7:30 am Registration & Breakfast
7:50 am Opening Remarks
8:00am – 8:50am The Latest Information Related to Auditor and Payer Denial Activity, including Responding to Medicare Advantage Plan Tactics – How to prepare and respond in order to get results
Course 180401 | CPE: 1.0 | Level: Entry | Prerequisites: None
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 premptively 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 weave into the discussion Medicare Advantage Plan tactics.
- 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
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.
8:50am – 10:20am Compliance
Course 180402 | CPE: 1.5 | Level: Intermediate | Prerequisites: None
The course will provide an overview of current healthcare trends including, fraud and abuse trends. The course will then review general duties of boards and officers and close with a discussion about lessons for establishing a cohesive organized compliance response to a regulatory inquiry.
To review why compliance with healthcare regulatory requirements is of paramount importance, and then present methods and strategies to prepare for and respond to a regulatory compliance inquiry.
Department level and senior managers of healthcare facilities.
Hospitals, health systems, physician practices and other healthcare providers throughout Texas rely on Fletcher Brown for assistance with operational and regulatory issues ranging from contract negotiations to Stark and anti‐kickback compliance. Fletcher is Martindale‐Hubbell® AV Preeminent™ Rated and recognized by Chambers USA as a leader in Texas health law, and widely respected for his precedent‐setting work with the Texas Medicaid 1115 Waiver which helped more than 45 healthcare providers receive additional funding to expand risk‐based managed care statewide. Additionally, tax‐exempt and investor‐owned healthcare providers turn to Fletcher for guidance on policies and procedures, physician contracting, board governance, and HIPAA and HITECH patient privacy issues. By listening to his clients and providing creative solutions to the issues they face, Fletcher has earned a reputation as a go‐to attorney known for helping healthcare providers surmount day‐to‐day challenges and achieve strategic long‐term goals.
10:20am – 10:45am Refreshment Break
10:45am – 11:35am Federal Health Care: Deeper Than the Headlines
Course 180403 | CPE: 1.0 | Level: Entry | Prerequisites: 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 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.
11:35am – 12:25pm Commercial Contracting for Value
Course 180404 | CPE: 1.0 | Level: Entry | Prerequisites: None
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.
12:25pm – 1:15pm Lunch and Networking
1:15pm – 2:05pm The Tax Cuts and Jobs Act of 2017: Big Changes Ahead for Healthcare Entities
Course 180405 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
The Good News: What provisions did not make it in the final bill? Several key proposals directly impacting healthcare organizations did not make their way into the final legislation. What does the future hold for these provisions and how might they impact your organization if they are resurrected in future legislation?
The Bad News: What provisions made the cut and how will they impact your organization? From increased excise taxes, unrelated business income, corporate and pass-thru taxes to changes in donor giving, TCJA will have a direct impact on all healthcare organizations. Learn how your organization will be impacted.
To develop an awareness of recent law changes and how they will impact your organization.
Persons responsible for federal tax reporting in an exempt or taxable health care organizations
As industry tax leader for BKD’s South Region, Paige is charged with growth and development of not-for-profit and governmental tax services in Texas, Oklahoma and Arkansas. She has more than 30 years of experience providing tax services to a broad range of health care institutions, physician and clinical practices and other not-for-profit entities.
She also serves as industry tax leader for BKD National Health Care Group and is a former member of the firmwide Health Care Committee.
Paige performs comprehensive reviews of not-for-profit activities to identify and help mitigate exposure areas related to private inurement, intermediate sanctions, worker classification and unrelated business taxable income issues. She has extensive experience with IRS examinations, obtaining favorable determination letters, private letter rulings and closing agreements. Paige also provides tax, financial and retirement planning services for key executives, in addition to compliance and business tax services.
Continually enhancing client service is a top priority for Paige. She helped BKD develop a Form 990 risk analysis report and been instrumental in compliance and readiness projects related to the Affordable Care Act, Community Health Needs Assessments and IRS Section 501(r) regulations.
Paige currently serves on the board of the Greater Houston Women’s Chamber of Commerce. She is also a member of the American Institute of CPAs, Texas Society of Certified Public Accountants and American Health Lawyers Association. She has led several tax-focused webinars and presented to a number of industry organizations, including the Risk Management Association, Government Finance Officers Association, National Association of College and University Business Officers and Healthcare Financial Management Association.
She is a past president of the Bauer College of Business Alumni Organization at the University of Houston, Texas, and a member of the Bauer College of Business Accounting Advisory Board.
Paige is a 1986 graduate of University of Houston, Texas, with a B.B.A. degree in accounting.
Andrea provides a broad range of tax compliance, consulting and controversy resolution services to public and private middle-market companies engaged primarily in the health care, retail, manufacturing and distribution industries. A majority of her clients have either C or S corporation structures.
Andrea’s career began in Indianapolis with a large international accounting firm where she gained significant experience involving federal and state income tax planning and compliance matters as well as accounting for income taxes in accordance with generally accepted accounting principles.
She is a member of the American Institute of CPAs and Texas Society of Certified Public Accountants and a licensed CPA in Indiana and Texas. She currently serves on the board of the First Colony Community Association.
Andrea is a graduate of Indiana State University, Terre Haute, with a B.S. degree in accounting, and of Indiana University-Purdue University, Indianapolis, with an M.S. degree in taxation.
2:05pm – 2:55pm Healthcare Legislative Update – Hospital Liens and Hospital Healthcare Subrogation
Course 180406 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
The industry’s experience with Chapter 140 of the Texas Civil Practices and Remedies Code, which controls subrogation reimbursement rights for most Texas health plans, since its effective date January 1, 2014, as well as the current best practices for hospital lien investigation and prosecution under Chapter 55 of the Texas Property Code. The talk will focus on best practices for identification, investigation, and prosecution of these third-party reimbursement claims; how to reduce any liability exposure and maximize your recoveries.
To offer guidance and assistance on hospital best practices as well as failed practices.
Chief Financial Officers, Hospital Administrators, Revenue Cycle, General Counsel
Since 1983, R. Louis Bratton has been involved in personal injury litigation for 35 years, in addition to all forms of subrogation claims. He is licensed to practice in all Federal Courts in the State of Texas, as well as in the US Court of Appeals for the Fifth Circuit. Mr. Bratton has argued cases before most of the Courts of Appeals in the State of Texas, the State Supreme Court and the Fifth Circuit Court of Appeals.
Mr. Bratton has resolved over $250,000,000 of subrogation / hospital lien claims for our clients providing subrogation and hospital lien services for over 4 million plan members nationwide. He assisted in writing the health care subrogation law (Chapter 140 of the Texas Civil Practice & Remedies Code) that went into effect in Texas in 2014. As a certified specialist in trial law through the Texas Board of Legal Specialization, he has a unique level of skill, dedication and training, which enables him to better identify and prosecute subrogation and hospital lien claims. Only three percent of Texas lawyers hold this distinction.
2:55pm Refreshment Break
3:10pm – 4:00pm What’s Happening in the Texas Legislature & Why You Need to Know
Course 180407 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
Representative Jeff Leach will provide a brief legislative update and discuss the pressing challenges and opportunities facing the Texas Legislature next session, which will begin in January of 2019. Questions are encouraged, as this will be an open discussion amongst the group.
State Representative Jeff Leach,Texas House of Representatives, District 67
State Representative Jeff Leach proudly serves the citizens of House District 67, consisting of portions of Plano, Allen, Richardson and Dallas in Collin County. During his three terms in office, Representative Leach has successfully authored legislation that limits the reckless expansion of Medicaid under the Affordable Care Act, as well as a provision spurring stable job growth by providing substantial tax relief for business owners that relocate to Texas.
Currently, Representative Leach serves as Vice-Chairman of the House Committee on Urban Affairs and as a Member on the House Committee on Economic & Small Business Development. Named a 2017 “Rising Star” by Texas Super Lawyer, Representative Leach currently practices at the law firm of Gray Reed & McGraw, P.C. in Dallas, where he specializes in complex commercial and civil litigation, construction law and real estate.
Representative Leach is a Member of the Board of Trustees for the Medical Center of Plano andserves on the Advisory Board of Meals on Wheels of Collin County.
4:00pm – 4:50pm Public Policy and Advocacy Update
Course 180407 | CPE: 1.0 | Level: Intermediate | Prerequisites: None
David has more than 25 years of experience in public policy and stakeholder relations. Joining Texas Health Resources in 1995, he is responsible for providing strategic direction and management in the areas of public policy, stakeholder relations, community health improvement and faith and spirituality integration.
Tesmer has held a variety of key leadership positions at the local, state and national level including serving as chair of the North Texas Commission and the Government Affairs Committee of Premier Inc. (Washington D.C). He is also a member of the American Hospital Association’s Regional Policy Board.
He has been recognized by Premier, AHA and THA for his outstanding advocacy efforts by receiving the Excellence in Advocacy Award, Most Valuable PAC Player and HOSPAC Star Award.
Tesmer earned both his undergraduate degree in political science and master of public administration from Texas Tech University.