ACDIS Live! CDI Role in Denials Management - On-Demand

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ACDIS Live! CDI Role in Denials Management - On-Demand

Product Code: YZHHA090617D

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ACDIS Live! CDI Role in Denials Management - On-Demand

Calendar

Available ON-DEMAND

Presented on:
Wednesday, September 6, 2017

Presented by:
Adelaide M. La Rosa, RN, BSN, CCDS
Thomas Owsinski, MPA
Mary Mastrandrea, RN, BSN, CCDS
Lori Viviano, RN, BSN, CCS, CDIP, CCDS

Level of Program:
Intermediate

Sponsor: 
ACDIS

For more than a dozen years, the team at Catholic Health Services of Long Island has continued to expand its CDI program, leveraging its strength to identify documentation improvement opportunities throughout the revenue cycle chain. Denials management and audit defense are areas where CDI efforts can make a world of difference.

Every day, government and private payers seem to come up with a new reason to deny healthcare claims. Keeping up with denials and identifying documentation improvement opportunities for audit prevention is one of the fastest-growing areas for CDI program expansion. Join us in this special, three-hour ACDIS Live! webinar event and learn from an experienced multidisciplinary team how to integrate CDI efforts into the denials management process.

At the conclusion of this program, attendees will be able to:

  • Identify documentation improvement opportunities for commonly denied diagnoses
  • Identify claims denial types
  • Understand system processes to facilitate interdepartmental collaboration regarding audit defense
  • Leverage CDI staff to reduce denials
  • Assist in creation of denial appeal letters
  • Engage physicians in denials education and prevention


Who Should Listen?

  • CDI specialists
  • Denials management specialists
  • Healthcare data analysts
  • Revenue cycle integrity specialists
  • HIM directors/managers
  • CDI directors/managers
  • Inpatient coders
  • CDI physician advisors


Agenda

  • Making the case for CDI involvement in denials prevention and audit defense
  • Addressing denials by:
    • MS-DRG, APR-DRG, Medicare Advantage, RAC
    • Top 10 denials
    • Clinical validation and clinical indicators
  • The path of the denied, and appealed, claim
    • Streamlining processes
    • Data coordinators: Denials tracking sheets
    • Drafting the appeal letter
    • Engaging physicians in appeal efforts
    • Levels and progress of appeal opportunities
    • Attestations and resubmissions of claims
  • Defining roles and responsibilities
    • Centralizing the denials system under CDI
    • Job descriptions, roles, and responsibilities (data coordinator role versus CDI specialist in denials)
    • Possible career ladder implementation
    • Assessing team members’ effectiveness
  • Leveraging data for documentation improvement opportunities
    • Building a feedback loop
      • Recurring team meetings
      • Coding alerts
      • Coding/documentation newsletters
    • Physician engagement/education
  • Live Q&A


Tools

  • Sample queries
  • Data coordinators: Denials tracking sheets
  • Sample job descriptions
  • Sample appeals letters


Continuing Education

Association of Clinical Documentation Improvement Specialists (ACDIS/CCDS)
(Live + On Demand) - This program has been approved for 3 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification, offered as a service of the Association of Clinical Documentation Improvement Specialists (ACDIS). (Ability to claim CEU’s for this webinar expires on: 09/05/2018)

American Health Information Management Association (AHIMA)
(Live + On Demand) - This program has been approved for 3 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. (Ability to claim CEU’s for this webinar expires on: 9/5/18)

American Nurses Credentialing Center (ANCC)
(Live webinar participant only) - HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This educational activity for 3 nursing contact hours is provided by HCPro. (Ability to claim nursing contact hours for this webinar expires on: 09/05/2018)


Meet the Speakers

Adelaide La Rosa

Adelaide La Rosa, RN, BSN, CCDS
Assistant Vice President, HIM/CDI/EMPI/DRG Appeals
Catholic Health Services of Long Island (CHS)

Adelaide La Rosa has 33 years of varied clinical healthcare and leadership experience. She has extensive knowledge of healthcare revenue cycle; ICD-9; ICD-10; CPT-4 coding rules and regulations; and DRG, MS-DRG, and APR payment methodology and outpatient reimbursement. La Rosa also has more than 25 years of experience in DRG validation, RAC, third-party insurance denials management, and clinical documentation improvement (CDI). Her CDI experience includes CDI program development and implementation for several health systems. She built the entire ICD-10 training curriculum and led the ICD-10 education of coders, CDI specialists, physicians, and midlevel providers for CHS. Currently, La Rosa oversees six acute care facilities.

Mary Mastrandrea

Mary Mastrandrea, RN, BSN, CCDS
CDI Specialist, DRG Appeals
CHS

Mary Mastrandrea is the lead CDI specialist for CHS, which encompasses six acute care facilities. She has over nine years of experience in CDI with a total of 30 years in the healthcare industry. Mastrandrea has extensive knowledge of ICD-9; ICD-10; coding rules and regulations; and DRG, MS-DRG, and APR payment methodology. In addition, she has experience with DRG validation, RAC, third-party insurance denials management, and clinical documentation improvement. Mastrandrea has played an integral part in centralization of DRG appeals for CHS. Previously, she worked in multiple roles and settings, including acute care, healthcare education, and utilization management. Mastrandrea is a current member of ACDIS and AHIMA.

Lori Viviano

Lori Viviano, RN, BSN, CCDS, CCS, CDIP
Director, CDI
CHS
St. Catherine of Siena Medical Center

Lori Viviano is the director of the CDI program at St. Catherine of Siena Medical Center in Smithtown, New York. She has been a practicing nurse for over 39 years, with a med-surg and critical care background, and has held leadership roles in performance improvement and revenue cycle management.

For the past 10 years, Viviano passionately dedicated her career to CDI. She grew as a mentor and leader in her current role by providing ongoing education to physician teams, nursing, and ancillary departments. Under her guidance, Viviano built a strong level of trust among the staff at St. Catherine of Siena. She collaborates with the HIM, PI, care management, nursing, and all other ancillary departments on a daily basis.

Thomas Owsinki

Thomas Owsinski, MPA
Data Analyst
CHS

Thomas Owsinski is a recent graduate from Long Island University at CW Post with a Master of Public Administration degree. He previously worked at Winthrop University Hospital as a revenue integrity and charge capture analyst. Currently, Owsinski works at CHS as a data analyst for the DRG appeals department. His responsibilities include managing information for DRG validation medical record requests/DRG denials, and reporting win/loss breakdowns of DRG denial appeals. Owsinski’s other reporting responsibilities include case-mix index analysis, DRG rankings, and DNFB management.

 


Webinar system requirements and program materials: 

To fully benefit from the webinar experience, please note you will need a computer equipped with the following: 

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

COULDN'T LISTEN LIVE? 
No problem. The On-Demand version is now available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $399 value! 

PLEASE NOTE 
Participation in the webinar is just $399 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email customerservice@hcpro.com if you have questions.