Denial Prevention: Addressing Root Causes through Data Analytics and a Team-based Culture

March 28, 2019
12:00 PM – 1:00 PM CT

At the completion of this educational activity, the learner will be able to:

  • Define data, data analysis, information and knowledge management.
  • Identify key contributors of data in various healthcare settings.
  • Clearly distinguish the difference between Reason Code, Issue and Root Cause.
  • Determine which data elements are relevant for analysis.
  • Establish an action plan based on the information obtained from data analysis (including reports and key stakeholders).

Speaker: Tracey A. Tomak, RHIA, PMP

From RUGs to PDPM: The Changing Alphabet of Medicare Skilled Nursing Prospective Payment in Long Term Care

This presentation will address the Medicare payment changes in skilled nursing facilities effective 10/1/19. The current system focuses on the resources required to manage the care of the resident. The new system will utilize ICD-10-CM coding from the Principal Diagnosis to determine part of the payment case mix index as well as base the case mix on the resident’s clinical and social characteristics. The reason for the change will also be addressed. The participants will have an opportunity to walk through the case mix calculation to become more familiar with the complexities of the new system.

Speaker: Mary Ann P. Leonard, RHIA, RAC-CT

Medical Necessity, Patient Status and Compliance Pitfalls

February 20, 2019
10:00 AM – 11:00 AM CT

In this presentation the speaker will review existing CMS rules and regulations relative to medical necessity and patient status. She will also provide information about recent enforcement activities and how to avoid compliance pitfalls. After the presentation the participants will be able to take back to their hospitals actionable items to support compliant billing practices.

Speaker: Joan C. Ragsdale, JD, Chief Executive Officer, MedManagement, LLC d/b/a EdiPhy Advisors

42 CFR Part 2

This intermediate level session covers changes to 42 CFR Part 2 from both March of 2017 and January 2018. These changes have an impact on the privacy and security of both federally funded programs and those entities possessing substance user disorder records. Specifically addressing processing release of information requests, confidentiality statement, accounting of disclosures, authorization requirements, and access to PHI for research purposes.

Moving from Denials Management to Denials Prevention

October 26, 2018
12:00 PM – 1:00 PM CT

Moving from Denials Management to Denials Prevention

  • How to define standard categories for denials and write-offs.
  • Discuss consistent reporting based on these categories.
  • Identify key stakeholders to meet consistently to reduce denials and write-offs.

Speaker: Tracey A. Tomak, RHIA, PMP

Denials Management

October 19, 2018
12:00 PM – 1:00 PM CT

The presentation will cover UHC and Anthem ED Denials, the PEPPER report and denials management strategies.

Speaker: Jeannie Ruch, RHIA, CPC, CSM