9:00 am Registration
9:30 am Avoiding False Claims Liability, Enhancing CMS Compliance & Addressing Issues around Patient Status Determinations: Two Midnight Rule Challenges
Session: 262416T1 | CPE: 1.0 | Level: Advanced
Course Description: It is critically important for health care professionals to understand practical approaches for maintaining compliance to address ever-changing rules and guidance. This session will deliver actionable insights for compliant process and decision-making relative to patient status, billing and documentation. We will explore recent final rulings and currently proposed changes that affect medical necessity and patient status. Learn potential implications of these changes.
Presented By: Patricia Mandt Prather, JD, Director of IRO Services, EdiPhy Advisors
Ms. Prather joined MedManagement in 2014 and is the Director of Independent Review Services. Tricia graduated Magna Cum Laude with a Bachelor of Science degree in Corporate Finance from The University of Alabama where she received a debate scholarship. She also graduated as Hugo Black Scholar and Leigh M. Harrison Scholar from The University of Alabama School of Law. While a student, Tricia served on the National Moot Court Team, finishing first in regional competition and earning the “Best Oral Advocate” award. Prior to joining MedManagement, Tricia served as General Counsel for Harbert Management Corporation. She also served as a litigation attorney and Partner for two different law firms; Bradley, Arant, Rose and White and Wilmer & Lee, PA. She has a passion for using her experience and expertise for the benefit of others. As such, she has served in leadership positions for various community and outreach organizations such as The Board of Directors of the Birmingham Boys Choir Foundation, Salty Oak Ministry (encourages Christian businesses in Ukraine), and Harbert Employees Reaching Out (HERO) Foundation. Tricia has also participated in ten international mission trips.
10:20 am From Challenge to Reimbursement – Successfully Collecting On Third Party Liability Accounts is No Accident
Session 062416T2 |CPE: 1.0| Level: Intermediate
Course Description: The purpose of this course is to describe the comprehensive process of evaluating, pursuing and collecting on accident-related accounts. All hospital representatives with exposure to patient accounts would benefit from this course as it will provide the appropriate road map to pursue accident-related accounts from both a compliance and a financial perspective.
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.
11:10 am Legal, Regulatory, and Managed Care Update
Session 062416T3 | CPE: 1.0 | Level: Intermediate
Chris Reed started his career at an international law firm over 15 years ago and has become a seasoned litigator who prides himself on serving his client’s interests by aggressively advocating for their needs. Chris focuses on reimbursement matters, bad faith litigation/coverage disputes, health care malpractice, health care compliance litigation and investigations, managed care cases, health care-related collection cases brought both under ERISA and state law, general commercial litigation and business disputes, construction defect litigation, premises liability litigation, toxic exposure cases, and catastrophic injury litigation. Chris has represented physicians before the Texas Medical Board and also has particular experience advising both in-network and out-of network health care providers on disputes with payors. He has also represented transportation companies in their civil litigation involving cargo damage and bodily injury, as well as before administrative proceedings with the Federal Motor Carriers Safety Administration.
With both first chair and second chair trial experience, Chris prides himself on efficiently handling matters and adding value to his client’s business by understanding their business needs, not just managing a file.
12:00 pm Working Lunch
12:15 pm A Nuts & Bolts Guide to Understanding the Medicare Cost Report
Session: 062416T4 |CPE: 1.0 | Level: Entry | Intermediate | Advanced
Course Description: Get a better understanding of the basic Medicare cost calculations, get comfortable reading the report and know what each worksheet series represents and find common Medicare metrics from your cost report. A brief history of the Medicare program and the payment methodologies for each type of hospital.
Presented By: Mike Trostel, Principal, Blue & Co., LLC
Mr. Trostel has over 30 years of experience in the healthcare industry. Prior to joining Blue & Co. Mike was the President of a healthcare consulting firm, specializing in reimbursement. He has worked in the areas of Medicare and Medicaid Reimbursement as a consultant and as reimbursement manager with two large national Healthcare corporations. Mr. Trostel’s experience includes cost report preparation, re-openings and appeals, Medicare/Medicaid audit assistance, reimbursement analysis, wage index review audits for a wide range of healthcare providers. He has also provided Medicare bad debt review, analysis, and log preparation assistance. Mike has provided State DSH and UC Tool preparation, audit, and appeals. He has sought exceptions to TEFRA target limitations and SNF routine cost limits in the past and had success in gaining relief for facilities. Additionally, Mike has sought geographic reclassifications, Sole community and CAH requests with success. He also has experience in setting up methodologies by which hospitals track their contractual allowances and their cost report receivable/payable. He has also assisted clients with hospital billing procedures, hospital logging support and review, financial proformas, and various “what-if” scenarios. Mike has also provided expert witness testimony to clients within the Reimbursement venue. Mr. Trostel earned a Bachelor’s of Business Administration degree from the University of Texas at Austin in Accounting. He is a member of HFMA, AICPA, TAHFA and TORCH.
1:05 pm UPL and MPAP and QIPP … Oh My – Where Are We Now and How Did We Get Here
Session 062416T5 |CPE: 1.0 | Level: Intermediate
Course Description: This session will provide a history of the Texas nursing home UPL/MPAP/QIPP program including its evolution through the transition to Medicaid Managed Care. We will discuss successes achieved and challenges faced so far as well as talk about the possible future of the program
As a member of BKD National Health Care Group, Jon provides audit and consulting services for health care entities. He has more than 20 years of public accounting experience, leads BKD’s Texas long-term care practice. Jon has presented numerous seminars for groups and organizations and has written multiple white papers related to the Texas nursing facility UPL program.
1:55 pm A Conversation with Texas State Representative Jeff Leach
Session 062416T6 | CPE: 1.0 | Level: TBD
State Representative Jeff Leach proudly serves the citizens of House District 67, consisting of portions of Plano, Allen, Richardson and Dallas in Collin County. A committed conservative, Representative Leach believes in limiting the size and scope of government, lowering taxes and wisely investing in the critical infrastructure necessary to ensure Texas remains prosperous and strong as our state continues to grow. Rep. Leach has been recognized by numerous organizations across the state for his work during both the 83rd and 84th Legislative Sessions. Specifically, Leach was named a “Taxpayer Champion” by Texans for Fiscal Responsibility, the state’s largest taxpayer watchdog organization, a “Courageous Conservative” by the Texas Conservative Coalition and he received an A Rating by Texas Eagle Forum. Leach was also named a “Champion for Free Enterprise” by the Texas Association of Business. In addition, in 2013 Capitol Inside named Leach as one of the “Best Freshman Legislators” and the Dallas Morning News singled Leach out as one of the “Best of the Dallas Area’s Freshman Class.” During his first session, Representative Leach successfully authored legislation limiting the reckless expansion of Medicaid under the Affordable Care Act, as well as a provision that will spur stable job growth in Texas by providing substantial tax relief for business owners that relocate to Texas. Most recently during the 84th Legislative Session, Leach passed legislation to crack down on sexual offenders and make our neighborhoods safer. Furthermore, Representative Leach successfully authored landmark legislation protecting the private property rights of Texas homeowners. Representative Leach serves on the House Committee on Government Transparency & Operation and the House Committee on Criminal Jurisprudence. Born and raised in Plano, Representative Leach graduated from Plano Senior High before attending Baylor University, where he served as Student Body President for two consecutive terms. During his time at Baylor he served President Bush in the White House Office of Political Affairs and the Republican National Committee. Leach went on to earn his law degree from Southern Methodist University’s Dedman School of Law and currently practices at the law firm of Gray Reed & McGraw, P.C. in Dallas. Representative Leach is a Member of the Board of Trustees for the Medical Center of Plano and was recently selected to serve as an Ex-Officio Member of the Executive Board for the North Central Texas Council of Governments. Jeff also serves on the advisory board of Meals on Wheels of Collin County. Representative Leach and his wife Becky, a small business owner, are the proud parents of Brady (age 8), Charlotte (age 5) and Landry (age 1). In addition to service with numerous other community organizations, Jeff and Becky are active members of Prestonwood Baptist Church, where they have served for several years in the Young Families Ministry.
2:45 pm Break
3:00 pm Reimbursement: Staying Ahead of the Curve
Session 062416T7|CPE: 1.0 | Level: TBD
Course Description: High level presentation on Transplant, IME/GME & IPPS 2017 updates
Presented By: Traudi Bandura, Principal, Discovery Healthcare Consulting Group, LLC & Tom Johansen, Consultant, Discovery Healthcare Consulting Group, LLC
Traudi Bandura, Principal, Discovery Healthcare Group, LLC
Traudi is a Principal at Discovery Healthcare Consulting Group and manages reimbursement and regulatory initiatives and solutions for our healthcare clients. She has over thirty years of experience in healthcare reimbursement and financial reporting experience, including large academic medical centers and hospital systems. Her consulting background includes over 11 years with Ernst and Young; and finance and reimbursement management positions with large for-profit and non-for profit hospitals. Her many accomplishments in regulatory and compliance matters include: successful resolution of federal and state disproportionate share reviews and appeals, reimbursement and regulatory strategies, appeal support, and provider based assistance.
Tom Johansen, Consultant, Discovery Healthcare Consulting Group, LLC
Tom recently joined Discovery Healthcare Consulting Group to focus on managing transplant and medical education program reimbursement solutions for hospitals. Starting out as a Medicare auditor, he has over 20 years as reimbursement manager for Baylor Scott & White Health and Columbia/HCA. He developed policies and procedures proven to be effective in claiming accurate, complete and compliant reimbursement. Tom led his hospitals to successfully claim and settle approximately $500 million in Medicare cost report reimbursement related to transplant/organ acquisition and medical education. Tom holds a BBA in Accounting from UT at Arlington and a C.P.A. license and also is a member of HFMA and AHLA.
3:50 pm Hot Topics
Session 062416T8 | CPE: 1.0 | Level: TBD
Presented By: Parkland Panel
Course Description: TBD