Medicare Coverage, Payment and Compliance (SC)

Section 1, Fall 18

Schedule Information

Enrollment: 7/16
Credits: 1
Day Date Time Room

Course Description

This course will provide a high-level overview of the Medicare Program and, to a lesser extent, Medicaid, with a focus on coverage, payment, and compliance requirements for health care providers. We will examine the legal and regulatory frameworks governing these federal healthcare program payments to hospitals and other healthcare providers and suppliers, demystifying central concepts and terminology as we go, to orient aspiring health law practitioners to the complexities of a healthcare reimbursement practice. We will discuss key federal requirements for coverage and payment of health care services, highlighting recent changes in the evolving reimbursement landscape and the drive towards paying for quality and outcomes instead of paying for costs and inputs. This course will also explore what happens when rules are broken: Has the provider been overpaid? Does the provider have to refund? To whom, if anyone, must the provider give notice? While some discussion of national health policy is inherent in the subject matter, this will be a very practical course. The instructors are private practice attorneys who have made their careers advising and advocating for healthcare providers on payment and compliance related issues, and will draw heavily from their own experiences to provide a structural and analytical framework for approaching Medicare (and Medicaid) issues raised by clients. Students will be challenged to demonstrate an understanding of these federal payment systems, and will be asked to analyze potential compliance and reimbursement issues within this framework.

Course Requirements

Exam Info:
Midterm Type (if any): None
Description: None

Final Type (if any): Due Date Only

A take-home exam will be distributed on the last day of class in a sealed envelope. Upon opening it, students will be on their honor to take no more than the instructed amount of time drafting their answers and then uploading to EXPO; The deadline for the upload will be announced at a later date by the instructors, but it will be no later than 2 weeks after the last class session.

Written Work Product
Written Work Product:

Other Work

Other Course Details
Prerequisites: None Concurrencies: None
Mutually Exclusive With: None
Laptops Allowed: Yes
First Day Attendance Required: Yes
Course Notes: Attendance at all class sessions is required. Enrolled students who do not attend the first class session will be disenrolled in accordance with Academic Policy. Students seeking to enroll in this course must attend the first class session.

Graduation Requirements

*Satisfies Writing Requirement: No
**Credits For Prof. Skills Requirement: No
Satisfies Professional Ethics: No

*Yes means professor requires everyone in the course to submit a substantial research paper (which is the requirement standard in Academic Policies), so no paperwork required to be submitted to SRO. No means student must timely submit paperwork to SRO if intending to use a paper in this course to satisfy the Writing Requirement.

**Yes indicates course credits count towards UVA Law’s Prof. Skills graduation requirement, not necessarily a skills requirements for any particular state bar.

Schedule No.
Law No.
Modified Type
Cross Listed: No
Cross-Listed Course Mnemonic:
Concentrations: Health Law
Public Syllabus Link: None
Evaluation Portal Via LawWeb Opens:
Evaluation Portal Via LawWeb Closes: