Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

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Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

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Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

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Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

Tuesday, March 30 – Wednesday, March 31, 2021

Maintaining a sound utilization review (UR) process remains critical in the face of inpatient and outpatient hospital admissions changes due to COVID-19 and the public health emergency. Changes to billing and coding guidelines, as well as a decline in elective procedures, have upended hospital revenue projections. But with a clear understanding of the latest patient status regulations and a robust UR program in place, facilities can work toward ensuring no money is left on the table. 

Bring your team to Mastering Utilization Review and Patient Status: A NAHRI Virtual Event to learn the latest strategies for concurrent and retrospective UR, Part A to B rebilling, inpatient-only list management, and prior authorization so you can protect your bottom line. 

During Mastering Utilization Review and Patient Status: A NAHRI Virtual Event, you can earn valuable CEUs and ask questions of our expert speakers. Plus, you can network with your colleagues and peers through our easy-to-use conference platform! 

By attending this one-of-a-kind virtual event, attendees will have the opportunity to listen live to the programs from March 30–31. Or attendees can choose to play the sessions at a later date that works for their schedule: Registrants have access to all educational sessions for 60 days. 

Who should attend?

  • Utilization review, utilization management team members
  • Physician advisors
  • Revenue integrity specialists and analysts
  • Revenue integrity managers, directors, and VPs
  • Revenue cycle managers, directors, and VPs
  • CFOs
  • Finance directors
  • Business office staff
  • Reimbursement managers and directors
  • Case management directors, managers, and staff
  • Chargemaster coordinators
  • HIM managers and directors
  • Coding managers and directors
  • Compliance officers
  • Compliance managers
  • Patient financial services managers
  • Patient financial services staff
  • Payer relations staff
  • Managed care contracting staff

Attendees will:

  • Discuss details of CMS’ new rules for procedures formerly on the inpatient-only list
  • Review coverage of outpatient and observation services and how they are counted toward the 2-midnight benchmark
  • Define observation status and the intricacies of observation billing to ensure compliance
  • Review the prior authorization program, including newly approved procedures and the rules and processes
  • Discover how to use the utilization management (UM) committee to go beyond the basic requirements to create greater healthcare value for your hospital
  • Identify ways physician advisors can strengthen revenue integrity while contributing to quality and documentation improvement
  • Describe key elements of support physician advisors need to deliver value
  • Identify ways clinical documentation integrity can support UR functions
  • Understand when and why self-denials can be more effective than using condition code 44

Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

Agenda

* All times are Eastern (EST)

Day 1 — Tuesday, March 30, 2021

12:00 p.m. – 12:45 p.m.
The Importance of Outpatient Services in the 2-Midnight Rule Benchmark
Kimberly A. Hoy, JD, CPC 
Outpatient services, including observation, are often provided before inpatient admission. This session will review coverage of outpatient and observation services and how they are counted toward the 2-midnight benchmark. Transfers and delays in care in relation to the 2-midnight benchmark will also be discussed.

12:55 p.m. – 1:40 p.m.
The Ins and Outs of Condition Code 44 and Self-Denial
Kimberly A. Hoy, JD, CPC 
Have you made the move from condition code 44 processes to self-denial after patient discharge? Learn when and why self-denials may make more sense than condition code 44, including differences in efficiency and reimbursement. Be informed to deploy your utilization review resources where they can do the most for your organization.

1:40 p.m. – 2:10 p.m.
Networking Break

2:10 p.m. – 2:55 p.m.
Utilization Management Committee: The Needs and the Wants
Edward P. Hu, MD, CHCQM-PHYADV
This session will review the regulatory basis of utilization management (UM) committees, including composition and required activities. Learn how to use the UM committee to go beyond the basic requirements and create greater healthcare value for your hospital.

3:05 p.m. – 3:50 p.m.
Out With the Inpatient-Only List, In With the Inpatient-Probably List
Kimberly A. Hoy, JD, CPC 
CMS is phasing out the inpatient-only list and replacing it with a list of procedures that will be subject to the 2-midnight rule but will not be subject to denial for failure to meet the 2-midnight rule. CMS adopted new standards for removing procedures from this new list and plans to update it annually, similar to the inpatient-only list. Learn the details of CMS’ new rules for procedures formerly on the inpatient-only list and how to deal with the transition period.

4:00 p.m. – 4:30 p.m.
Live Q&A
Join Kimberly A. Hoy, JD, CPC, and Edward P. Hu, MD, CHCQM-PHYADV, for a Q&A session and have all your questions answered.


Day 2 — Wednesday, March 31, 2021

12:00 p.m. – 12:45 p.m.
Equipped for Success: What Support Do Physician Advisor Programs Need to Deliver on C-Suite Expectations?
Kurt Hopfensperger, MD, JD
Physician advisors can immediately and significantly strengthen revenue integrity while also contributing to quality and documentation improvement. Despite this potential, implementing an effective program is challenging. Most hospitals struggle to find enough qualified physician advisors. Even when appropriately staffed, a physician advisor program faces four significant challenges that prevents them from delivering this value. This presentation will review the four kinds of support physician advisors must have to deliver the value hospital leadership expects.

12:55p.m. – 1:40 p.m.
Observation Services: A Guide to Proper Use and Billing
Ronald Hirsch, MD, FACP, CHCQM, CHRI
The compliant use and billing of observation services has baffled many for years. Errors in observation billing can result in lost revenue and audit scrutiny. This session will review the proper application of observation status and the intricacies of billing to ensure that all regulations are followed and all compliant revenue is captured. Observation for medical and surgical patients will be discussed.

1:40 p.m. – 2:10 p.m.
Networking Break

2:10 p.m. – 2:55 p.m.
Prior Authorization: Complying With Expanded Guidance
Ronald Hirsch, MD, FACP, CHCQM, CHRI
What started as an attempt to avoid Medicare paying for cosmetic surgery on its beneficiaries is now morphing into a program to reduce the utilization of procedures where CMS feels growth has exceeded need. This session will review the prior authorization program, including newly approved procedures and the rules and processes necessary to ensure success.

3:05 p.m. – 3:50 p.m.
Utilization Review and Clinical Documentation Integrity: A Yin to Your Yang!
Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC
Clinical documentation integrity (CDI) has evolved over the last decade to address not only working to obtain the highest DRG payment based on patient acuity, but also assisting with quality measures, denials prevention, and capture of severity of illness and risk adjustment. These efforts require collaboration with other departments to ensure success. CDI efforts to obtain accurate DRG assignment/patient complexity will allow for capture of the most applicable GMLOS and will work to support medical necessity of treatment. These efforts support utilization review functions, which means utilization review and CDI must collaborate to ensure consistent provider education and messaging as well as long-term organizational success.

4:30 p.m. – 5:00 p.m.
Live Q&A
Join Kurt Hopfensperger, MD, JD, Ronald Hirsch, MD, FACP, CHCQM, CHRI, and Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, for a Q&A session and have all your questions answered.


Agenda subject to change

Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

Speakers

Ronald L. Hirsch Ronald L. Hirsch, MD, FACP, CHCQM, CHRI, is vice president of physician advisory services with R1 RCM in Chicago. He is a general internist and HIV specialist. Hirsch was the medical director of case management at Sherman Hospital in Elgin, Illinois. He is certified in healthcare quality and management by the American Board of Quality Assurance and Utilization Review Physicians. In addition, he is a member of the American Case Management Association, a member of the American College of Physician Advisors, and a fellow of the American College of Physicians. Hirsch serves as an advisory board member for NAHRI.

 

Kurt Hopfensperger Kurt Hopfensperger, MD, JD, serves as vice president of medical solutions with Optum Market Solutions Group. Prior to joining Optum Market Solutions Group, he practiced medicine in his specialty of neurology, also serving as the medical director of patient safety and chair of the employed physician group, among other roles, during his most recent hospital staff membership. Hopfensperger is also an attorney and practiced law in the Chicago area. He remains actively licensed to practice both law and medicine.

Kimberly A. Hoy
Kimberly A. Hoy, JD, CPC, 
is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist and lead instructor for HCPro’s Medicare Boot Camp®—Hospital Version and Medicare Boot Camp—Utilization Review Version. She is also an instructor for HCPro’s Medicare Boot Camp—Critical Access Hospital Version. Baker is a former hospital compliance officer and in-house legal counsel, and has 10 years of experience teaching, speaking, and writing about Medicare coverage, payment, and coding regulations and requirements.

Laurie L. Prescott

Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, is the CDI education director at HCPro, a division of Simplify Compliance LLC, in Brentwood, Tennessee. She is an instructor for the CDI Boot Camps, a subject matter expert for ACDIS, a member of the CCDS and CCDS-O exam boards, and a member of the ACDIS Advisory Board. Prescott is a frequent speaker on webinars and authored The CDI Specialist’s Complete Training Guide and the best-selling ACDIS Pocket Guide and ACDIS Outpatient Pocket Guide. Prescott has been in the nursing field since 1985. Her experience also includes specialization in the role of compliance officer. She developed and implemented a CDI program in 2007 before coming to HCPro in 2013.

Edward P. Hu, MD, CHCQM-PHYADV Edward P. Hu, MD, CHCQM-PHYADV, is the system executive director of hospital physician advisor services at UNC Health Care System, where he supports the development of physician advisor programs at 10 system hospitals. He completed his medical education at Washington University School of Medicine in St. Louis, Missouri, and went on to complete his residency in internal medicine at Duke University Medical Center in Durham, North Carolina. Hu is board certified in internal medicine and healthcare quality and management with a subspecialty certification as a physician advisor. He practiced as a hospitalist for 14 years and served as a medical director of case management at UNC Rex Hospital in Raleigh, North Carolina. His areas of interest include Medicare regulations, revenue cycle, compliance, patient safety and quality, and risk adjustment. He served as the second president of the American College of Physician Advisors from 2016 to 2019.

Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

Continuing Education

AAPC
This program has the prior approval of AAPC for 7 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

AHIMA
This program has been approved for 7 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

American Nurses Credentialing Center (ANCC)
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 7 nursing contact hours is provided by HCPro.

Compliance Certification Board (CCB)
This education activity has been submitted to the Compliance Certification Board (CCB)® and is currently pending their review for approval of CCB CEUs.

Commission for Case Manager Certification (CCMC)
This program has been submitted to The Commission for Case Manager Certification for approval to provide board certified case managers with 7 clock hour(s).

National Association of Healthcare Revenue Integrity (NAHRI)
This program has been approved for 7 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

The National Association of Healthcare Revenue Integrity (NAHRI)

Save by Joining Today!

NAHRI’s mission is to enhance the revenue integrity profession through standards, advocacy, networking, and the promotion of shared knowledge and resources. This mission statement was developed by our NAHRI Advisory Board, an amazing group of revenue integrity professionals who bring a wide range of expertise and experience to this organization’s leadership.

PEER-BASED RESOURES AND TOOLS

As a NAHRI member, you’ll get unlimited access to our vast members-only resources, tools, and content such as white papers, best practices, and research reports written by the most respected names in the industry.

Resources include:

  • Member-Only Content, explore the hundreds of the latest articles and research by topic, including white papers and best practices, plus an extensive archive on the NAHRI website
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  • Quickly integrate and network with other revenue cycle professionals 
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CAREER RESOURCES AND CREDENTIAL PROGRAM

NAHRI members receive $100 off the Certification in Healthcare Revenue Integrity (CHRI) credential program. This program will provide professionals like you a tangible way to enhance and promote your revenue cycle skills.

I speak for the NAHRI Advisory Board when I say we all have visions of amazing strides we can make together in the industry, now is the time. I look forward to you joining our growing community of revenue integrity professionals.

 

Sincerely,

Jaclyn Fitzgerald, Director, NAHRI
jfitzgerald@hcpro.com