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7:30 am Registration & Breakfast
8:10 am Meet the New Boss. Same as the old Boss? New auditors for Medicare Inpatient Medical Necessity
Session: 050616T1 | CPE: 1.0 | Level: Advanced
Explore and understand the implications of the new Audit structure for Medicare Inpatient admissions.
After this session Attendees will be able to
1: Learn the differences in audit rules and agencies in 2016 compared with the RAC era.
2: Understand the likely impact this will have on hospitals
Dr. Palega, a practicing hospitalist and board-certified in internal medicine, serves as Medical Director of Regulatory Affairs for EdiPhy Advisors. In this role, he frequently serves as an expert witness in Medicare Fraud cases as well as educates physicians and healthcare administrators about medical necessity rules and regulations. Dr. Palega has experience working with hospitals, physicians, and other healthcare companies to improve compliance with state and federal healthcare compliance. This covers the spectrum from recommending measures to optimize documentation and compliance with billing and necessity rules to compliance with federal corporate integrity agreements (CIAs) to responding to government audits, recoupments, and fraud investigations. In addition, Dr. Palega frequently represents healthcare providers at state and federal administrative hearings to prevent recoupment of payment.
9:00 am Advancing Your Career in Healthcare Finance
Session: 050616T2 |CPE: 1.0 | Level: Entry
In today’s competitive job market having a strong network and being able to sell yourself are critical for success in advancing your career. Stefan will provide an overview of the current healthcare career market, share strategies for successfully growing your career, and provide best practices on how to develop your personal brand.
After this session, attendees will:
- Have an understanding of the healthcare market and where to discover emerging career opportunities
- Learn best practices in developing a powerful network and effective resume
- Understand how to develop your value proposition
- Learn effective strategies for interviewing
- Identify key steps in building your personal brand
Before joining the firm Stefan was Vice President at Tyler & Company, a national healthcare retained search firm where he led their Healthcare IT executive search practice. Prior to this Stefan was in strategic client relationship management and business development roles at Siemens Healthcare. He also spent time at Allscripts (formerly Eclipsys) in a key account management position. Prior to these positions, he spent more than seven years in enterprise information technology sales with Unisys, a worldwide IT services and technology company. Stefan is passionate about helping organizations hire the right executive talent. He has worked with clients including community hospitals, large IDNs, physician organizations, Private Equity firms, HIT/Revenue Cycle vendors and related companies. He is a frequent speaker and moderator on career development and hiring at a number of industry events (regional and national) including HIMSS, ACHE, HFMA and The Texas Association for Healthcare Financial Administration. He has taught career development classes at The University of Texas Austin and St. Edward’s University Austin. Stefan also enjoys providing career coaching for executives in a number of areas in healthcare, sales and technology.
9:50 am Break
10:00 am Using Analytics to Bridge the Reimbursement Gap
Session 050616T3|CPE: 1.0| Level: Intermediate
Implementing and Managing Revenue Cycle Best Practices To Drive Medicare Reimbursement
- We’ll walk through two examples of how data analytics can be used to identify gaps in reimbursement (Medicare reimbursable bad debt and complex DRG review)
- Understand how analytics should be used by management to benchmark hospital performance against peers and state averages
- Discuss organizational challenges to implementing the process improvements needed to increase reimbursement
- Review lessons learned with Texas hospitals for utilizing analytics to uncover and quantify deficiencies in business office processes that were impacting their Medicare reimbursement
Todd is responsible for setting the strategy and direction of the company and leading all new product initiatives. Under Todd’s leadership, HPS has evolved from a service-based firm to a software company offering market leading solutions for hospital reimbursement issues. Prior to joining HPS in 2009, Todd was a partner and co-founder of Trinity Healthcare Resources, a healthcare consulting firm that provided services to hospitals on a variety of reimbursement issues. Todd earned his MBA degree in finance from Texas Christian University, and his BA from Southwestern University.
10:50 am The Hidden Waste in Key Employee Retention & Retirement Planning
Session 050616T4 | CPE: 1.0 | Level: Intermediate
- Review of most common defined contribution structures and their attributes
- Identify and explain the hidden risks and waste
- Discuss potential alternatives and their effect on eliminating and/or mitigating wast/risks.
- Convey that, while familiar, the status quo is not necessarily the best option and may be causing the hospital to spend unnecessary amounts on key employee retention and retirement.’
- Expand the participants’ thinking in terms of evaluating and recommending the best options for kep employees.
Mr. Wright is a co-founder and has served in this position for the past 15 years. He is primarily responsible for the testing, design and development of products and strategies offered to the firm’s clients. In addition to a deep knowledge of many advanced planning arrangements, his particular areas of expertise include business development, business transactions and finance and accounting. Additionally, he has over 12 years of previous experience in the healthcare field and has held executive positions ranging from operations to business development. Prior to entering financial services, he served as area vice president for a national, publicly traded physician practice development firm. In that capacity, Mr. Wright played a leadership role in securing multiple affiliations for the company. Mr. Wright also served as director of business development for one of the nation’s largest emergency medicine management providers.
11:40 am Lunch
12:30 pm Supplemental Payments in Texas , 1115 Waiver Style
Session 050616T5|CPE: 1.0 | Level: Intermediate
Supplemental Payments in Texas have been used by the Texas Legislature for years to offset low reimbursement rates for hospital services. However, in recent years, the Legislature has expanding their use to include mental health services, academically rendered services, acute and outpatient services, and long term care services, for nursing homes and group homes.
With the Texas 1115 Waiver up for negotiation, the questions are on the rise for all these providers and businesses who are dependent on these funds to provide Medicaid services. The Texas Medicaid Agency, HHSC, and the Centers for Medicare and Medicaid Services (CMS) are trying to find a way to address each contingency’s concerns and not jeopardize the safety-net across Texas.
While no decisions have been made yet, funds stop September 30, 2016.
Update stakeholders with regard to expectations on cashflow, funding opportunities, funding reductions, timelines, and compliance.
Bilse served the State of Texas in offices of the highly prestigious and powerful Senate Finance Committee under the leadership of Chairman Steve Ogden; the Public Health Committee under the leadership of Chairwoman Lois W. Kolkhorst; the Office of the Honorable Kevin Eltife; and the Texas Health and Human Services Commission (HHSC) under the direction of then-Commissioner Albert Hawkins. Since opening her private practice in May of 2012, Bilse represents, consults, and lobbies for health and human services providers and other stakeholders with HHSC and the Texas Legislature. A native Texan, Bilse lives in Austin, Texas, with her husband Corey, two sons Brady and Charlie, and daughter Tilly Jane.
1:20 pm Jail Break Your EMR for Financial Transparency
Session 050616T6| CPE: 1.0 | Level: Entry, Intermediate
EMR’s have the promise to provide workflow efficiency, increased patient safety, significant cost savings, and the ability to practice better medicine, but the task is proving monumental. The challenges have been well documented. A single EMR solution is unlikely to meet the rapidly changing demands of healthcare patients and the business of healthcare services. The complexity of modern medicine has a great need for systems collaboration and flexibility.
Many industries have benefited from the decentralization of large single-purpose software develop. The functional power phones today could barely be imagined by people 10-20 years ago. The user experience of our phones, tablets, and PC continues to amaze. While the devices are roughly the same, the apps on each phone are highly customized to the individual users needs and desires. How do we get that in healthcare to physicians and other care givers to deliver the promise of a better healthcare?
We need that in healthcare. Jail breaking your EMR has several major opportunities.
Reason to Jail break your EMR:
- More data – Important data exists inside and outside the EMR’s and could be displayed in user-friendly ways. The display and timing of the data should not be hidden from caregivers due to EMR preferences or development timelines.
- Access to more applications – population health, personalized medicine, and other application need a way to integrate important data into the EMR workflow.
- Quick and Easy – Access to data and custom views need not be lengthy and expensive.
- Fully Reversible – If you decide the solution implemented does not fit your needs, uninstall it.
- Dangers of multiple apps – Limitations of multiple applications is minimized by the hardware developments. Hosting solutions minimize the investment and provide virtually unlimited scaling opportunities
- System updates – easier with cloud base applications.
- System instability – multiple apps does not imply untested.
Creating context sensitive displays that co-exist with your EMR is a way to leverage your existing EMR investment and meet the needs of the caregivers your serve.
Harvey Nix has more than 25 years’ small business technology sales and entrepreneurial experience. Nix moved to Birmingham to start work in the healthcare industry in 1998 as director of business development for NicholsTxen. Nix led the acquisition of the largest service agreements in their history. NicholsTxen was acquired by Computer Science Corporation and continues to operate in Birmingham as DST. The relationships from NicholsTxen lead to a senior sales role at MedMined. Nix leveraged his payor sales experience from NicholsTxen to lead the first payor/hospital joint initiative model to reduce healthcare associated infections. The initiatives contributed to the significant growth of MedMined and ultimate acquisition by Cardinal Health. The initiatives included high-profile insurance companies BCBS AL, BCBS TX, BS CA, Excellus BCBS NY, Horizon -BCBS NJ and Highmark- BCBS PA, with more than 200 hospital participants. For the past seven years, Nix was the CEO of Proventix System Inc., a provider of RFID-based, hospital hand hygiene compliance monitoring. Nix led the business from start-up to 50 hospital customers.
2:10 pm Break
2:20 pm From Challenge to Reimbursement—Successfully Collecting on Third Party Liability Accounts is No Accident
Session 050616T7|CPE: 1.0 | Level: Intermediate
The purpose of this course is to describe the comprehensive process of evauating, pursuing and accident-related accounts. All hospital representative with exposure to patient accounts would be this course as it will provide the appropriate road map to pursue accident-related accounts from compliance and a financial perspective.
After this course attendees will be educated on:
- The Personal Injury System as it Relates to Hospital Accounts
- The Texas Hospital Lien Statute
- Coordination of Benefits when an Accident has occurred
- The Medicare Secondary Payer System
- The Texas Medical Third Party Recovery System
- Current Trends and Developments relating to Third Party Liability accounts in Texas.
Douglas Turek has been in the healthcare receivables industry since 2001 and is currently the Senior VP of Operations for Alegis Revenue Group, overseeing all company operations. Alegis combines legal expertise and technology driven processes to maximize reimbursement on difficult to collect hospital accounts. His law firm, The Turek Law Firm, P.C., handles third party liability, denials and other types of reimbursement litigation for hospital clients across the country. Mr. Turek has been a licensed attorney in Texas for over 19 years and is also licensed in Utah, California, Nevada, Oklahoma, Pennsylvania, Kansas, Tennessee, Missouri, and Florida.
3:10 pm Are you “Quoting” or Marketing your Insurance Program?
Session 050616T8 | CPE: 1.0 | Level: Intermediate
Will discuss the difference between typical marketing strategies against what Fortune 500 CEO’s and CFO’s do to maximize their leverage against the markets. How to achieve better rates, negotiate broader coverage, and dictate to the markets what you want for your hospital. Explanation of the benefits of Policy Reviews. Explain what they uncover and how they can help you customize your Property and Casualty Insurance Program. I will also discuss the current Property state of the market.
To educate CEO’s, CFO’s, Risk Managers, or Corporate Counsels to large hospitals or systems to leverage their large size against carriers to win better rates and overall efficiency out of their Property & Casualty Insurance Program.
Eric is an Assistant VP and Business Development Officer for McNeary, Inc. In this role, he is responsible for business growth, while also working with his clients to ensure the delivery of consistently high quality professional services from the McNeary Account Team. This includes policy reviews, customized annual service plans, and stewardship reporting to his clients. Eric’s area of focus includes healthcare with an emphasis on hospitals, as well as manufacturing and industrial companies. Prior to joining McNeary, Eric’s professional history includes a successful 15 year property & casualty career working for international brokerage firms such as Willis and Marsh & McClennon.
Eric is a native Texan with a Bachelor of Science degree in Business Management from Southwest Texas State University in San Marcos, TX. He is a licensed Property & Casualty broker in the State of Texas.
4:00 pm Closing Remarks