7:30 AM Registration & Breakfast
8:00 AM Opening Remarks
8:10 AM Understanding the basics of Social Security Disability and its impact on patients and providers
Course: 180301 | CPE: 1.0 | Level: Intermediate | Prerequisite: None
Healthcare Providers are increasingly presented with patients who are uninsured and underinsured, resulting in unprecedented levels of uncompensated care. Patients with insurance who become disabled often become future self-pay of the hospital because these patients usually require ongoing treatment and are unable to continue work, which in turn, results in the loss of employer health insurance. Patients who are awarded SSI and/or SSDI benefits will immediately receive a monthly income from the federal government and often become eligible for Medicaid or Medicare, but, if left unassisted, these patients face major challenges securing federal disability benefits.
Jonathan Smelley provides an informative overview of the Social Security Disability approval process and touches on a number of helpful resources healthcare provider case managers and social workers can use to help assist this patient demographic. In addition, he explains how Social Security Disability concepts can help facilitate and bolster the hospital’s self-pay revenue recovery efforts, as the disabled patient demographic tends to have chronic medical conditions, be of advanced age, and have large unpaid medical balances. Providers have found that strengthening their disability expertise leads to an improved patient experience and financial outcomes.
To educate on the complexities of the Social Security disability process and how it impacts patients and providers.
Course is designed and built to educate case managers, social workers and hospital administration
Jonathan Smelley, VP Social Security Disability, MedData
Jonathan Smelley is MedData’s Vice President of Social Security Disability. Jonathan has practiced Social Security Disability for 18 years and is nationally recognized by the Social Security Administration as a qualified disability representative. The National Association of Disability Representatives has awarded Jonathan their highest honor as an Accredited Disability Representative.
He has represented thousands of hospital patients in front of Social Security Administrative law judges in multiple districts, converting hundreds of millions of dollars in unfunded hospital debt through SSI Medicaid and SSDI Medicare. Hospitals across the country engage Jonathan to architect disability processes that help lower AR days, assist in 340b status and increase revenue recovery.
9:00 AM The Latest Information Related to Auditor and Payer Denial Activity
Course: 180302 | CPE: 1.0 | Level: Advanced | Prerequisite:
It is critically important for compliance and for sound fiscal management for health care professionals to understand current audit and denial activity. This session will provide an overview of the current activity and provide practical approaches for maintaining compliance with billing regulations in an attempt to preemptively avert the need for denial response, as well as providing a discussion on how to approach denials. We will explore regulations that govern medical necessity and patient status, common targets of denials. We will also weave into the discussion Medicare Advantage Plan tactics – how to prepare and respond in order to get results.
- Understand current audit activity and the implications
- Obtain practical denial response approaches
- Comprehend the medical necessity and patient status regulations in order to avoid denials
- Discuss Medicare Advantage Plan tactics
Hospital CFOs, Accountants, Directors of Case Management, Audit Coordinators, UR and UM Staff, Chief Medical Officers, In-house Counsel
Joan Ragsdale, CEO, MedManagement
Joan serves as Chief Executive Officer for MedManagement, LLC, a company she cofounded in 1995 and renamed as EdiPhy Advisors in 2015. She is a Phi Beta Kappa graduate of the University of Alabama where she received her Bachelor of Arts degree, magna cum laude and her law degree. Joan was a partner with two law firms, working in health care.
She is a past-President of the Health Law Section of the Alabama Bar, was previously selected for inclusion in the Best Lawyers in America, was chosen as one of the Birmingham Business Journal’s “Top Ten Business Women in Birmingham” and was identified as a Birmingham Health Care Hero. In April 2016, she was featured as one of “The Birmingham 205 Influential Execs” by BhmBiz magazine. Joan is Chair of the UAB Callahan Eye Foundation, Inc. Board, a Board member of the Jefferson County Medical Foundation Trust, and a member of the University of Alabama at Birmingham Medical Leadership Committee.
9:50 AM Refreshment Break
10:00 AM State of the Healthcare Industry – A Legislative Update
Course: 180303 | CPE: 1.0 | Level: Entry | Prerequisite: None
A legislative update on state and federal issues related to the healthcare industry
Sara Lisa González is from Rio Grande City, Texas, and attended the University of Texas at Austin where she earned a Bachelor’s Degree in English. While at UT, she earned an internship position as a Luna Scholar in the office of the Lieutenant Governor. She went on to serve as Deputy Legislative Director for Senator Van de Putte, Legislative Director for Senator Eddie Lucio, and Chief of Staff for Senator Sylvia Garcia.
After 13 years of service in the Texas Senate, Sara joined the Texas Hospital Association in April of 2016, as Vice President of Advocacy and Public Policy, focusing on Insurance, Managed Care, Behavioral Health, and Health Information Technology.
10:50 AM The Healthcare Restructuring Epidemic – Containing the Spread and Capitalizing on the Remains
Course: 180304 | CPE: 1.0 | Level: Entry | Prerequisite: None
This course is designed to survey some of the current economic trends that are forcing distressed situations and bankruptcy filings in the healthcare industry, as well as point out opportunities to derive value from these situations. Several recent bankruptcy filings by healthcare organizations in North Texas will be discussed, along with the strategies utilized by those organizations to dispose of assets and eliminate liabilities. The course will also provide an overview of the events that may trigger a distressed situation, what business leadership can expect in these situations, and what opportunities may exist in distressed situations for opportunistic buyers and investors in the healthcare sector.
To understand recent trends involving distressed healthcare organizations and assets, and explore opportunities that can be created in distressed healthcare situations
Rachael Smiley has advised businesses and public institutions in variety of transactions and disputes since 2008. Rachael currently practices commercial bankruptcy and business reorganization law at The Law Offices of Judith W. Ross in Dallas, Texas. From 2014-2017, she served as Manager of the Office of Contracts Management at UT Southwestern Medical Center, negotiating agreements on behalf of the University and its Hospitals. She received her J.D., cum laude, from Southern Methodist University in 2008, and her B.A., magna cum laude, from Texas Christian University in 1999.
11:40 PM Lunch and Networking
12:30 PM Advanced Bundle Payment Care Initiative: What You Need to Know
Course: 180305 | CPE: 1.0 | Level: Intermediate | Prerequisite: None
On January 9, 2018 CMS released the much anticipated news that they were going to commence a new round of their successful Bundled Payment Care Initiative, BPCI. With the cancelation of Cardiovascular bundles last summer and the rollback of CJR later in the fall, this is the first indication that CMS is committed to this payment methodology for the future. In addition this Advanced BPCI will qualify as an APM for MACRA.
This course will introduce Advanced BPCI, describe the process for applying for this program, and DHG will share our experiences in working with over 100 clients that manage over 400 bundles collectively.
The participant will be prepared to evaluate this opportunity to participate and gain an understanding of the application process.
Attendees should include:
CEO’s; CFO’s; CMO’s; Physician Group Executives
As a principal with DHG Healthcare, Bill serves as the Principal in Charge for DHG’s Healthcare Practice in the Southwest.
His professional career spans over 30 years in the healthcare industry and he has held leadership roles with international professional service firms and large health systems.
At DHG Healthcare, Bill led the development of the Revenue Cycle and Compliance practice and was instrumental in developing the firm’s thought leadership and approach related to Risk Capability and revenue transformation. Bill regularly assists his clients in navigating the challenging and difficult transition to alternative payment models and is a highly regarded and sought-after speaker on topics such as: “Revenue Portfolio Design for Healthcare Providers”; “Transparency in Healthcare Pricing”; “Realizing the Value in Your Managed Care Contracts”; as well as other topics related to the ongoing transformation in the industry. Bill provides assistance to clients contemplating complex transactions and provides expert witness assistance on payment and reimbursement related issues.
Through his expertise and industry experience, Bill continues to be actively engaged in leadership initiatives at DHG Healthcare.
1:20 PM Federal Health Care: Deeper Than the Headlines
Course: 180306 | CPE: 1.0 | Level: Entry | Prerequisite: None
The HHS Office of Inspector General (OIG) is a government watchdog charged with combating fraud, waste and abuse in Federal health care programs, such as Medicare and Medicaid. The session will review the OIG’s core mission and work plan, sample projects, and how OIG views the top challenges in Federal health care for 2018 and forward.
- Understand the core mission and organization of the HHS OIG.
- Gain insight about the OIG’s current priorities and the top HHS challenges for the coming year.
- Have the opportunity to interact and ask questions about OIG processes and contacts.
Ruth Ann Dorrill, Office of Inspector General, U.S. Department of Health and Human Services, Regional Inspector General
Ruth Ann Dorrill is the Regional Inspector General for the U.S. Department of Health and Human Services in Dallas. She has led national teams in evaluating HHS programs, including a leading a series about adverse events in hospitals and nursing homes that is referenced in hundreds of academic journal articles and media publications. In 2016, she led a case study of HHS’s problematic implementation of HealthCare.gov. Ruth Ann has received the Bronze Medal for Outstanding OIG Service and the HHS Secretary’s Award for Excellence in Management. She has been a featured speaker at many healthcare conferences and is a Fellow at the Partnership for Public Service in Washington, DC.
2:10 PM Refreshment Break
2:20 PM Texas Nursing Home QIPP
Course: 180307 | CPE: 1.0 | Level: Entry | Prerequisite: None
This course will cover the transition of the nursing home supplemental program, primarily established as a supplemental program for public nursing homes. Public nursing homes have been owned and operated by hospital district. Additionally, this will cover the transition from a traditional UPL payment program to a managed care supplemental payment program, and the challenges involved.
Chris Dockal has over 25 years of public accounting and healthcare experience. The work experience includes nursing home administrator and chief financial of Texas nursing home chain, Medicaid cost report auditor for NHIC, Director of Acute Care Rate Analysis and the Interim Director Hospital Reimbursement at the Health and Human Services Commission.
Chris began providing consulting services to healthcare facilities on the 1115 Waiver, Disproportionate Share Program, Graduate Medical Education, and I/P and O/P Reimbursement Methodologies. Chris expanded to providing nursing home management oversight for various public hospital districts in the state nursing home supplemental payment program. This is responsible for sixty (60) public nursing homes and manages the oversight of the quality program and the nursing home financial services. The financial services include the full array of financial statements and monitoring/forecasting of the supplemental payments. Chris works with HHSC to ensure changes to the program for the managed care services can be accurately captured for the public nursing homes.
Chris is a graduate from the University of Texas at Austin with a Bachelor’s of Business Administration Degree and is a license certified public accountant.
3:10 PM FQHC 101: Who knew?
Course: 180308 | CPE: 1.0 | Level: TBD | Prerequisite: TBD
The topic will be about FQHC’s and in particular explaining what they are, why they exist, advantages of being an FQHC, and some potential ideas on how they can partner with other healthcare providers in the community they serve. People who should attend this will be primarily financial folks who do not know what FQHC’s are, and people who may not know of possible collaboration opportunities that FQHC’s present. The benefit of this presentation is understanding what an FQHC is, and learning about potential collaboration opportunities that exist.
Erich is the CFO of Tyler Family Circle of Care (TFCC) located in Tyler, TX. TFCC is a 5 location FQHC situated in Eastern Texas with revenues of over $15 Million.
Erich has 18 years of healthcare management and accounting experience as he has served as a CFO or Controller for a Critical Access Hospital, Psychiatric Hospital, Acute Care Hospital, FQHC, and FQHC look-a-like. Erich specializes in FQHC’s and FQHC look-a-likes.
Erich is involved with the Health Financial Management Association (HFMA), the American College of Healthcare Executives (ACHE), and The Texas Association for Healthcare Financial Administration (TAHFA).
Erich is a graduate of Heriot-Watt University (MBA, November 2005), and Lakehead University (BA Administration, May 1998).