SCHEDULE OVERVIEW

Tuesday: 

Morning session: Introduction to Claims Denials

Time / Duration: 10:00 AM - 11:45 AM EST (45 minute lecture | 15 minute break  | 45 minute breakout session)

Description: Payer claims denials are prevalent in all hospitals, healthcare systems and physician practices. To alleviate many of these denials through a proactive approach, it is imperative that all providers and those involved in some capacity in the revenue cycle have a strong understanding of the various types of claim denials and the wide array of contributing factors. This session will provide an encompassing outline of the various types of claim denials, reasons and contributing factors, and most importantly offer tips and strategies to alleviate and prevent recurring denials in the name of proactive preemptive denials as the strong foundation for a high performing revenue cycle. Interactive discussions will be an integral part of this session with ample time allowed for questions and answers at the conclusion of the presentation.

Lunch: 11:45 - 12:15

Afternoon session: Denials Avoidance vs. Denials Management

Time / Duration: 12:15 PM - 2:00 PM EST (45 minute lecture | 15 minute break  | 45 minute breakout session)

Description:  An integral component of the hospital and healthcare system revenue cycle is Denials Management given the abundance of denials initiated by payers. Denials Management is an inefficient manner of attempting to collect revenues due the facility compared to Denials Avoidance. Denials Avoidance requires a whole change in culture and mindsets throughout the organization in all disciplines starting with all providers, clinical documentation integrity specialists, physician advisors, case management/utilization review and coding staff.  This session will define the steps and processes necessary to transform a Denials Management approach into a more highly efficient Denials Avoidance approach to increasing net patient revenue while decreasing cost to collect. Lessons learned from a similar initiative to transform Denials Management to Denials Avoidance at a large level I Trauma Academic Medical Center will be incorporated into the discussion with inclusion of how best to measure return on investment as a key part of the transformation process

Total: 4 hours 15 min (including breakouts and lunch)

Wednesday

On-demand session + access to additional resources

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Thursday

Morning session: Working Smarter, Not Harder: How to Apply Standards to Avoid Denials

Time / Duration: 10:00 AM - 11:45 AM EST (45 minute lecture | 15 minute break  | 45 minute breakout session)

Description: Most Non-Technical Denials providers receive from payers are considered avoidable, attributable to insufficient and/or provider documentation. Every year’s CERT Contractor Report on Improper Payments reveals that the overwhelming majority of Medicare Fee-for-Service Improper Payments are due to two of the five Improper Payment Categories, Insufficient Documentation and Medical Necessity, virtually one and the same since the latter is directly related to the former. Providers often take short cuts to documentation leading to an incomplete picture of the true representation of the patient’s clinical story and clinical facts of the case. The end result is provider communication potentially suffers with unnecessary tests being ordered, patient avoidable time spent in the hospital, delayed discharge, and increased healthcare costs all around. This session will define and outline physician documentation standards and best practices, allowing physicians and other providers to become more efficient in documentation and charting within the electronic health record. A practicing hospitalist will utilize real case studies of patient inpatient encounters to show and demonstrate in detail how best to apply established standards of documentation, accurately capturing the patient’s clinical story and picture including a clear reporting of the physician’s clinical judgment, medical decision making, thought processes, and clinical rationale, all fundamental and germane to the establishment of medical necessity from both the hospital and physician perspective. Appropriate Copy and Paste functionality will be highlighted and discussed with a focus upon avoiding known perils and pitfalls of inappropriate Copy and paste including exposure to unnecessary Medicolegal and Compliance Risks.

–30 min Lunch–

Afternoon session: Maintaining Compliance: Don’t Get Caught With Your Pants Down

Time / Duration: 12:15 PM - 2:00 PM EST (45 minute lecture | 15 minute break  | 45 minute breakout session)

Description:  Compliance and allegations of Fraud and Abuse remain pervasive throughout the healthcare community. The mainstay to staying the course in compliance is complete and accurate provider documentation that establishes medical necessity for the service ordered and/or rendered accompanied by a clear telling and describing of the patient story, depicting the clinical picture and need for patient care. In addition, the capture and accurate reporting of the provider’s clinical judgment, medical decision making, thought processes and clinical rationale 

are essential in maintaining compliance with a host of CMS and other payer guidelines and regulations. In short, providers control their own destiny in maintaining compliance with the host of payer guidelines and regulations through their documentation. This session will provide attendees with the knowledge of the wide array of guidelines governing documentation, coding, and billing from both a diagnosis, procedure, coding and billing perspective including Evaluation and Management documentation, coding, and billing. Real case studies with provider documentation will be utilized that demonstrate potentially noncompliant practices along with case studies summarized in frequent OIG Hospital and Physician Practice Compliance Reports. Key strategies and concepts to consider in effectively maintaining compliance with a whirlwind of compliance regulations and guidelines will be shared with all attendees. Attendees will walk away with an encompassing list of resources to use in keeping up with and proactively maintaining compliance in documentation, coding, and billing within the practice of medicine. 

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Total: 4 hours 15 min (including breakouts and lunch)