2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event - On-Demand

Now Available On-Demand.

Join us for the only virtual conference designed for everyone in utilization review!

An effective utilization review (UR) process is a must as hospitals grapple with fluctuations in patient volume due to COVID-19 and rapidly evolving payer guidelines and denials. Even as elective procedures and services return, new admission criteria and expanded prepayment review tactics such as prior authorization put hospitals at risk of losing revenue. But with an understanding of the latest patient status regulations and a robust UR program supported by expert-tested best practices, hospitals can maximize revenue and avoid costly compliance pitfalls.

Get on demand access to 2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event to learn the latest strategies for concurrent and retrospective UR, inpatient-only list management, and prior authorization so you can protect your bottom line.

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 also receive 60-day access to the on-demand recording of this course.

2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event - On-Demand

Agenda

Day 1

45 minutes
Practical Solutions for Inpatient-Only Compliance
Kimberly A. Hoy, JD
Confusion about the inpatient-only (IPO) list is a long-standing problem. With the IPO list here to stay, it’s crucial that hospitals address misconceptions and process issues and understand the list’s effect on reimbursement. Expert speaker Kimberly A. Hoy, JD, will dispel persistent misunderstandings of IPO list compliance and provide practical answers to common questions. She’ll also compare inpatient and outpatient reimbursement and patient coinsurance for typical procedures removed from the IPO list.

45 minutes
Emergency Hospital Admissions: Is Your UR Focus Askew?
Edward P. Hu, MD, CHCQM-PHYADV
Most hospitals are very familiar with prior authorization processes, including standard and expedited time frames. This session will discuss different rules that apply to emergency hospital admissions for Medicare Advantage and Managed Medicaid enrollees, and how these rules offer additional protections for enrollees and providers over the more familiar authorization process.

30 minutes
How to Master Medicare Rules for Utilization Review With Powerful Training Solutions (demo)
Join HCPro for a look at our line of utilization review training solutions. We’ll explore how our clients leverage virtual and in-person intensive boot camps, the Medicare Watchdog service, and more through year-round training and education programs. Attendees will gather valuable information about available solutions, as well as qualify for session-only discounts!

35 minutes
Understanding Revenue Cycle on the Front End for Denials Prevention on the Back End
Tiffany Ferguson, LMSW, CMAC, ACM; Marie A. Stinebuck, MBA, MSN, RN, ACM
Utilization review (UR) is typically a retrospective process, but that often puts UR professionals at a disadvantage. By adding UR and patient status checks to the front-end revenue cycle, UR professionals can get ahead of the curve and ensure patients are correctly statused from the start. In this session, learn how to apply UR principles to front-end processes and use key performance indicators to monitor programs.

45 minutes
Breaking Down Prior Authorization Requirements for OPPS Departments
Kimberly A. Hoy, JD
As Medicare applies prior authorization to a growing list of procedures, utilization review professionals are increasingly called on to coordinate these processes and include prior authorizations in their reviews. Prior authorization processes can be complex to implement and may call for additional scrutiny to ensure medical necessity is met. In this session, attendees will learn the ins and outs of Medicare’s OPPS prior authorization rules and how to apply them.

30 minutes
Recorded Q&A
Tiffany Ferguson, LMSW, CMAC, ACM; Kimberly A. Hoy, JD; and Marie A. Stinebuck, MBA, MSN, RN, ACM
Join Day 1 speakers for a recorded question and answer session.

Day 2

45 minutes
Managing Capacity and Reimbursement at the Access Point During and After COVID-19
Bonnie Geld, MSW; and Heidi Rohloff, NP, MSN
Learn new strategies to ensure that utilization review and case management teams support and positively influence clinical and financial outcomes. This session will review key opportunities to collaborate with emergency department (ED) physicians to ensure appropriate admissions, status, and implementation of alternative plans for patients who can discharge safely from the ED. 

45 minutes
Medicare Advantage and The 2-Midnight Rule: Level the Field with Medicare Advantage Payers
Jerilyn Morrissey, MD; and Joseph Zebrowitz, MD
Misconceptions abound about how the 2-midnight rule applies to Medicare Advantage (MA) cases. Poor communication, insufficient processes, and misunderstandings of the rule and MA payers leave organizations at serious risk of lost revenue and compliance gaps. Clear up the confusion and get expert tips on process improvements in this session.

45 minutes
Prioritizing Patient Status Reviews
Valerie A. Rinkle, MPA, CHRI
Is your utilization review team properly balancing inpatient and observation reviews? Although many teams focus on reviewing inpatients to convert to outpatient status before discharge to enable condition code 44, they may not be putting enough resources into reviewing outpatients that can be admitted to inpatient status, which are typically costlier and more complex. In this session, learn how to more effectively prioritize reviews of outpatient and inpatient admissions and better ensure that patient status is compliant with Medicare’s rules.

45 minutes
From Insight to Action! Mastering Utilization Review Data
Jeffrey M. Echternach, MBA, NRP, AAS
Measuring utilization review (UR) activities and programs is a must, but selecting the right metrics to track isn’t simple; neither is interpreting and communicating results. Clear, meaningful data is the key to achieving accurate performance evaluation and identifying opportunities for improvement. In this session, learn about essential UR metrics, data strategies, tips for creating a UR dashboard, and demonstrating return on investment.

30 minutes
Recorded Q&A
Jeffrey M. Echternach, MBA, NRP, AAS; Bonnie Geld, MSW; Jerilyn Morrissey, MD; Valerie A. Rinkle, MPA, CHRI; Heidi Rohloff, NP, MSN; and Joseph R. Zebrowitz, MD
Join Day 2 speakers for a recorded question and answer session.

2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event - On-Demand

Speakers

	Jeffrey M. Echternach, MBA, NRP, AAS, is the technology officer at The Center for Case Management. He is the founder and developer of CARTBoard, an interactive case management dashboard product, and is the author of Case Management Data, a workbook for hospital case management administrators. He is proficient in several reporting languages (including SQL, DAX, R, Python, and M-Language), and is an Epic-certified BI developer. He has spent the past decade supporting hospitals across the nation with workflow translation and dashboard development.
	Tiffany Ferguson, LMSW, CMAC, ACM, is the CEO of Phoenix Medical Management Inc., a hospital case management company. Ferguson is a graduate of Northern Arizona University and received her MSW at UCLA. After practicing as a hospital social worker, she was tapped by administration at Northern Arizona Healthcare to serve as director of community case management and quickly assumed leadership responsibility as system director of health and care management, later becoming top administrator for the employed medical group. She is ACM certified, serves on the board for the Northern Arizona Gerontology Association, contributes regularly to RACmonitor and the Journal of Case Management, and is a commentator for Finally Friday.
	Bonnie Geld, MSW, is president and CEO of The Center for Case Management and has more than 20 years’ experience in case management with a focus on design of longitudinal case management programs, strategic design and development of transition programs, process improvement, team building, and integration of social work and RN roles. She has been the system director for case management services for a five-hospital system in western Massachusetts, has served as director of care management in Minneapolis and Houston, and has developed and implemented successful care management programs in other states. She has launched a variety of educational programs and workshops on promoting Lean actions, team interventions, rapid-cycle assessments, and integrated care planning.
	Kimberly A. Hoy, JD, s 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. Hoy 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.
	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.
	Jerilyn Morrissey, MD, is senior vice president of clinical and regulatory affairs at Versalus Health. She is responsible for regulatory, private payer, and utilization management education for case management staff and physicians. Morrissey is passionate about using data and technology to help hospitals navigate complex Medicare regulations and understand payer practices and their impact on the hospital revenue cycle. Morrissey’s experience as a practicing physician, a physician advisor for a nationally recognized health system, and a director of clinical information for a national payer affords her a unique perspective to solve utilization management’s evolving challenges.
	Heidi Rohloff, NP, MSN, is an acute care nurse practitioner at Ascension Providence Hospital and a consultant with the Center for Case Management. As a nurse practitioner and clinical operations leader, Rohloff successfully aligns patient care with administrative and regulatory requirements in dynamic healthcare organizations. In her role as a consultant, Rohloff performs deep analysis on emergency department (ED) assessment and implementation of ED metrics, discharge planning, InterQual criteria for admission status, and high utilizer programs.
	Valerie Rinkle, MPA, CHRI, is president of Valorize Consulting and has more than 35 years’ experience in healthcare policy, finance, strategy, and revenue management operations. Her expertise spans all CMS reimbursement methodologies and the operational capabilities necessary to effectively achieve accurate and defensible payment. She has extensive hospital chargemaster, OPPS and physician fee schedule, and provider-based department experience. Rinkle also has significant experience in leading compliance due diligence in support of M&A as well as defense strategies surrounding OIG, DOJ, RAC, and other audit agencies, including state Medicaid programs. She has served as an expert witness in litigation. She works with device manufacturers and pharmaceutical manufacturers for their coding and reimbursement support. Rinkle is a frequent public speaker with HCPro and an annual presenter on OPPS at the Institute on Medicare and Medicaid Payment Policy by the American Health Lawyers Association, where she co-presents with CMS representatives.
	Marie Stinebuck, MBA, MSN, RN, ACM, has been a nurse for 25 years with 13 years in case management and more than a decade in hospital case management leadership. Her roles have included leadership of teams in case management, utilization review, denials management, clinical documentation integrity, and medical record integrity. She holds an MBA from the University of Phoenix and an MSN in Nursing Leadership from Grand Canyon University and currently holds an active role on the AMCA Arizona Board.
	Joseph R. 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. He is a NAHRI Advisory Board member.

2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event - On-Demand

Learning Objectives

After attending this virtual conference, learners will be able to:

• Identify strategies to ensure compliance with the inpatient-only list
• Describe prior authorization processes and requirements
• Discuss methods to support appropriate inpatient admissions
• Explain the application of the 2-midnight benchmark
• Compare utilization review program performance metrics
• Define medical necessity requirements for inpatient admissions

2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event - On-Demand

Pricing

Retail price: $399.00
NAHRI Membership price: $379.00

Group pricing is as follows:

• 4-10 attendees = each attendee receives 10% discount off retail price
• 11-15 attendees = each attendee receives 15% discount off retail price
• 16-20 attendees = each attendee receives 20% discount off retail price
• 21 or more attendees = each attendees receive 25% discount off retail price

2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event - On-Demand

Continuing Education

ACDIS
This program has been approved for 7 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 credits for this webinar expires on: 3/9/23

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).

Ability to claim credits for this webinar expires on: 3/9/23

2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event - On-Demand

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
• A library of sample webinars and other content on the latest revenue cycle topics
• NAHRI quarterly journal, featuring in-depth, members-only content on the latest developments in revenue cycle

LOCAL CHAPTERS

Be on the ground floor in establishing your local chapter! It’s a great way to: 

• Quickly integrate and network with other revenue cycle professionals 
• Expand your management, leadership, and public speaking skills by volunteering for the chapter executive board

CONFERENCES AND TRAINING

Members receive significant discounts on all national and local NAHRI events. Learn from the best and brightest, interact and network with industry leaders, or roll your sleeves up and participate in an intensive, in-person, training events.

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,

Nicole Votta, Director, NAHRI
nvotta@hcpro.com