Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event

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Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event

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Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event

Tuesday, October 6 – Thursday, October 8, 2020 | Virtual Conference

Ensuring revenue is accurate and compliant has never been more critical, but with CMS and other payers releasing new guidance and rules at lightning speed simply keeping up has become a significant challenge. Healthcare organizations have never been under more stress. The COVID-19 pandemic has led to unprecedented revenue shortfalls. Strong revenue integrity practices to support accurate coding, billing, and reimbursement will continue to be vital as organizations face the ongoing financial toll of COVID-19 and CMS and other payers pick up audit activity.

Join us for Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event to get the expert advice and analysis you need to maintain revenue integrity now and prepare for the coming year. Learn about the latest CMS changes, earn valuable CEUs, and connect with your revenue integrity peers during this one-of-a-kind virtual event.

Attendees will receive ongoing access to all 12 educational session as well as daily moderated Q&A sessions and peer networking. Our expert speakers will provide detailed analysis of the latest CMS regulations, their impact on reimbursement, and practical steps organizations can take to comply and succeed.

Here are some details on this unique event:

  • Educational sessions include video and audio streamed through an interactive event platform
  • Your questions on educational sessions are answered during live daily panel Q&A sessions
  • Participants can follow our daily agenda or view educational session recordings at their convenience through December 2020
  • Dedicated networking times allow participants to share ideas and connect through the event platform 


Benefits of Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event:

  • Analyze the financial and operational impact of the 2021 IPPS final rule and the 2021 OPPS and MPFS proposed rules as well as CMS’ COVID-19 interim final rule
  • Gain the tools to enhance revenue integrity and develop strategies for accurately documenting, coding, and billing patient encounters and stays
  • Gain insights into chargemaster management and practical strategies for updates
  • Get the latest information on external auditors and learn new strategies for dealing with claim denials and appeals
  • Learn how to strengthen processes across the revenue cycle to support revenue integrity
  • Discuss billing and coding hot topics that may impact your facility’s financial performance
  • Understand methods to address price transparency requirements and the impact they will have on revenue integrity processes and goals

Agenda

Agenda – Main Conference Day 1

Tuesday, October 6, 2020

The Revenue Integrity Show Presents: A Panel Discussion on COVID-19

In this special edition of The Revenue Integrity Show: A NAHRI Podcast, industry experts weigh in on how the COVID-19 pandemic has impacted revenue integrity operations.

12:05 p.m. -12:5o p.m.

Round Robin on Medicare Rules: Get the Latest Updates on IPPS, OPPS, and the MPFS (Part 1)
Marc Hartstein, MA; Valerie Rinkle, MPA, CHRI; Jugna Shah, MPH, CHRI

Learn all you need to know about the latest finalized IPPS changes for FY 2021 and the major proposed changes for OPPS and MPFS. Ensure your hospital is prepared from a reimbursement and compliance perspective!

  • Explain the major FY 2021 IPPS changes
  • Describe the major CY 2021 OPPS and MPFS proposed changes that, if finalized, would have operational and financial impact
  • Analyze other major regulatory changes for 2021, such as E/M coding and Appropriate Use Criteria
  • Understand other initiatives, such as drug pricing changes, that could impact hospitals

1:10 p.m.- 1:40 p.m.

Lunch-n-Learn Lightning Round with Featured Sponsors

1:45 p.m. - 2:15 p.m.

Networking Break and Exhibit Hall Games

2:20 p.m. - 3:05 p.m.

Round Robin on Medicare Rules: Get the Latest Updates on IPPS, OPPS, and the MPFS (Part 2)
Marc Hartstein, MA; Valerie Rinkle, MPA, CHRI; Jugna Shah, MPH, CHRI

Learn all you need to know about the latest finalized IPPS changes for FY 2021 and the major proposed changes for OPPS and MPFS. Ensure your hospital is prepared from a reimbursement and compliance perspective!

  • Explain the major FY 2021 IPPS changes
  • Describe the major CY 2021 OPPS and MPFS proposed changes that, if finalized, would have operational and financial impact
  • Analyze other major regulatory changes for 2021, such as E/M coding and Appropriate Use Criteria
  • Understand other initiatives, such as drug pricing changes, that could impact hospitals

3:10 p.m. - 3:55 p.m.

Appealability: Assessing and Rating a Denial for the Possibility of Overturn
Tracey A. Tomak, RHIA, PMP; Denise R. Wilson, MS, RN, RRT

Sometimes it doesn’t make sense to go after all denied claims—many hospitals just don’t have the resources to do so. Instead, the better approach may be to appeal denials with the best chance for overturn. Join us as we teach you how to develop your own payer-specific scoring system! Attendees will learn how to analyze types of denials to increase chances of revenue recovery.

  • Describe the elements required in medical record documentation for a successful appeal
  • Select and assign a scoring system that is specific to the denial issue
  • Assess the accuracy of the scoring system
  • Identify data patterns and trends for education and process improvement

4:00 p.m. - 4:30 p.m.

Live Q&A Session

4:30 p.m. - 5:00 p.m.

Virtual Gala

Agenda – Main Conference Day 2  

Wednesday, October 7, 2020

11:30 a.m. - 12:15 p.m.

Creating a Rational Pricing Model: Where Transparency and Strategy Collide
Caroline Znaniec, MBA, MS-HCA

Healthcare organizations’ pricing methodologies have varied over the years, and many are no longer easily understood. The lack of pricing defensibility hinders the industry’s move toward pricing transparency. Rational pricing provides for a combination of key strategies, all while supporting the objectives of transparent pricing. This session will provide attendees with an understanding of rational pricing strategies and how to operationalize a rational pricing model.

  • Define the differences between various pricing models, understanding the pros and cons
  • Understand the objectives of a rational pricing model and how it aligns with CMS’ pricing transparency initiatives
  • Explain examples of rational pricing application in key healthcare service offerings

12:30 p.m. - 1:00 p.m.

Lunch-n-Learn Lightning Round With Featured Sponsors

1:05 p.m. - 1:35 p.m.

Networking Break and Exhibit Hall Games

1:40 p.m. - 2:25 p.m.

CDM Governance: Best Practices and Processes
Sarah Goodman, MBA, CHCAF, COC, CCP, FCS, CHRI; Kay Larsen, CRCR, CHRI; John Settlemyer, MBA, MHA, CPC, CHRI

This session will address charge description master (CDM) governance, including implementing a team approach to CDM management, utilizing proven strategies for maintaining the CDM, navigating CMS resources, and ensuring successful charge capture across a sampling of ancillary departments. It will highlight tips on addressing the latest changes brought about by the COVID-19 public health emergency. The panelists will discuss their real-life experiences with internal policies, procedures, and timelines that govern operational processes regarding CDM additions, changes, and deactivations.

2:30 p.m. - 3:15 p.m.

How Hitting Your Key Performance Indicators May Actually Reduce Your Hospital Performance
Joseph Zebrowitz, MD

Using key performance indicators (KPI), hospital leadership can determine whether the organization is on the right track. But have you ever wondered why your KPIs look great, yet your hospital is still losing revenue? In many cases, payers may be leveraging your KPIs against you. This session will demonstrate how hospital KPIs used in isolation by UM, CDI/coding, and managed care can adversely undermine hospital revenue. Learn a new approach to measuring performance across the clinical revenue cycle and how to keep up with the payers’ evolving tactics.

  • Identify the latest private payer tactics directed to avoid traditional KPIs
  • Explain how traditional metrics used to track performance are interrelated and their effect on revenue
  • Describe how new KPIs provide improved visibility into hospital performance using a case study

3:20 p.m. - 3:50 p.m.

Networking Break and Exhibit Hall Games

3:55 p.m. - 4:40 p.m.

Patient Status Through the Lens of Inpatient-Only Procedures
Kimberly Anderwood Hoy Baker, JD, CPC

This session discusses the recent controversial changes to the Medicare inpatient only list as well as CMS’ proposal in the 2021 OPPS Proposed Rule to eliminate the list over the next three years.  Recent guidance on inpatient only procedures has provided helpful direction on two midnight and case-by-case admissions.  Although not finalized, the proposed elimination of the list and the approach CMS will take moving forward will be discussed.  The exceptions to the inpatient only list will also be reviewed to ensure you don’t miss revenue for inpatient only procedures provided on an outpatient basis when available.

  • Understand CMS’ inpatient-only rule and its three exceptions
  • Describe CMS’ proposal to eliminate the inpatient-list list
  • Analyze case-by-case and 2-midnight guidance for removal of total knee arthroplasty and total hip arthoplasty

4:45 p.m. - 5:15 p.m.

Live Q&A Session

Agenda – Main Conference Day 3  

Thursday, October 8, 2020

11:30 a.m. - 12:15 p.m.

Analyzing the Impact of Requirements for Hospitals to Make Standard Charges Public
Marc Hartstein, MA

Hear former CMS Senior Executive Marc Hartstein speak on hospital price transparency requirements that were announced in the 2020 outpatient prospective payment system final rule. In this session, you’ll gain a deeper understanding of CMS' manual provisions that require charges to be reasonably related to cost, as well as the statutory and regulatory history leading up to the current requirements.

  • Define gross charges, payer-specific negotiated charges, and discounted cash prices
  • Describe hospital reporting obligations
  • Analyze data requirements

12:30 p.m. - 1:00 p.m.

Networking Break and Exhibit Hall Games

1:05 p.m. - 1:50 p.m.

Charge Capture: Hot Spots in Your Facility
William L. Malm, ND, RN, CRCR, CMAS, CHIAP

Charge capture remains the mainstay process to ensure revenue for all documented services. This session will review the diagrammed charge capture process against best practice and isolate charge capture opportunities by department.

  • Explain the strategic purpose of charge capture and how to diagram the charge capture process
  • Define why charges don’t always equate to payment/reimbursement
  • Analyze a pharmacy multiplier and understand that reimbursement is based on the units, not just the J code

1:55 p.m. - 2:40 p.m.

The Wild West: Bringing Structure and Oversight to Commercial Payer Integrity Audits
Dawn Crump, MA, SSBB, CHC

The pressure to reduce the cost of healthcare has caused government and commercial payers to increase audits. CMS implemented the Recovery Audit Contractor (RAC) program, for example, to identify Medicare overpayments. Commercial payers use audits similarly. However, contrary to the RAC program’s recent evolution into a more streamlined process, many commercial payer audits are more challenging, time-consuming, and burdensome due to the lack of structure and oversight. This session will delve into the challenges of commercial payer audits, provide insight to improve audit integrity, and offer best practices to navigate the complicated process.

  • Describe the differences between the RAC program and commercial payer audits
  • Identify commercial payer audit challenges and recognize ways to improve the process
  • Apply best practices to navigating commercial payer audits
  • Analyze case studies and apply lessons learned

2:45 p.m. - 3:15 p.m.

Networking Coffee Break

3:20 p.m. - 4:05 p.m.

Analyze THIS! Healthcare Revenue Cycle Analytics and the Role of Revenue Integrity
Caroline Znaniec, MBA, MS-HCA

This session will provide an understanding of how revenue cycle metrics are used to measure financial performance across the organization. Although revenue integrity may not own them, the metrics can identify breakdowns within the revenue cycle that directly affect the organization’s ability to effectively and efficiently bill and receive payment. Attendees will walk away with a guide to common revenue cycle key performance indicators (KPI) and benchmark resources, a troubleshooting guide to address underperforming metrics, and an example KPI dashboard.

  • Identify KPIs for measurement of revenue cycle performance across the organization
  • Describe methodologies for developing KPIs, establishing internal benchmarks, and measuring and reporting on performance
  • Understand how individual revenue cycle measures are interdependent to support overall revenue cycle success
  • Understand the role of revenue integrity in affecting change to improve revenue cycle performance

 

Who Should Attend

  • Revenue integrity specialists and analysts
  • Revenue integrity managers, directors, and VPs
  • Revenue cycle managers, directors, and VPs
  • CFOs
  • Finance directors
  • Reimbursement managers and directors
  • 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

About Your Presenters

Kimberly Anderwood Hoy Baker, 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.

Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, CHRI, is president/CEO and principal consultant for SLG, Inc., in Raleigh, North Carolina. She is a nationally known speaker and author on the chargemaster, outpatient facility coding, and billing compliance, and has more than 30 years’ experience in the healthcare industry. Goodman has been actively involved and held leadership roles in a number of professional organizations on the local, state, and national levels—including NAHRI, where she serves as an advisory board member.

Marc Hartstein, MA, came to Health Policy Alternatives in Washington, D.C. after 26 years with CMS. Hartstein held several management and staff positions during his time at CMS, most recently as the director of the Hospital and Ambulatory Policy Group. At CMS, Hartstein was central to the development of MS-DRGs, the 2-midnight rule, Medicare’s policy for off-campus hospital outpatient departments, the misvalued code initiative, and regulations to implement Medicare’s new clinical laboratory fee schedule, among other policies. Hartstein’s experience spans both the executive and legislative branches of the government. He has assisted in the drafting of legislation, working with the congressional committees that have subject matter jurisdiction over Medicare.

Kay Larsen, CRCR, CHRI, is a revenue integrity specialist at Glendale Adventist Medical Center (soon to be Adventist Health Glendale) in California. She has enjoyed 17 years working in healthcare, including many years as a chargemaster coordinator. Larsen’s favorite part of her job is working with departments to maximize revenue through education and charge review. In her years of work, she has experienced standardization projects, extensive price reviews, and conversion of financial systems and is still passionate about revenue integrity. Larsen serves as an advisory board member for NAHRI.

William L. Malm, ND, RN, CRCR, CMAS, CHIAP, is a managing consultant at Berkley Research Group, Health Performance Improvement Group. He is a nationally recognized author and speaker on topics such as value-based care, healthcare compliance, chargemasters, and CMS recovery audits. He also brings a decade of experience with payer acute care audits. Malm has over 25 years of experience with a combination of clinical and financial healthcare knowledge that encompasses all aspects of revenue integrity. Previously, Malm played a key role in providing revenue integrity and data expertise for Craneware, PLC. He also serves as the president for the Certification Council of Medical Auditors. He has extensive experience with all prepayment and post payment audits, having worked as a systems compliance officer at a large for-profit healthcare system. Malm also co-hosts Appeal Academy’s “Finally Friday” discussions.

Valerie A. Rinkle, MPA, CHRI, is a lead regulatory specialist and instructor for HCPro’s Revenue Integrity and Chargemaster Boot Camp as well as instructor for the Medicare Boot Camp—Hospital Version, Medicare Boot Camp—Utilization Review Version, and Medicare Boot Camp—Critical Access Hospital Version. Rinkle is a former hospital revenue cycle director and has over 30 years of experience in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations.

John D. Settlemyer, MBA, MHA, CPC, CHRI, is an assistant vice president, revenue cycle, with Atrium Health (formerly Carolinas HealthCare System) based in Charlotte, North Carolina. Atrium Health is one of the most comprehensive public, not-for-profit systems in the nation. Settlemyer has 25 years’ experience in healthcare finance/reimbursement and has been with Atrium Health for more than 15 years, with focus in chargemaster compliance, charge capture, and revenue integrity. He has direct or consulting oversight of the chargemaster for 40 hospitals and their associated outpatient care locations, such as provider-based clinics, healthcare pavilions, and freestanding emergency departments. He is a charter member and inaugural chair (serving two terms) of The Provider Roundtable, a national group of volunteer providers whose focus is providing comment to CMS on the operational and financial impact of OPPS proposed rules. In addition, he is an adjunct instructor for HCPro’s Revenue Integrity and Chargemaster Boot Camp and is an Advisory Board member for NAHRI.

Jugna Shah, MPH, CHRI, is the president and founder of Nimitt Consulting, Inc., a firm specializing in case-mix payment system design, development, and implementation. She has 15 years of experience working with providers on the ongoing clinical, operational, financial, and compliance implications of Medicare’s OPPS based on APCs. Shah has educated and audited numerous hospitals on their drug administration coding and billing practices. She has contributed to several books and numerous OPPS/APC articles and is a contributing editor of HCPro’s Briefings on APCs. Shah serves as an advisory board member for NAHRI.

Tracey A. Tomak, RHIA, PMP, is the director of project management and client engagement at Intersect Healthcare in Towson, Maryland. She has more than 20 years of experience in revenue cycle with a focus on hospital coding, charge capture, and denials management. In her current role, Tomak is responsible for coordinating project implementation of Intersect Healthcare’s Veracity software. She works directly with clients to ensure that they are fully utilizing the Veracity software to effectively manage commercial and government audits and denials. Tomak is an active member of IHIMA, serving as the nominating committee chair for the 2018–2019 year.

Joseph Zebrowitz, MD, is founder/president of Versalus Health, a company providing hospitals with next-generation analytic and operational solutions focused on the intersection of utilization management, revenue cycle, and compliance. Previously, Zebrowitz served as executive vice president for Executive Health Resources, where he was a trusted advisor to thousands of hospitals and established the standard for medical necessity reviews. He has focused his career on helping hospitals gain an accurate picture of their compliance and revenue integrity.

Denise Wilson, MS, RN, RRT, is the senior vice president of Denial Research Group – AppealMasters. She has more than 30 years of experience in healthcare, including clinical management, education, compliance, and appeal writing. Wilson has extensive experience as a medical appeals expert, having personally managed hundreds of Medicare, Managed Medicare, and commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level.

Continuing Education

Full event information coming soon!