Track A

9:10 a.m. – 10:10 a.m.
2024 OPPS, MPFS, and IPPS: Analyzing the Latest Final and Proposed Changes
Marc Hartstein; John D. Settlemyer, MBA, MHA, CPC, CHRI; and Jugna Shah, MPH, CHRI
Learn all you need to know about the latest finalized IPPS changes for FY 2024 and the major proposed changes for OPPS and MPFS for CY 2024. Ensure your hospital is prepared from a reimbursement and compliance perspective!

• Explain the most recent final and proposed changes for the IPPS, OPPS, and MPFS
• Describe methods to ensure compliance with the final rules
• Analyze the impact of the proposed and final changes on revenue

10:10 a.m. – 10:40 a.m.
NETWORKING & REFRESHMENT BREAK IN THE EXHIBIT HALL

10:40 a.m. – 11:40 a.m.
Adding Clarity and Value to the CDM
Sarah L. Goodman, MBA, CHCAF, COC, CHRI, CCP, FCS; Rosemary Holliday, MHA; Kay Larsen, CHRI; and Linda J. McCray, CPA, MBA
How can you add value and clarity to your charge description master (CDM)? What resources should you use? Get an inside look at best-practice strategies for maintaining an up-to-date and accurate CDM and promoting collaboration among CDM professionals, financial leadership, and external experts. This panel session will use case studies and real-life examples to explain the role of the CDM coordinator, the CFO, and outside consultants and vendors. Attendees will take away key tips for addressing CDM challenges and for promoting revenue integrity in the facility setting.

• Identify the organization’s unique CDM management approach
• Explain the roles of the CDM coordinator, the CFO, outside CDM consultants, and CDM software vendors, and how they can best assist and support team members
• Identify best practices for promoting revenue integrity as part of a CDM and charge data management strategy
• Evaluate some of the most common CDM and charge capture challenges

11:40 a.m. – 12:40 p.m.
NETWORKING LUNCH—(PROVIDED) IN THE EXHIBIT HALL

12:40 p.m. – 1:10 p.m.
SPONSORED SESSION
TBD

1:20 p.m. – 2:20 p.m.
A Story of Revenue Integrity Transformation
Heather Davidson, MBA, CCS; Lydia C. Walker, MBA, CPC; and Lauren Winn, MBA
This session will explain how UC San Diego Health transformed their revenue integrity to achieve higher staff engagement, stronger relationships with clinical departments, more efficient processes, and improved charge reconciliation. The speakers will discuss revenue integrity structures, calculating return on investment and scope of work, strategies to support clinical departments, using qualitative and quantitative measures for success, and more.

• Discuss revenue integrity organizational structure leading practice
• Assess interdepartmental success factors and measure revenue integrity KPIs
• Describe implementation of systemwide charge reconciliation

2:20 p.m. – 2:50 p.m.
NETWORKING & REFRESHMENT BREAK IN THE EXHIBIT HALL

2:50 p.m. – 3:50 p.m.
Coding, Billing, and Payment Implications of Patient Status, Observation Services, and the Three-Day Payment Window
Ronald L. Hirsch, MD, FACP, CHCQM, CHRI; Valerie A. Rinkle, MPA, CHRI; and Jugna Shah, MPH, CHRI
Patient status has a ripple effect on billing, coding, and reimbursement, but there are common misconceptions about how it’s defined and how it interacts with observation and other services, the three-day payment window, and C-APC assignment. This session will dispel misunderstandings about billing, coding, documentation, and reimbursement related to patient status. It will also address the definition of the three-day payment window and explain when and how observation may be ordered and the criteria for payment under the IPPS vs. the OPPS. The speakers will use clinical scenarios to illustrate how these concepts are applied in real-life situations.

• Describe the two types of patient status
• Explain why observation is a service and not a status
• Discuss the coding and billing rules associated with Medicare’s three-day payment window
• Analyze how the observation C-APC is and is not triggered

4:00 p.m. – 5:00 p.m.
Defense Strategies for Commercial Payer Line Item Charge Denials
Valerie A. Rinkle, MPA, CHRI, and Glenn Solomon, JD
Commercial payer charge denials can be complex and confusing to unravel and appeal. In this session, learn how typical contract language in commercial payer contracts obligates payers to follow both HIPAA and Medicare requirements for charges. The session will discuss examples of how provider organizations have used arbitration or litigation to overturn line item charge denials. Attendees will leave with a better understanding of the criteria to evaluate whether this approach should be used for payers that deny common hospital charges for point-of-care lab tests, IV solutions, and bedside procedures.

• Explain contract language
• Define methods to overturn line item denials
• Identify denials that can be overturned

5:00 p.m. – 6:30 p.m.
NETWORKING & EXHIBITS RECEPTION

Track B

9:10 a.m. – 10:10 a.m.
Analytics for Revenue Integrity
Rochell Dahmen, CSBI
The future economy is all about data, so make sure your data is working for you! Information from analyzing data trends can help your health system determine areas of vulnerability or hidden risk. Using data analytics in conjunction with compliance and internal audit gives your organization a point-in-time response, allowing it to layer analytics with ongoing monitoring to mitigate risk exposure and improve operational efficiency.

• Explain the future of data-driven healthcare
• Describe what data analytics is and why it is important
• Identify the impact data analytics has on an organization
• Name key elements of an effective data strategy

10:10 a.m. – 10:40 a.m.
NETWORKING & REFRESHMENT BREAK IN THE EXHIBIT HALL

10:40 a.m. – 11:40 a.m.
Successful Proactive Denials Management: Inviting CDI to the Table
Laurie L. Prescott, MSN, RN, CCDS, CCDS-O, CDIP, CRC
Clinical documentation integrity (CDI) is focused on capturing strong documentation. Record reviews are performed concurrently, while the patient is present, to capture needed documentation prior to discharge. These efforts focus on DRG assignment, accurate capture of principal and secondary diagnoses, and clinical validation. CDI professionals are becoming increasingly involved in denials management, which requires strong documentation. Despite this fact, many organizations still have not invited CDI to the table. Concurrent CDI reviews focused on known vulnerable encounters or diagnoses can lower denial rates by preventing denials BEFORE they occur, saving time and resources down the line. This presentation will highlight how to incorporate CDI department efforts in your denials management plan.

• Explain the role of CDI in denials management
• Identify opportunities to incorporate CDI into denials management
• Describe methods to prevent denials through cross-functional collaboration

11:40 a.m. – 12:40 p.m.
NETWORKING LUNCH—(PROVIDED) IN THE EXHIBIT HALL

12:40 p.m. – 1:10 p.m.
SPONSORED SESSION
TBD

1:20 p.m. – 2:20 p.m.
Common Revenue Integrity Issues With Patient Status
Kimberly A. Hoy, JD, CPC, and Teri Rice, RN, MSN, MBA, MHA, CHC
Struggling with confusing orders, translating utilization review determinations to the claim, or getting full reimbursement when there are patient status issues? This session will review issues with inpatient orders and what they mean for submission of correct claims. The session will also review common problems and questions with the self-denial process and inpatient Part B claims for both benefits exhaustion and medical necessity issues, including new guidance from CMS regarding edits for revenue codes and HCPCS codes on inpatient Part B claims. Finally, the speakers will compare inpatient Part B and self-denial processes and payment with condition code 44 using several case studies.

• Explain Medicare’s rules for patient status determinations
• Describe the use of condition codes 44 and W2
• Analyze the reimbursement impact of patient status changes

2:20 p.m. – 2:50 p.m.
NETWORKING & REFRESHMENT BREAK IN THE EXHIBIT HALL

2:50 p.m. – 3:50 p.m.
A Day in the Life of a Revenue Integrity Professional
Aleah B. Martagon, MBA, RHIA, CRCL, and Rachel Pugliano, CHC, RHIT, CRCR
Regardless of size, all organizations face similar challenges when it comes to things like facility charging, charge capture workflows, and split billing. This session will cover these challenges and share solutions that the speakers have found useful. It will also cover how compliance has been integral to the resolution process within revenue integrity.

• Discuss challenges faced across all organizations
• Describe options for resolution of common challenges
• Demonstrate how to integrate compliance into revenue integrity tasks and functions

4:00 p.m. – 5:00 p.m.
Leveraging RCM and Coding to Address the Health Equity Gap
Leigh Poland, RHIA, CCS, CDIP
The events of the past few years have thrust health equity into the spotlight as providers, regulatory agencies, and payers seek to identify and close areas of weakness to achieve care parity across race and ethnicity, gender, sexual orientation, socioeconomic status, and other factors. In this session, we will walk through how revenue cycle management (RCM) and coding play important roles in addressing the health equity gap.

• Discuss social determinants of health (SDoH) and review recent legislation on advancing health equity
• Assess the business case for involving RCM in any comprehensive SDoH/health equity strategy
• Explain steps providers can take to close the health equity gap

5:00 p.m. – 6:30 p.m.
NETWORKING & EXHIBITS RECEPTION

Track A

7:00 a.m. – 8:00 a.m.
CONTINENTAL BREAKFAST IN THE EXHIBIT HALL

8:00 a.m. – 9:00 a.m.
Implementing a Multidisciplinary Approach to Managing Transfers at a Tertiary Care Center
Kristin A. McKee, RN, and Anuja Mohla, DO, MBA, CHCQM-PHYADV
Stewardship of tertiary resources is essential for revenue integrity and patient throughput. Transfers from outside facilities can present a unique challenge to the revenue cycle. Collaboration with a hospital transfer center and with compliance, legal, medical staff, case management, and finance departments is critical to developing an efficient workflow for transfers in and out of tertiary care centers. Effective management of interfacility transfers is a multistep process that requires collaboration from internal and external stakeholders to ensure a community’s tertiary resources are available when needed. In this session, learn how ChristianaCare developed a multidisciplinary approach to interfacility transfers centered on identifying patient needs and resource use. Learn to collaborate with patients, utilization management, and other departments, and include a route to escalate issues to the C-suite.

• Recognize the role of utilization management in managing transfers
• Describe an interfacility transfer agreement
• Explain methods to effectively manage length of stay of transferred patients
• Assess electronic tools for data collection and analysis

9:10 a.m. – 10:10 a.m.
Preventing Lost Revenue in the Charge Capture Process
Camille Ruiz, RHIA, CHRI
Charge capture is one of the most critical functions supporting revenue integrity and a strong revenue cycle. However, it’s highly prone to errors and other issues that result in missing or late charges, leading to unnecessarily lost revenue. This session will discuss practical methods for identifying weaknesses in the charge capture process and preventing revenue loss.

• Describe common sources of missed charges
• Identify methods to reduce lost revenue due to missed charges
• Explain the role of revenue integrity in reducing missed charges

10:10 a.m. – 10:40 a.m.
NETWORKING & REFRESHMENT BREAK IN THE EXHIBIT HALL

10:40 a.m. – 11:40 a.m.
Managing Contemporary Payer Audits
Sandy Giangreco Brown, MHA, BS, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC, PCS, and Diane Weiss, CPC, CPB, CHRI
This session will present an update on all of the current audit activity, not only from government and commercial payers. The speakers will discuss what to do when notified of an audit, who should be involved in the audit management process, how to prepare the most complete and appropriate response, and how to make use of the offered education. This session will also include best practices for appealing audit results as well as for developing educational opportunities and process improvements.

• Identify current audit activities
• Explain how to respond to audit requests
• Assess when to ask for additional education from payers in conjunction with audit requests

11:40 a.m. – 12:50 p.m.
NETWORKING LUNCH—(PROVIDED) EXHIBIT HALL FINALE

12:50 p.m. – 1:50 p.m.
Compliance and Revenue Integrity: A Complementary Relationship
Rachel Pugliano, CHC, RHIT, CRCR
Healthcare organizations are pulled in many directions, all of which are important from both an operations perspective and a risk management perspective. How do you determine what takes priority? Revenue integrity is a vital function in any healthcare organization, while compliance brings an independent and objective eye to assess and reduce risk. But the two shouldn’t be in competition with each other. In this session, we will share how one organization's compliance work plan assisted the revenue integrity team as well as revenue-producing departments to address risks, identify opportunities, make improvements, and streamline processes. We will share examples of the reviews performed and how revenue integrity was able to benefit from the findings and recommendations.

• Demonstrate how to create an annual compliance plan that includes the revenue cycle, specifically the revenue integrity function
• Explain the value of incorporating charge capture and coding/billing reviews into the compliance plan
• Describe how revenue integrity functions and revenue cycle oversight can impact performance as well as compliance

2:00 p.m. – 3:00 p.m.
Taking Charge of Your Charge Capture
Rebecca Haworth, MHA, BSN, RN, and Sherry Nardi
A hospital’s financial health includes ensuring that all appropriate charges are captured during a patient’s stay. Yet many things can go awry during this process, impacting charge integrity and resulting in revenue leakage. These include incomplete knowledge, personnel turnover, complexity/volume of coding requirements, and coding/billing mismatches. Even the EHR and its automation can cause system errors. A strong charge capture program, whether manual or automated, is key to help preserve revenue integrity. This session will discuss solutions to these challenges and methods to support an organization’s financial health.

• Identify the risks of not having a defined charge capture program
• Describe how to implement a charge capture program
• Explain best practices to ensure a successful charge capture and revenue integrity program

3:00 p.m.
SYMPOSIUM ADJOURNS

Track B

7:00 a.m. – 8:00 a.m.
CONTINENTAL BREAKFAST IN THE EXHIBIT HALL

8:00 a.m. – 9:00 a.m.
Healthcare Evolution: Revenue Protection in an Era of Uncertainty
Jonathan G. Wiik, MSHA, MBA, CHFP
Payment uncertainty in the U.S. healthcare system has become an exhaustive burden for all stakeholders—further amplified by COVID-19. Healthcare costs and inconsistent volumes demand a holistic, long-term strategy for financial viability. At the same time, legislative reform and regulatory attempts to address shortfalls in quality, cost , and outcomes have stalled, perpetuating inefficiencies and burdensome rules that add expenses instead of removing them. This session will offer effective strategies to help healthcare providers protect their earned revenue and empower smooth, positive patient experiences.

• Define application methodologies from those who have demonstrated revenue protection excellence
• Select workflows and solutions to problems like underpayments, denials, and patient affordability
• Describe how providers are meeting the challenges of current market dynamics
• Evaluate ideas to manage access, risk, cost, regulation, revenue cycle, and payment strategies

9:10 a.m. – 10:10 a.m.
How Incorrect or Incomplete Authorizations Create Denials and What Carilion Clinic CVI Did to Address Them
Terresa F. Odum, MBA-HM, PMP, CCS, CPC
In this session, learn how Carilion Clinic reduced authorization denials in its Cardiovascular Institute, modified the structure of its revenue integrity program, and tracked success. The session will discuss the process for developing and staffing a dedicated position, the structure of the revenue integrity program, and the metrics to monitor the value of the new position and processes.

• Explain how issues with authorizations can impact denial rates
• Demonstrate how to address authorization denials
• Discuss staffing and job descriptions for positions focused on authorization denials

10:10 a.m. – 10:40 a.m.
NETWORKING & REFRESHMENT BREAK IN THE EXHIBIT HALL

10:40 a.m. – 11:40 a.m.
Financial Impact of the January 2023 Evaluation and Management Update
Sherry Goyal, MD, MBA, CHRI, CRCS, CPC
The January 2023 evaluation and management (E/M) update aimed to decrease provider documentation workload and increase patient satisfaction. However, inappropriate planning and implementation can create reworks for coding and billing staff, shifting rather than eliminating workloads and placing pressure on the entire system. Organizations may also see an increase in claim edits and accounts receivable as many of these accounts may get stuck in claim edit work queues. This presentation will provide information on streamlining provider education related to future updates and decreasing the opportunity cost associated with reworks.

• Discuss the financial impact of the E/M 2023 update
• Explain provider education guidelines
• Describe best practices for organizational policy related to provider education and compliance requirements
• Assess opportunity cost related to accounts receivable and claim edit rework

11:40 a.m. – 12:50 p.m.
NETWORKING LUNCH—(PROVIDED) EXHIBIT HALL FINALE

12:50 p.m. – 1:50 p.m.
NCCI Edits: The Importance of Clinical Reviews and Appealing
Teri Rice, RN, MSN, MBA, MHA, CHC
Managing National Correct Coding Initiative (NCCI) edits and the denials associated with them is an important piece of revenue cycle operations. Establishing a robust clinical review process is essential to resolving denials and identifying issues that can be addressed to prevent similar denials in the future. At the same time, it’s critical to identify which NCCI edit–related denials are strong candidates for appeals and how to efficiently navigate the appeals process. This session will discuss the types of NCCI edits and the denials associated with them, as well as the clinical review process and tips for crafting appeals.

• Describe the types of NCCI edits
• Explain strategies for managing NCCI edits
• Assess methods for appealing NCCI-related denials

2:00 p.m. – 3:00 p.m.
Telehealth: The New Normal
Joy Krush, RHIT, CCS, CCS-P, CDIP
This presentation will review the current state of telehealth rules, regulations, and coverage. The session will poll the audience on how telehealth services are provided in their respective environments. Case studies from large and small organizations will explore various challenges, opportunities, and solutions.

• Explain Medicare telehealth coverage and billing guidelines
• Discuss various commercial plans’ coverage of telehealth
• Describe behavioral health updates in telehealth
• Demonstrate how to use remote patient monitoring with telehealth
• Illustrate the impact of state regulations around telehealth licensing and requirements

3:00 p.m.
SYMPOSIUM ADJOURNS

Sandy Giangreco Brown,  MHA, BS, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC, PCS, is the director of coding and revenue integrity at CliftonLarsonAllen, LLP. She manages and develops relationships, audit services, and education for clients, coding staff, and providers. She has more than 35 years of experience in healthcare and medical records management, coding, auditing, and compliance in the hospital, outpatient, and physician settings. She loves presenting and sharing education, with her areas of specialty including OB-GYN, general surgery, cardiology, anesthesia, E/M, oncology, and radiology coding. She conducts regional and national presentations for groups such as AHIMA, WHIMA, CHIMA, NCHIMA, HCCA, AAPC, and MGMA, and teaches courses for the AAPC.

Rochelle Dahmen, CSBI, is the revenue cycle manager for Eide Bailly, LLP, in Minneapolis, Minnesota. She has more than 20 years of healthcare experience, including more than three years at Blue Cross Blue Shield of Minnesota and more than 17 years working in healthcare organizations across the country. Specializing in revenue cycle and technology implementations, she has assisted health systems throughout the country with denials management, chargemaster assessments, compliance reviews, and charge capture improvements, as well as EHR implementations, conversions, and optimizations. With her strong analytical skills and thorough understanding of the revenue cycle, she can quickly identify issues and create solutions to improve revenue cycle performance.

Heather Davidson, MBA, CCS, is the director of hospital coding, revenue integrity, and HIM at UC San Diego Health. She is a performance-driven healthcare revenue cycle leader, with 20 years of achievements across HIM coding and revenue integrity and proven success with revenue cycle operational leadership and business development. She is a team builder and collaborator who exceeds organizational and industry-standard KPI targets in accounts receivable and denials troubleshooting and remediation. She has expertise in EMR and coding software implementation and program design, and is a coding subject matter expert.

Sarah L. Goodman, MBA, CHCAF, COC, CHRI, CCP, FCS, 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 held leadership roles in professional organizations on the local, state, and national levels—including the NAHRI Advisory Board. She also serves as an alternate adjunct instructor for HCPro’s Revenue Integrity and Chargemaster Boot Camp and as a frequent presenter at NAHRI-sponsored events.

Sherry Goyal, MD, MBA, CHRI, CRCS, CPC, is the charge master analyst at Monument Health in Rapid City, South Dakota. Goyal graduated from medical school in India in 2003 and served in the Indian Army Medical Corps as a medical officer until 2007. She was awarded lifetime membership in the Beta Gamma Sigma honor society for her excellence in business education. She is an active member of the American Medical Association, the American College of Healthcare Executives, and the HFMA. She joined the AAPC in 2018 and is an active member of its Rapid City local chapter. She has more than 19 years of healthcare experience working in diverse roles as a physician, medical officer, USMLE tutor, Epic trainer, revenue integrity analyst, and chargemaster supervisor. She worked at Synchrony for more than one and a half years before joining Monument Health as a credentialed Epic inpatient provider trainer. She is Epic Resolute Hospital Charging Administration Certified.

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.

Rebecca Haworth, MHA, BSN, RN, is vice president of product management for FinThrive revenue integrity products. Haworth is an accomplished revenue integrity and software management professional specializing in charge capture consulting, chargemaster pricing and standardization, and product management. She has launched startup operations including a new charge capture product and a best-practice charge capture advisory program. Haworth is a frequent speaker at HFMA Annual and Map Events and authored “The Top 10 Charge Capture Requirements” article for The Edge, the HFMA’s Northern California publication. Prior to joining FinThrive, Haworth worked with the Department of Veterans Affairs as a health systems specialist in long-term, intermediate, and domiciliary care. Haworth is a member of the HFMA and AHIMA.

Ronald L. Hirsch, MD, FACP, CHCQM, CHRI, is vice president of R1 RCM in Chicago. Hirsch was the medical director of case management at Sherman Hospital in Elgin, Illinois. 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.

Rosemary Holliday, MHA, began her healthcare career in the mid-1970s as a radiologic technologist. While working in hospital and vendor management roles in the early 1990s, she and her husband developed web-based software solutions to solve the nation’s chargemaster management challenges. Over 32 years as a niche vendor, their company, Holliday & Associates, provided charge management software, consulting, and educational solutions to hospitals and healthcare systems nationwide. To ensure the legacy of their successful ChargeAssist® software product, the company recently joined forces with Panacea Healthcare Solutions, an industry leader in strategic pricing and revenue cycle solutions, where she and her husband serve in leadership roles.

Kimberly A. Hoy, JD, CPC, is the director of Medicare and compliance for HCPro, a division of Simplify Compliance. 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.

Joy Krush, RHIT, CCS, CCS-P, CDIP, is a senior healthcare manager with Eide Bailly, LLP, in Bismarck, North Dakota. She has more than 30 years of experience in the healthcare industry with an emphasis in coding, HIM, compliance, charge capture, and documentation improvement. She is trained in ICD-10, Current Procedural Terminology (CPT®), and clinical documentation integrity with understanding of MS-DRGs and APC payment methodologies. Krush provides reviews of facilities’ chargemasters to evaluate overall accuracy of coding, revenue codes, and line item descriptions and assists with implementation of chargemaster recommendations. She performs coding and documentation reviews for facility reimbursement and has experience managing appeals to Recovery Auditors and other payers for DRG and APC denials. She assists clients with day-to-day revenue cycle questions, including questions and processes related to telehealth services. She has served as president of the North Dakota Health Information Management Association (NDHIMA) and in several other positions with NDHIMA. She is currently a member of AHIMA’s Revenue Cycle Practice Council.

Kay Larsen, CHRI, is a revenue integrity specialist at Adventist Health Glendale in California. She has enjoyed 20+ 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.

Aleah B. Martagon, MBA, RHIA, CRCL, is a revenue integrity manager at Hennepin Healthcare in Minneapolis, Minnesota. She has more than 20 years of experience in healthcare revenue cycle and IT, specializing in HIM, chargemaster, and EHR (Epic) support. She is skilled in process improvement, change management, and data analysis, and has attained various Epic certifications in HIM, chargemaster, and ambulatory applications during her time as an EHR analyst. Martagon is a member of AHIMA, the HFMA, and NAHRI, where she is currently a Leadership Council member.

Linda J. McCray, CPA, MBA, started her accounting career in a small public accounting firm in northwest Washington. She began her journey in healthcare as an internal auditor for Adventist Health. She worked in several positions during her career with Adventist Health, such as director of fiscal services, CFO, and regional CFO. Since retirement, she has consulted with hospitals working to improve charge capture in EMRs.

Kristin A. McKee, RN, is the manager of the utilization management department at ChristianaCare in Newark, Delaware. In her current role, she has successfully implemented several initiatives within the utilization management department that had a significant impact on operational workflow. She has more than 16 years of experience as a bedside nurse, including several years of management experience.

Anuja Mohla, DO, MBA, CHCQM-PHYADV, is the medical director of revenue integrity and a hospitalist at ChristianaCare in Newark, Delaware. She most recently served as a senior physician advisor and medical director of patient access and flow for several years at ChristianaCare before transitioning to her current role. She is dual board certified in internal medicine as well as healthcare quality management with a subspecialty designation as a physician advisor. A graduate of the Philadelphia College of Osteopathic Medicine, Dr. Mohla went on to complete her internal medicine residency at UMDNJ, New Jersey Medical School. She serves on the board of American College of Physician Advisors as the chair of its Observation Committee. She is a frequent national speaker on denials management, appeals, and regulatory requirements.

Sherry Nardi has more than 20 years of healthcare experience in revenue cycle operations, sales, and supply chain roles. She provides charge integrity solution strategy expertise to providers in partnership with FinThrive sales and client management, with a focus on consulting and web-based solutions. Nardi works closely with product management to ensure charge integrity solutions are meeting the needs of customers and addressing healthcare industry changes. She also previously led implementations for these solutions for FinThrive. Prior to joining FinThrive in 2000, Nardi oversaw supply chain purchasing/contracting at Children’s Healthcare of Atlanta.

KEYNOTE: Larry O’Brien, MA, is a senior facilitator and leadership coach who has more than 20 years of experience working in various corporate leadership roles and leading global system, process, and training implementations. O’Brien led global leadership development programs for a Fortune 50 financial services company, where he introduced programs for high-potential leaders and new leaders. These programs continue to be the highest-rated programs at the company. O’Brien works with leaders who are in a transition or need to develop new skills to prepare them for the next level. He coaches leaders in executive presence, cultural intelligence, change management, and leadership effectiveness. Coaching in both English and Spanish, he has worked with leaders from Argentina, Brazil, China, France, Germany, Ireland, India, Japan, Mexico, Spain, and the United States. O’Brien was born in Latin America and has lived in Buenos Aires, Argentina, and Caracas, Venezuela, as well as up and down the U.S. east coast. Given his global upbringing, education, and experience, he has expertise in helping leaders harness the full potential of their multicultural teams. He believes that cultural intelligence is a critical leadership skill that can be mastered. He is a certified coach by the International Coach Federation.

Terresa F. Odum, MBA-HM, PMP, CCS, CPC, is director of the Cardiovascular Institute’s revenue operations department at Carilion Clinic in Roanoke, Virginia. Carilion Clinic is a multihospital organization throughout Southwest Virginia that has partnerships with the Virginia Tech School of Medicine and the Radford University schools of health sciences and nursing. Odum has more than 20 years of experience in coding. She began her career as a frontline radiology coder and has served as a coding team lead, a senior revenue operations advisor, and a revenue operations manager. Through her many years working in coding and billing, Odum has gained experience with multispecialty coding and comprehensive billing and reimbursement processes. In addition, she has managed major projects involving process changes and improvements related to coding and billing. She also spearheaded the development of new positions within Carilion Clinic, with a focus on improving the authorization process and reducing denial percentages.

Leigh Poland, RHIA, CCS, CDIP, is vice president of the coding service line at AGS Health based in Washington, D.C. She has more than 25 years of coding, auditing, and CDI experience and has worked extensively in coding and education for the last 15 years. Her passion is making sure coders are equipped to do their job accurately and with excellence. She has presented at the AHIMA National Convention, the national ACDIS conference, and the AAPC Convention on multiple occasions. She has spoken at multiple state AHIMA conventions, including TXHIMA, PHIMA, ILHIMA, LHIMA, and WHIMA. She has been a guest speaker on AHIMA webinars and written articles for the Journal of AHIMA. She has traveled internationally providing coding education. 

Laurie L. Prescott, MSN, RN, CCDS, CCDS-O, CDIP, CRC, is the interim director of the Association of Clinical Documentation Integrity Specialists (ACDIS) at HCPro in Middleton, Massachusetts. 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. She is also the co-author of the CDI Specialist’s Training Guide, Third Edition, and the best-selling ACDIS Pocket Guide series.

Rachel Pugliano, RHIT, CHC, CRCR, is a senior manager of healthcare with Eide Bailly, LLP, in Minneapolis, Minnesota. She assists clients with improving their revenue cycle functions as well as maintaining compliance with government regulations. Her specific expertise is in the mid-revenue cycle, which includes coding, documentation improvement, revenue integrity, and charge capture.

Teri Rice, RN, MSN, MBA, MHA, CHC, is the lead instructor for HCPro’s Medicare Boot Camp®—Critical Access Hospital Version and Rural Health Clinic Version and an instructor for the Medicare Boot Camp—Utilization Review Version. She is a regulatory specialist for HCPro’s Medicare Propel Advisory Services, providing guidance on coverage, billing, and reimbursement. A nurse with extensive experience in compliance, Rice has assisted an acute care hospital with documentation integrity, internal auditing, charge capturing, and education; played an active role in software implementation, process improvement, and establishment of workgroups; and co-designed physical therapy software to promote compliance with federal Medicare regulations. She has assisted with EHR rule-based functionality for accurate charge capture and presented department-specific educational programs on documentation, charging practices, and Medicare regulations. Rice has developed policies and procedures focused on Medicare regulations to promote compliance. She has collaborated on compliance work plans, internal organizational risk assessments, and root cause analysis.

Valerie A. 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 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, Recovery Auditors, and other audit agencies, including state Medicaid programs. She has served as an expert witness in litigation and 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.

Camille Ruiz, RHIA, CHRI, is a regulatory specialist for HCPro and an instructor for HCPro’s Revenue Integrity and Chargemaster Boot Camp®. She has served as a clinic coder, HIM manager and director, charge description master (CDM) analyst, and CDM and revenue integrity consultant. She has more than 15 years of experience with revenue systems coordination and CDM and revenue cycle consulting. Ruiz is an AHIMA-Approved Revenue Cycle Trainer.

John D. Settlemyer, MBA, MHA, CPC, CHRI, is an assistant vice president of revenue cycle with Atrium Health, based in Charlotte, North Carolina. Atrium Health is an integrated, nonprofit health system serving patients at 40 hospitals and more than 1,400 care locations. Atrium Health is part of Advocate Health, the fifth largest nonprofit health system in the United States, which was created from the combination with Advocate Aurora Health. It also provides care under the Atrium Health Wake Forest Baptist, Atrium Health Navicent, and Atrium Health Floyd names throughout the Southeast. Settlemyer has over 25 years in healthcare finance/reimbursement with Atrium Health, with focus in charge description master (CDM) operations and compliance, charge capture, and revenue integrity. He has direct oversight of the CDM 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 of The Provider Roundtable. He also serves on the Government Relations Committee for the American Society for Transplantation and Cellular Therapy. 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.

Glenn Solomon, JD, is a partner in the healthcare practice of King & Spalding. He specializes in commercial and government managed care, complex business litigation, arbitration, mediation, class action, investigations, and other dispute resolution matters. His diverse clientele includes prominent hospitals and health systems, medical groups, independent physician associations, management services organizations, and other healthcare providers and entities. On behalf of providers, he has both resolved significant disputes with health plans and negotiated high-profile contracts with them, as well as solved disagreements with other providers.

Lydia Walker, MBA, CPC, is the manager of healthcare performance improvement at Huron Consulting Group. She is a strategic leader with 30 years of experience in healthcare operations, technology, and business insights across all care continuums. Her extensive knowledge of front-to-back operational and clinical infrastructure allows her to assess and identify gaps across the enterprise to design integration and workflows that drive best practice performance. Prior to joining Huron, Walker was an executive healthcare consultant independently and with Roundtable Strategic Solutions. Prior to that, she served in multiple roles during her 23-year tenure at Atrium Heath, where she focused on operational efficiencies in process design, technology, and clinical charge capture workflows across medical group and hospital locations.

Diane Weiss, CPC, CPB, CHRI, is the vice president of revenue integrity and education with RestorixHealth, where she oversees several internal auditing processes as well as monitors all external payer audit activity and programs. Weiss also oversees the coding team and provides reimbursement and denials management for the organization’s professional services division. She works closely with senior leadership on a national and regional basis and serves on the audit and compliance committee. Weiss provides general coding, billing, and documentation education to all internal staff as well as to providers and staff who provide care in the wound care centers that RestorixHealth manages. Weiss and her audit team participate in external auditing follow-up calls with payers through the SMRC D&E process as well as all education provided through CMS’ TPE program. Prior to joining RestorixHealth, Weiss was the internal Medicare consultant for Ochsner Health System, and before that she spent 12 years at Pinnacle Medicare Services, a Medicare contractor, as a provider relations education specialist.

Jonathan G. Wiik, MSHA, MBA, CHFP, is the vice president of health insights at FinThrive. Wiik has more than 25 years of healthcare experience in acute care, health IT, and insurance settings. He started his career as a hospital transporter and served in clinical operations, patient access, billing, case management, and many other roles at a large not-for-profit acute care hospital and prominent commercial payer before serving as chief revenue officer. In his current role, he is responsible for leading healthcare data insights and research. Wiik works closely with the market and hospitals on industry best practices for revenue management. He is considered an expert in the industry for healthcare finance, legislation, revenue management, and strategic transformation. Wiik is an active advocate of legislative changes that evolve the healthcare industry. He’s the author of Healthcare Revolution: The Patient Is the New Payer, and Revenue Evolution: Helping Providers Get Paid in an Era of Uncertainty, which was released in early 2020. He frequently speaks as a thought leader at state and national events. Wiik is the past president of Colorado HFMA, and previously served as a board member for the American College of Healthcare Executives and the Colorado Association of Healthcare Executives.

Lauren Winn, MBA, is a director at Huron Consulting Group. She has collaborated with and advised top-tier physician organizations and hospital systems across the country. She has over 10 years of experience in managing projects and overseeing performance improvement assessments and HIS optimizations. Her specialties include optimizing overall revenue cycle operations, with a strong focus in professional billing and follow-up, charge capture, revenue integrity, shared services, and cost-to-collect. She serves as a lead for Huron’s internal revenue integrity and charge capture methodology team.