2018 Revenue Integrity Symposium

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2018 Revenue Integrity Symposium

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NAHRI Members save $100

Call Customer Service at 615-724-7200 to receive your Exclusive Member Discount.

Non-NAHRI Members: Register today to take advantage of Early Bird Pricing! $100 savings ends August 17, 2018 .

Save 15% (discount shown in cart) when you register for BOTH the 2018 Revenue Integrity Symposium and a Pre-Conference or a Post-Conference Boot Camp!
See Pre/Post-Cons tab below for details.

2018 Revenue Integrity Symposium

Coming October 16–17, 2018 | The Wigwam Hotel - Litchfield Park, Arizona

Pre-conference: October 14-15 (See Pre-/Post-Cons Tab)
Main event: October 16-17
Post-conferences (choose one): October 18-19 or October 18-20

The 2018 Revenue Integrity Symposium brings together training on Medicare billing and compliance, patient status, revenue integrity, case management, coding, and clinical documentation improvement (CDI), helping attendees ensure compliance and accurate billing and reimbursement across the revenue cycle. Unlike any other, this conference offers a wide range of exciting sessions on critical revenue integrity topics and the chance to learn from and network with trusted industry experts and revenue cycle professionals of all varieties.

Our expert speakers will cover critical topics essential to revenue integrity, such as IPPS and OPPS annual updates, chargemaster maintenance, patient status, denials management, appeals and Medicare Fair Hearings, payer audits, value-based purchasing, utilization review (UR), revenue cycle management strategies, and much more!

Benefits from the 2018 Revenue Integrity Symposium:

  • Return to your facility armed with the tools to enhance revenue integrity and develop strategies for accurately documenting, coding, and billing patient encounters and stays
  • Gauge the financial and operational impact of the 2019 OPPS proposed rule
  • Develop strategies for enhancing your UR committee, using PEPPER and other analytics to strengthen internal audits and defend against external audits, and creating a revenue integrity workplan
  • Gain insight into billing and coding hot topics that may impact your facility’s financial performance, including injections and infusions, claim edits, and the inpatient-only rule
  • Discover best practices for maintaining an up-to-date and compliant charge description master and learn to identify charge capture strategies for typical ancillary services
  • Explore the role of physician advisors and compliance in the overall revenue cycle and in a value-based model landscape
  • Get the latest information on external auditors and learn new strategies for dealing with claim denials and appeals
  • Learn strategies for designing a revenue integrity program, defining leadership, and setting and meeting revenue integrity goals

2018 Highlights 

  • Highlights of the 2019 OPPS proposed rule
  • Properly addressing National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits
  • Fundamentals of managing a compliance investigation and Medicare’s 60-day overpayment provision
  • Impact of value-based reimbursement models on revenue
  • Reimbursement, documentation, and coding strategies for new technologies, laboratory tests, cardiac procedures, and joint replacements
  • PEPPER implications for audit, reimbursement, and denial management 
  • Current payer audit targets and strategies to protect revenue
  • Links between ICD-10 and revenue integrity
  • Best practices for reducing payer denials using targeted data analytics
  • Understanding the impact of patient status and navigating payer regulations

Thank you for your interest in the Revenue Integrity Symposium. Please continue to visit us for updates. We will be updating this page frequently as details are finalized.

Please note that the program materials will be available via download and the conference app only. A download link will be provided prior to the event, but a printed book of the presentations will not be available on-site.


Day 1—Tuesday, October 16, 2018

Continental Breakfast (Provided) (Exhibit Hall Open)
7:00 a.m. – 8:00 a.m.

General Session 1
8:00 a.m. – 9:15 a.m.
Revenue Integrity Panel: A Look at 340B, Noncovered Services, and Medicare Advantage
Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, Elizabeth Lamkin, MHA, ACPA, Debra May, Terri Rinker, MHA, MT(ASCP), John Settlemyer, MBA, MHA, CPC, Angela Lynne Simmons, CPA
Join a select group of revenue integrity experts as they discuss the latest trends impacting revenue. This roundtable discussion will use case studies to examine changes to the 340B drug program, Medicare Advantage, noncovered services, and more.

General Session 2
9:15 a.m. – 10:30 a.m.
CMS' Proposed Changes for CY 2019 OPPS
Jugna Shah, MPH
CMS’ payment systems continue to evolve, and the OPPS/APC system is no exception. What’s in store for CY 2019? Take a front-row seat for an analysis of the latest OPPS proposals and news. Session highlights will include the 340B drug program, site neutral payment policies, the future of C-APCs, changes to drug pricing, and much more. Join us as we decode what CMS’ rules will mean for your outpatient services next year.

Networking Refreshment Break (Exhibit Hall Open)
10:30 a.m. – 11:00 a.m.

Breakout Session 1
11:00 a.m. – 12:15 p.m.

Revenue Integrity and the CDM: The Road to Success
Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, and Kay Larsen, CRCR
The chargemaster is your most vital tool. This session will dive into the structure and maintenance of the chargemaster with best practices for keeping it up to date. The audience will learn about the impact of common reimbursement methodologies, how to navigate the NCCI and other edit tools, how to identify charge capture strategies for common ancillary services, and tips for promoting revenue integrity in the facility setting.
  Physician Advisor: The Silver Bullet for Revenue Integrity
Elizabeth Lamkin, MHA, ACPA
This session will introduce participants to the role of the physician advisor (PA) and why it is so important. Participants will gain an understanding of how the PA fits into the revenue integrity continuum to lead and operationalize improvements along with how to measure the return on investment for the PA program. Sample tools and scorecards will be provided.
  Walk in the Shoes of a Compliance Investigation
Melissa J. McCarthy, RHIT, CCS, CHC, and Greg Radinsky, JD, MBA, CHC, CCEP
This session will help you to understand how to manage difficult issues that arise in a compliance investigation including attorney-client privilege, self-disclosures to government payers, and reporting compliance matters to management and the board. Through attending this session, you will also learn how to leverage publicly available CMS data to support your investigations and pro-active compliance efforts. Attendees will also have the opportunity walk through a case study to practice their investigatory skills.

Networking Lunch (Provided) (Exhibit Hall Open)
12:15 p.m. – 1:00 p.m.

Sponsored Session
1:00 p.m. – 1:30 p.m.

Transition Break (Exhibit Hall Closed)
1:30 p.m. – 1:45 p.m.

Breakout Session 2
1:45 p.m. – 3:00 p.m.

Patient Status and Inpatient Admission Orders: New Developments for Part A Payment
Kimberly A. H. Baker, JD, CPC, and Ralph Wuebker, MD, MBA
Patient status continues to be a tricky determination. Although CMS’ proposed changes to the inpatient only list and proposed changes to inpatient admission order requirements might appear to ease some of these concerns, they open up new questions while leaving other long-term issues such as the two midnight determination unresolved for providers. This session will cut through the confusion and provide the audience with expert analysis of the new patient status landscape and recommendations regarding the most recent regulations.
  The Revenue Integrity Workplan: Collaboration, Communication, Comprehension
Marilyn Hart Niedzwiecki, MBA, CPA, RN, CPC, COC, CIRCC
Revenue integrity is an essential component of an organization. This area has become very transparent in an organization and the activities performed require collaboration, communication, and a comprehensive understanding of clinical, financial, and information systems. An annual workplan is essential to ensure that that all areas of charge capture are reviewed on a regular basis. This presentation will provide an overview of how an annual workplan has been developed and implemented at Ann & Robert H. Lurie Children’s Hospital of Chicago. It will demonstrate what is included in the workplan, complexities encountered, and the importance of collaboration, communication, and comprehension of the EMR in use.
  An Insider’s Guide to Medicare Fair Hearings
Alicia Kutzer Esq., LLM, MHA
This session will provide an inside look at the Medicare Fair Hearings process from a former Administrative Law Judge. Learn what to expect at a Fair Hearing, how to determine the value of a 3rd level appeal, and tips for presenting a persuasive argument. Attendees will come out of the session with best practices and strategies for navigating the appeals process wisely.

Networking Refreshment Break (Exhibit Hall Open)
3:00 p.m. – 3:30 p.m.

Breakout Session 3
3:30 p.m. – 4:45 p.m.

Injections and Infusions: Test Your Knowledge and Get Answer
Jugna Shah, MPH
This session will help participants challenge their coding, billing, and documentation knowledge related to facility reporting of drug administration (injection/infusion) services, including hydration, therapeutic, and chemotherapy injections. We will also cover new codes and/or reporting requirements for CY 2019 and will address the financial implications of series billing with respect to drug admin services as well as reviewing some of the most frequently asked questions over the last year. This will be an interactive session, with attendees responding to quiz questions and clinical scenarios.
  Utilization Management Committee: Enhancing Value in Your Hospital
The utilization management (UM) committee is little more than a regulatory checkbox at many hospitals. However, it can and should be so much more. This session will review how to set up an effective UM Committee, and provide a detailed process map with real world examples demonstrating how this committee can reduce clinical variation, enhance efficiency, and reduce costs.
  MACRA, MIPS, Alternate Payment Models, ACOs: Where Are We Headed With Value-Based Care? 
William L. Malm, ND, RN, CRCR, CMAS
Confusion reigns among providers about required reporting for the QPP and MIPS. As the stakes rise and the threshold increases, providers need to deploy analytics to avoid sizable penalties. This session will discuss the necessities of reporting and how providers can improve their reporting methods. The audience will be given detailed information on how to use analytics to score more points and transform their organization for success under new payment models.

4:45 p.m.

Welcome Reception
4:45 p.m. – 6:00 p.m.


Day 2—Wednesday, October 17, 2018

Continental Breakfast (Provided) (Exhibit Hall Open)
7:00 a.m. – 8:00 a.m.

Breakout Session 4
8:00 a.m. – 9:15 a.m.

Next Generation Technologies: Practical Guidance for Success
Jugna Shah, MPH, and John Settlemyer, MBA, MHA, CPC
Providers struggle with how to report and price new, innovative and sometimes very expensive therapies for drugs, devices and procedural services. An example is CAR-T especially if no codes exist and when there are debates on what charges should be included given the product code description. This session will walk providers through coding, charging and billing strategies as well as Medicare's rules/citations on appropriate charging practices which impact the outlier and new tech add-on payment. We will show how provider charges fundamentally impact the ability or inability to generate outlier and/or new technology add-on payment (NTAP).
  Best Practices to Decrease Managed Care Denials
Steven A. Greenspan, JD, LLM, and Ralph Wuebker, MD, MBA
Managing denial and appeal processes can be a long and frustrating undertaking. Hospitals face serious threats to their financial health from revenue lingering in denial limbo.  This presentation provides best practices for managing medical necessity denials from managed care payers, as well as examples of how some facilities are addressing the growing threat to their revenue from medical necessity denials. It will be didactic with case presentations and a facilitated question and answer period.
  Medicare’s Secondary Payer Provisions: What Every Provider Needs to Know
Alicia Kutzer Esq., LLM, MHA
Take a look at how the Medicare Secondary Payer (MSP) provisions can impact your organization and learn how to prepare for major changes that will likely hit hospitals hard. This session will give attendees an overview of MSP and will break down how CMS interprets and applies the complex, and far-reaching, regulatory language. By tying payments from programs such as worker’s compensation, liability insurance, no-fault insurance, and other non-group health plans to all future treatment related to the injury, hospitals could find themselves hit by major overpayment recoupment actions. As provider organizations more frequently report diagnoses attributable to past injuries and conditions in risk-adjusted reimbursement models and recent legal action has opened the door to aggressive MSP recoupment, organizations must be prepared. This session will help attendees comply with regulations and avoid/combat  targeted recoupment.

Breakout Session 5
9:15 a.m. – 10:30 a.m.

NCCI/MUE Processes: Reduce Edits by Confronting and Eliminating Obstacles
Valerie Rinkle, MPA, and Denise Williams, RN, COC
This session will provide a review of the background of NCCI and MUE edits and why they were established. Scenarios will be used to demonstrate how to apply the NCCI and MUE edits. There will be a discussion of strategies to mitigate edits, appeal appropriate scenarios, protect revenue integrity, and meet the requirements to charge every patient the same.
  PEPPER Implications for Audit, Reimbursement, and Denial Management
William L. Malm, ND, RN, CRCR, CMAS
PEPPER is a critical but frequently overlooked benchmark that is significant to clean claim submission. This session will provide an overview of PEPPER and will walk the audience through how to use PEPPER to improve revenue integrity and reduce risk. We will illustrate how to create sustainable audit processes using PEPPER and will look at how PEPPER can be used to create a sustainable audit model.
  Medicare Beneficiary Notices: Optimize Delivery and Reduce Burden
Judith L. Kares, JD
This session will focus on primary patient notice responsibilities of hospitals and staff while providing guidance on implementing common practices for effective delivery of notices. We will also discuss consequences of noncompliance, including the impact of notices on billing and reimbursement, particularly where occurrence codes 31 and 32 are concerned.

Networking Refreshment Break (Exhibit Hall Open)
10:30 a.m. – 11:00 a.m.

Breakout Session 6
11:00 a.m. – 12:15 p.m.

Revenue Integrity Audits: It's Not Just About Coding Accuracy
Diana Snow, CCS, CHC, CHPC, CHRC
It is easy to think about coding accuracy and clinical documentation improvement when thinking about revenue integrity auditing, but there are many other areas of the revenue cycle where revenue leakage can occur. This session will explore how one organization began auditing from the beginning to the end of the revenue cycle and will discuss experiences in design, implementation, and execution of the program.
  Joint Replacements and Cardiac Procedures: A Clinical and Financial Review
Ronald L. Hirsch, MD, FACP, CHCQM
The removal of total knee replacement from the Medicare inpatient-only list may mark the start of a quantum shift of procedures traditionally performed as inpatient to the outpatient setting and even to ambulatory surgery centers. Furthermore, the application of the 2-midnight rule to these patients has created tremendous confusion and financial consternation. This session will review the regulations and financial considerations applicable to total knee replacement and discuss the clinical and financial implications of the shift of orthopedic and cardiac procedures from the hospital to the surgery center that is anticipated to accelerate.
  Basics of Hierarchical Condition Coding and Value-Based Contracting
Becky Cook, CPA, MHA
Using  risk factor scoring in financial management is a new skill needed to thrive with shared savings, Medicare Advantage, Managed Medicaid, ACO contracts and other value-based payment methods. Learn how risk scoring may be used to stratify patient populations, project cost of care for those patient populations and manage the reimbursements required to care for your patients. Examples using risk scoring in contracting decisions, operational decisions, benchmarking and communications with physician leadership will be presented.

Lunch (Provided) (Exhibit Hall Open)
12:15 p.m. – 1:00 p.m.

Sponsored Session
1:00 p.m. – 1:30 p.m.

Transition Break (Exhibit Hall Closed)
1:30 p.m. – 1:45 p.m.

Breakout Session 7
1:45 p.m. – 3:00 p.m.

A Practical Guide to the Outpatient Code Editor
Kimberly A. H. Baker, JD, CPC
CMS has substantially revised the OCE Specifications and is now publishing many code lists only with the OCE quarterly updates. Understanding the OCE is vital to keeping up with edits and quarterly changes, including retroactive changes that allow rebilling. This session will provide a practical look at how to use the OCE files and track OCE updates to keep your organization on top of CMS quarterly changes.
  Target Probe and Educate Audits and Other CMS Initiatives
Diane Weiss, CPC, CPB, CCP
CMS seems to be retooling their audit programs and medical review initiatives. This presentation will review the Targeted Probe & Education initiative as well as other CMS / MAC audits. Be sure you understand the scope of an audit, what documentation is actually required, the method for replying and how to appeal if there are unfavorable findings.
  Tick Tock You’re On the Clock: The 60-Day Provision
Jennie Bryan, MBA, RHIA, CCS, and Kim Cusson, CCS, CPC
This session will provide a general overview of the Centers for Medicare and Medicaid Services (CMS) Final Rule implementing the Affordable Care Act’s (ACA) 60-day report and return provision for self-identified overpayments, which were effective May 14, 2016. The session will examine when overpayments are identified for the purpose of the 60-day requirement as well as examine the look back period, how to report, and how to return overpayments. 

Networking Refreshment Break (Exhibit Hall Open)
3:00 p.m. – 3:30 p.m.

Breakout Session 8
3:30 p.m. – 4:45 p.m.

Implementing the New Outpatient Lab DOS Exception
Valerie A. Rinkle, MPA, ACHE
The 2018 OPPS final rule changed the current clinical laboratory date of service (DOS) policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests (ADLT), since they are now excluded from the OPPS packaging policy for laboratory tests. Although CMS has not yet designated any tests as ADLTs, it is critical for facilities to begin working through operational and reference lab contracting issues to implement the required changes for molecular pathology tests. These tests are paid separately under the Clinical Laboratory Fee Schedule (CLFS) rate and are not packaged into outpatient hospital Ambulatory Payment Classification (APC) payment rates, even when they are performed on the same date of service and/or billed on the same outpatient claim.
  Denial Prevention: Addressing Root Causes through Data Analytics and a Team-Based Culture
Tracey A. Tomak, PMP, RHIA
This session will highlight the differences between denial reason codes and root causes as well as define root causes that will allow for effective process improvement activity. Key players that must be involved to facilitate a team-based approach to denial prevention will be covered as well as ways to mitigate denials.
  One Size Does Not Fit All: Revenue Integrity Program Design Options
Caroline Rader Znaniec
Start breaking down silos related to denials. This session will describe the varied approaches to the design of a revenue integrity program. As one size does not fit all, the audience will be introduced to approaches seen nationwide. The session provides for pros and cons to each approach, addressing leadership and buy‐in, roles and responsibilities, and staffing models.


4:45 p.m.

Thank you for your interest in the Revenue Integrity Symposium. Please continue to visit us for updates. We will be updating this page frequently as details are finalized.

Please note that the program materials will be available via download and the conference app only. A download link will be provided prior to the event, but a printed book of the presentations will not be available on-site.

Pre-Conference and Post-Conferences

Save 15% when you register for BOTH the 2018 Revenue Integrity Symposium and a Pre-Conference or Post-Conference Boot Camp!


Medicare Boot Camp - Utilization Review
October 14–15, 2018
Price: $1,099
CLICK HERE to learn more and register for this Boot Camp.


Case Management Boot Camp
October 18–20, 2018
Price: $1,299
CLICK HERE to learn more and register for this Boot Camp.

Medicare Boot Camp - Provider-Based Departments Version
October 18–19, 2018
Price: $1,149
CLICK HERE to learn more and register for this Boot Camp.

Thank you for your interest in the Revenue Integrity Symposium. Please continue to visit us for updates. We will be updating this page frequently as details are finalized.

Please note that the program materials will be available via download and the conference app only. A download link will be provided prior to the event, but a printed book of the presentations will not be available on-site.


The Wigham HotelWHERE: The Wigwam Hotel

300 East Wigwam Blvd.

Litchfield Park (Phoenix, AZ 85340

• Room rate $203/night ($189/night + $7/night resort fee + $7/night resort gratuity)
• Hotel cut-off date is Friday, September 21, 2018
• Reservation Center: 1-800-327-0396 and referencing the Revenue Integrity Symposium
CLICK HERE for Hotel Reservations


A Resort Charge applies to all guest rooms.  This charge is $7.00 per room, per day, plus tax and includes the following.  All items subject to change

  • Complimentary high-speed internet service in all public space, lobby and guest rooms (which includes up to 4 devices per day per paid room)
  • Fitness Center access that includes Power Plate, rowing machines, ski simulator and Freeform Tread Runner and more
  • Access to Motion Studio that includes resistance bands, stability balls, bosu balls, medicine balls and yoga mats
  • Complimentary scheduled fitness classes that include Pure Yoga, Total Body Conditioning, Contemporary Pilates and Hydro Fit at Oasis Pool
  • Game room access including foosball, arcade games and televisions
  • Complimentary bocce ball, ping pong, sand volleyball
  • Live music Thursday, Friday and Saturday
  • Unlimited local and toll-free telephone calls
  • Complimentary USA Today
  • Complimentary valet and self-parking
  • Shuttle service offered Wednesday – Sunday from 10am – 6pm to Wildlife Zoo, Westgate Entertainment Center and Tanger Outlets based on availability
  • Complimentary bike rentals based on availability
  • Business Center services (fees may apply)
  • Complimentary boarding pass printer and computer access
  • Access to putting green
  • Special Red Door Spa offers
  • Complimentary tennis court usage 11am – 4pm based on availability
  • Complimentary hopper of tennis balls and rental racquets
  • Discount of $5.00 off private tennis lessons
  • Discounts of 15% off regular priced Golf shop items
  • Unlimited same day golf with purchase of round (cart included)
  • Complimentary resort historical tour Friday – Sunday morning at 10am

Thank you for your interest in the Revenue Integrity Symposium. Please continue to visit us for updates. We will be updating this page frequently as details are finalized.

Please note that the program materials will be available via download and the conference app only. A download link will be provided prior to the event, but a printed book of the presentations will not be available on-site.

2018 Sponsors

Interested in becoming a 2018 RIS Sponsor?
For information on sponsorship and exhibition, please contact Carrie Dry at cdry@h3.group or 630-235-2745.

Platinum Sponsor:

Xtend Healthcare


Gold Sponsor:

Chartwise Medical



Peak Health
Practical Data Solutions


The Revenue Integrity Symposium brings together revenue integrity, revenue cycle, compliance, HIM, CDI, and financial professionals together to connect on this pressing area of healthcare. Over 200 attendees will be present, along with additional revenue cycle leadership participating in the co-located Revenue Cycle Leadership Exchange.

For information on sponsorship and exhibition, please contact Carrie Dry at cdry@h3.group or 630-235-2745.

Thank you for your interest in the 2018 Revenue Integrity Symposium. Please continue to visit us for updates. We will be updating this page frequently as details are finalized.

Please note that the program materials will be available via download and the conference app only. A download link will be provided prior to the event, but a printed book of the presentations will not be available on-site.