 24, 2014
This toolkit provides practitioners with an updated, comprehensive set of EMTALA authorities, including, but not limited to, relevant statutory and regulatory authorities, the Centers for Medicare & Medicaid Services' (CMS') interpretive guidelines, and other U.S. Department of Health & Human Services, Office of Inspector General (OIG) and CMS pronouncements related to EMTALA. 

340B Toolkit - Published on June 10, 2014
The Toolkit is designed to assist health lawyers with understanding and researching 340B Drug Pricing Program (340B Program) issues. Although the 340B Program was established in 1992, the 340B Program has recently received increased attention from stakeholders and policymakers, creating a new interest in understanding 340B Program eligibility and participation requirements. This Toolkit provides the key statutes, regulations, policy guidance, case law, and forms necessary for legal counsel to understand the 340B Program.

Graduate Medical Education and Indirect Medical Education Payments for "Non-Provider" Site Training - Last updated on March 15, 2013
The updated version of the Graduate Medical Education (GME) and Indirect Medical Education (IME) Toolkit addresses Medicare payments to hospitals when residents provide services in "Non-Provider" site locations. This Toolkit includes relevant statutes, regulations, program documents, administrative and court decisions, links, and analyses related to Medicare GME and IME add-on payments to hospitals that rotate residents through these "Non-Provider" settings. 

Medicare and Medicaid Provider Enrollment Toolkit - Published on March 5, 2013
This Toolkit is designed to assist health lawyers with understanding and researching Medicare and Medicaid provider enrollment issues.

Diagnostic Testing Legal Issues Toolkit - Published on December 20, 2012
The Toolkit is designed to assist lawyers in advising clients on diagnostic testing matters and in structuring diagnostic testing arrangements.The RAP PG wishes to thank the Physician Organizations PG for sharing this Toolkit with their members.

Provider-Based Status Toolkit - Last updated on January 11, 2012
The Toolkit follows a logical progression, starting with a discussion of why provider-based status is important, and continuing to a checklist of requirements for provider-based status, and then continuing to more complex issues, such as provider-based status for joint ventures, intersection of provider-based rules with physician supervision requirements, and attestations.

Medicare Claims Appeals Toolkit - Published on March 18, 2010
The purpose of this toolkit is to provide a ready reference for the experienced practitioner as well as a “primer” for the newcomer to the field of Medicare claims appeals. With the implementation of the RAC process, providers are expected to experience an increased volume of claims audits. Consequently, there likely will be an increased volume in the Medicare Claims Appeals process, with a greater number of health lawyers being asked to represent their clients in the process.

Medicare and Medicaid Research Toolkit - Published on March 24, 2009
This toolkit has been designed to assist health lawyers with researching complex Medicare and Medicaid issues. It is a web-enabled research guide that helps practitioners: (1) organize reimbursement research; (2) identify appropriate resources; and (3) carry out a successful and organized research project.

CMS Hospital Surveys: The Legal Perspective - Published on April 30, 2007
This toolkit contains valuable resources on hospital surveys conducted by the Centers for Medicare & Medicaid Services.

 

Tutorials are pre-recorded audio lessons on topics of interest pertaining to Regulation, Accreditation, and Payment Practice Group members. The tutorial program features talented faculty with expertise in the topic addressed.

You may access this content by joining AHLA and enrolling in Regulation, Accreditation, and Payment Practice Group.


Already a member? Sign in

You may access this content by enrolling in Regulation, Accreditation, and Payment Practice Group.

You may access this content by Renewing your membership for Regulation, Accreditation, and Payment

Upcoming:

Past:

July 16, 2015 2:00 PM-3:30 PM Eastern
July 14, 2015 2:00 PM-3:30 PM Eastern
July 9, 2015 2:00 PM-3:30 PM Eastern
Telemedicine: Making the Business Case for Telemedicine--Exploring Different Delivery Models
Part 4: How to Protect Against Fraud and Abuse While Promoting Telemedicine (Intermediate)
June 23, 2015 2:00 PM-3:30 PM Eastern

Upcoming:

Past:

There are no upcoming educational calls offered by the Regulation, Accreditation, and Payment Practice Group at this time. Please check back periodically for updates.

Upcoming:

Past:

July 1, 2015 12:30 PM-1:45 PM Eastern
June 29, 2015 12:30 PM-1:45 PM Eastern
April 16, 2015 12:00 PM-1:15 PM Eastern
March 26, 2015 12:15 PM-1:35 PM Eastern
Institute on Medicare and Medicaid Payment Issues 2015
The Ever-Changing Legislative and Reimbursement Landscape That Is Telemedicine
March 25, 2015 12:20 PM-1:35 PM Eastern
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​Affinity Groups

Affinity Groups are created to facilitate networking opportunities with other Practice Group members who share similar professional interests.
Please note: You must be a member of the Regulation, Accreditation, and Payment Practice Group or a government, academician, student, or PG 15 member (all-Practice Groups access) to enroll in this Affinity Group. 

If you are intested in getting more information on the Affinity Group activities, please contact Chair of the Accreditation, Certification, and Enrollment Practice Group Jeanne Vance.

Task Forces

Task Forces are established for those health law topics that cross over several Practice Groups, and they provide collaborative, substantive resources for the benefit of the sponsoring Practice Groups members.
Please note: You must be a member of the Regulation, Accreditation, and Payment Practice Group or one of the other sponsoring Practice Groups to receive benefits produced by these Task Forces. 

  • Accountable Care Organization Task Force
    The Accountable Care Organization (ACO) Task Force monitors and evaluates the implementing statutes, regulations, cases, and secondary materials concerning ACOs. It provides written materials, webinars, and in-person educational activities to assist AHLA's members to implement ACOs and comply with ACO laws and rules. Since the ACO subject matter is so broad, and impacts the missions and interests of so many Practice Groups, the ACO Task Force is a multi-disciplinary/multi-group entity, and focuses its efforts on the production of a coherent and effective line of ACO-related educational materials using a variety of media and employing AHLA’s vast resources
  • Behavioral Health Task Force
    The Behavioral Health (BH) Task Force is committed to advancing the understanding of laws impacting behavioral health, including the delivery of services to those living with mental illness, certain neurological conditions, substance use disorders or developmental disabilities, and reimbursement for such services. A complex framework of federal and state laws concerning privacy, information sharing and exchange, reimbursement, involuntary commitment, and other subjects provides unique challenges to health care providers and payers of behavioral health services. Scientific, legislative, and other developments, including health care reform, have presented new issues and opportunities in this area, including primary and behavioral health care integration initiatives, insurance coverage parity mandates, changes to Medicaid, and evolving public policy, to name a few. The BH Task Force monitors and evaluates these laws and developments through written materials, webinars, and in-person educational activities so that AHLA members are better equipped to advise clients on behavioral health topics. In addition, the work of the BH Task Force serves to raise awareness about how behavioral health laws influence health improvement efforts, and will include collaborative efforts with AHLA's Public Interest activities.  
  • Enterprise Risk Management Task Force
    The Enterprise Risk Management (ERM) Task Force is committed to advancing the understanding and application of enterprise risk principles to the health care industry. The premise of health care ERM is that by evaluating all risk exposures confronting an organization and addressing these risks proactively, the organization will optimize its ability to provide safe, efficient, and effective patient care while preserving the organizational assets required to deliver such care. The scope of health care ERM is broad, and encompasses all risk domains (categories): operational, financial, technology, human capital, strategic, legal and regulatory. The ERM approach facilitates the development and implementation of pragmatic, reasonable, and realistic solutions to managing risk for health care organizations and providers. 
  • Health Care Reform Educational Task Force
    The Health Care Reform Educational Task Force serves as a single key point-of-contact for the Association membership for institutional resources regarding comprehensive health care reform initiatives at the state and federal levels. The Task Force works to educate AHLA members on proposed health care reform initiatives as well as report on ongoing experiences with recently enacted reform initiatives.

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LeadershipView Project Reports

Image of ClaireMiley
Claire F. Miley Chair Bass Berry & Sims PLC Nashville, TN (615) 742-7847 Email
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Daniel J. Hettich Vice Chair - Educational Programs King & Spalding LLP Washington, DC (202) 626-9128 Email
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Jeffrey S. Moore Vice Chair - Publications Phelps Dunbar LLP Tupelo, MS (662) 842-7907 Email
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Ross E. Sallade Vice Chair - Membership Polsinelli PC Raleigh, NC (919) 832-1718 Email
Image of JeanneVance
Jeanne L. Vance Vice Chair - Strategic Planning and Special Projects Salem & Green PC Sacramento, CA (916) 563-1818 Email
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Judith A. Waltz Vice Chair - Research & Website Foley & Lardner LLP San Francisco, CA (415) 438-6412 Email
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Richard Ross Burris Social Media Coordinator Polsinelli PC Atlanta, GA (404) 253-6000 Email

 

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