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Product Id : 20189PACK

Overview: Hospitals must file a National Practitioner Data Bank report on any physician’s surrender of privileges if an investigation is underway. This has always been a Data Bank reporting requirement, intended to discourage plea bargains which allowed physicians to avoid being reported if they agreed to waive hearing rights. Under the new Guidebook, expanded descriptions of "investigation" and "surrender" stretch what is to be considered a reportable surrender of privileges.

OPPE and FPPE and other peer review can be affected, as are physicians’ ability to make practice decisions without inadvertently tripping Data Bank reporting triggers. Medical staff bylaws and policies need to be reworked under the new Data Bank Guidebook.

Why should you Attend: Are you aware of the revisions to the National Practitioner Data Bank Guidebook? New and surprising government interpretations of the regulatory scheme have been recently published. Most medical staff policies and bylaws in hospitals today do not reflect these changes. Legal protections for medical staff leaders and hospitals could be lost. Physicians will be surprised by reports generated under the new Guidebook.

Areas Covered in the Session:
  • National Practitioner Data Bank Guidebook changes
  • Hospital reporting requirements
  • Medical staff bylaws problems
  • Peer review process issues
  • Physician credentialing

Who Will Benefit:
  • Medical Staff President/Chief of Staff
  • Bylaws Committee
  • Credentialing Committee
  • Chief Medical Officer
  • Vice President of Medical Affairs
  • Chief of Staff
  • Director of Medical Staff
  • Medical Staff Attorney
  • Hospital Counsel
  • Medical Staff Manager
  • Credentialing Specialist
  • Human Resources professionals
Elizabeth Snelson works for medical staffs and medical societies across the country. Medical staff bylaws are a primary focus of her practice. She also handles "disruptive practitioner" procedures, peer review problems, and other compliance matters.

A frequent speaker on medical staff legal issues, Elizabeth Snelson presents at medical staff leadership retreats and serves as an expert witness in credentialing and Data Bank cases. She is Past President of the American Society of Medical Association Counsel, and past Vice President of the ABA’s Physician Issues Interest Group. She was a member of the Joint Commission’s Task Force on medical staff bylaws. Her articles on medical staff legal issues have appeared in various publications. She is the author of The Physicians’ Guide to Medical Staff Organization Bylaws, published by the American Medical Association.
Instructor : Joseph Wolfe
Product Id : 20189PACK

Overview: In this session Mr. Wolfe will provide an overview of the Stark Law, including its 2016 changes. He will also discuss best practices for negotiating and drafting physician employment agreements on behalf of health systems, hospitals and medical groups. He will explain key provisions and potential pitfalls in both types of agreements.

Why should you Attend: Given the substantial awards and settlements in recent enforcement actions, Stark Law compliance has become more than just a compliance issue: it is an enterprise risk management issue. As medical groups, hospitals, and health systems transition to more innovative compensation structures, they must manage their compliance and enterprise risk by ensuring their physician employment arrangements are defensible under the Stark Law.

Areas Covered in the Session:
  • Provide a general Stark Law overview.
  • Examine critical components of Stark and Anti-Kickback compliant employment arrangements
  • Discuss best practices for drafting physician employment agreements, related compensation plans and facilitating effective onboarding
  • Discuss best practices for auditing existing employment arrangements
  • Describe alternative structures for organizations intending to qualify as Stark group practices

Who Will Benefit:
  • In-House Counsel
  • Health Care Compliance Officers
  • Health Care Human Resources
  • Health Care CFOs
  • Health Care executives

Joseph Wolfe is an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country. Mr. Wolfe provides advice and counsel to some of the nation's largest health systems, hospitals and medical groups on a variety of health care issues. He regularly counsels clients on a national basis regarding compliance-focused physician compensation and alignment strategies. He is a frequent speaker on issues related to the physician self-referral statute (Stark Law), hospital-physician transactions, physician compensation governance and health care valuation issues. Before attending law school at the University of Wisconsin, he served as a combat engineer in the United States Army.
Instructor : Joseph Wolfe
Product Id : 20189PACK

Overview: In this session Mr. Wolfe will provide an overview of the Quality Payment Program, including its MIPS and Advanced APM pathways. Mr. Wolfe will provide a straight-forward, practical explanation of key provisions and options for clinicians and health care leaders as they navigate the 2017 transition year and beyond.

Why should you Attend: Going forward, clinicians and health care leaders need to be developing strategies so they can position their organizations for financial success under the new Quality Payment Program. Beginning in 2017, CMS will start rewarding clinicians for their delivery of high-quality patient care through one of two pathways:
1. Payment of incentives for participation in Advanced Alternative Payment Models (Advanced APMs)
2. Application of a positive or negative adjustment pursuant to the clinician's performance under the new Merit-based Incentive Payment System (MIPS). CMS is allowing clinicians to pick their pace of participation for the 2017 performance year.

They will have three flexible options to submit data under MIPS and a fourth option to join an Advanced APMs in order ensure they will not trigger a negative payment adjustment in 2019. This webinar will focus on the Quality Payment Program, its pathways and potential options for clinicians as they navigate the Quality Payment Program during the 2017 transition year and beyond.

Areas Covered in the Session:
  • Provide a general overview of MACRA and the CMS Quality Payment Program.
  • Explain the consolidation of historic incentive programs into MIPS and provide an overview of the underlying MIPS scoring methodologies.
  • Discuss qualifying Advanced APMs and the process for earning program incentives for APM participation .
  • Describe strategies for engaging key stakeholders, and for picking your pace in the transition year.
  • Discuss potential strategies for incentivizing physicians in connection with the rollout of the new Quality Payment Program.

Who Will Benefit:
  • In-House Counsel
  • Health Care Compliance Officers
  • Health Care Human Resources
  • Health Care CFOs
Joseph Wolfe is an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country. Mr. Wolfe provides advice and counsel to some of the nation's largest health systems, hospitals and medical groups on a variety of health care issues. He regularly counsels clients on a national basis regarding compliance-focused physician compensation and alignment strategies. He is a frequent speaker on issues related to the physician self-referral statute (Stark Law), hospital-physician transactions, physician compensation governance and health care valuation issues. Before attending law school at the University of Wisconsin, he served as a combat engineer in the United States Army.
Instructor : Jugna Shah
Product Id : 20189PACK

Overview: Medicare release of the final CY 2017 OPPS rule is critical for providers to understand so they can be ready to implement all changes by January 1, 2017 while also obtaining a keen sense of where they can expect to see financial impact on their book of business. Many of the expected changes if finalized could have tremendous financial and/or operational impact on providers. The final rule is typically released around November 1st which gives providers less than 60 days to be ready for the new year's changes. Joining for this program will allow providers to be ready

Why should you Attend: It's better to know what changes CMS has finalized so that providers are ready to implement new coding or billing requirements such as the use of new modifiers, etc. Additionally, providers will have a sense of what payment rate changes/shifts are expected for individual services (by CPT code, such as evaluation and management visits, observation, drugs, etc.) and/or for Comprehensive APCs, which are like mini-outpatient DRGs or episodes. Knowing where the largest changes are can help finance directors, hospital CFOs, coding, billing, reimbursement, and compliance staff be ready for impact on their organizations.

Areas Covered in the Session:
  • All major financial and/or operational changes finalized by CMS for CY 2017 OPPS
  • Status indicator changes
  • Packaging changes
  • Comprehensive APC (mini-DRG) changes
  • Payment changes for drug administration, E/M visit codes, observation, composite APCs, drugs, biologicals, radiopharmaceuticals, blood and blood products, as well as other major APC category payment rate changes
  • Changes related to reporting modifiers and much more!
  • Observation Notice Act changes if released
  • Section 603 related technical and operational changes for grandfathered vs. non-grandfathered provider-based off-campus locations
  • And much more!


Who Will Benefit:
  • Health Information Management
  • Revenue Cycle Directors
  • Finance
  • Billing Office
  • Charge Description Master Coordinators
  • Others in the hospital interested in understanding the changes CMS has finalized for CY 2017.
Jugna Shah is a Nationally recognized expert in health care policy and financing reform and the founder of Nimitt Consulting, Inc. Since 2001, Nimitt Consulting has specialized in providing information and education on regulatory initiatives and policies that affect health care service delivery, quality, cost, accessibility, and compliance.

In the U.S., Ms. Shah works with a variety of hospitals and health systems to address the clinical, operational, and financial challenges they face under Medicare's payment systems - specifically, Medicare's Outpatient Prospective Payment System (OPPS), based on Ambulatory Payment Classifications (APCs). She helps providers address and overcome complex coding, billing, revenue cycle, and compliance issues, with a focus on medical and radiation oncology, pharmacy and drug coverage, radiology, use and refinement of E/M visit guidelines, and more. In addition to working with providers, Nimitt Consulting provides expertise on reimbursement and policy to drug and device manufacturers, trade associations, and law firms.

A successful advocate, Ms. Shah has raised important payment system concerns to the Centers for Medicaid and Medicare Services (CMS) and the federal Advisory Panel on APCs. Many of her recommendations have been accepted and implemented by CMS, thereby making the APC system not only operationally simpler but also more equitable for providers nationwide. Nimitt Consulting Inc. also works internationally on case-mix design, system development, and implementation initiatives. Ms. Shah has led several World Bank and US Agency for International Development (USAID) health care financing reform initiatives that involve providing long-term policy and technical assistance to foreign governments. She has worked in Albania, Bulgaria, the Czech Republic, Hungary, Iceland, the Republic of Moldova, Romania, Turkey, and Slovakia. Since 2007, Ms. Shah has served as Secretary for Patient Classification Systems International (PCSI), an international case-mix organization and was recently elected to Vice-President.

Ms. Shah is a popular and dynamic educator who regularly presents on OPPS, APCs, and related topics. She is a frequent speaker at local, regional, national, and international conferences including the Healthcare Financial Management Association (HFMA), the American Health Information Management Association (AHIMA), HCPro, and Ingenix. She is also a lead instructor at the PCSI case-mix summer school held annually in June. As part of her commitment to education, Ms. Shah helped create several of the field's leading publications on OPPS/APCs, including HCPRO's APC Answer Letter, The APC Weekly Monitor, and Briefings on APCs. She is also the author of several books, including OPPS Drug Administration Strategies: Your Comprehensive Guide to Accurate Coding, Billing and Charging and The Drug Revenue Toolkit.

Prior to founding Nimitt Consulting, Inc., Ms. Shah was a senior manager with KPMG's Assurance-Based Advisory Services Practice, guiding providers through the clinical and financial implications of APC implementation. Previously, Ms. Shah worked with 3M Health Information Systems as an Ambulatory Care Product Marketing Manager. She holds a Bachelors of Science in Biopsychology from Oberlin College, and a Masters of Public Health Policy & Administration from the University of Michigan.
Instructor : Marianne H. Harper
Product Id : 20189PACK

Overview: Medical Coding in dental practices is gradually becoming a necessity. Many dental practices have long been sheltered from having to explain to dental carriers why they performed the patients' procedures. They have simply submitted codes for the procedures that were performed.

It has been an entirely different case for medical practices. They have been required to submit the reasons for the completion of the different medical procedures along with submitting the procedures performed through the use of diagnosis codes and procedure codes. The diagnosis code set is used to identify diseases, disorders, symptoms, injuries, human response patterns, and medical signs. Dental practices need to learn how to use this code set so that they can accurately show the medical necessity of the applicable dental procedures. Diagnosis codes must be chosen that have a true relationship to the procedures performed. It can only be through the use of these diagnosis codes that dental procedures can be considered medically necessary and, therefore, covered by a patient's medical plan. The procedure code set was developed as a means for medical providers to report medical services with a uniform language that accurately describes medical, surgical, and diagnostic services. By making this code-set uniform, it becomes an effective means for reliable communication between medical providers and insurance companies. Dental practices will need to become familiar with this coding system so that they can accurately communicate the procedures that they performed to medical insurance carriers. Once accurate codes are chosen for procedures performed, they must be submitted on the most current medical claim form. This form is then submitted to medical insurance plans either electronically or on a paper form. Once received by the insurance carrier, claims will go through an adjudication process whereby they will be reviewed for eligibility of the patient and coverage of the procedures. Once a determination is made, the insurance carrier will make a determination of benefits and will then notify the patient and medical provider as to their decisions on coverage and benefits. This is why it is so important that dental practices understand this full process so that they can submit accurate claims for those dental services that the dentist believes to be medically necessary. Dental practices that implement dental-medical cross coding will be able to submit medical claims to a patient's medical plan and then follow that with submitting to a patient's dental plan if the patient has both types of coverage, thereby providing optimum benefits for the patients.

Why you should attend: Dentistry today is quickly becoming the field of dental medicine. As part of this paradigm shift, dental practices now have the opportunity to help their patients more easily afford those dental procedures that are medically necessary. In addition, more and more dental insurance carriers are suspending payment on dental claims until the procedures are first filed with the patients' medical plans. Most dental practices have no idea of how to submit a medical claim and, if the medical claim is not filed, how will the patient receive any benefits?

This webinar will provide the basics of medical coding and will take away the difficulty of implementing a cross coding system. By understanding the medical coding systems, dental practices will be able to submit these claims correctly and help to obtain plan benefits for their patients. Dental practices are familiar with working with one coding system, procedure codes, but after attending this webinar, dental practices will be familiar with the multiple coding systems of medical insurance. Attendees will learn that they probably already have the tools to begin cross coding right away and, if they don't have the software, suggestions will be made on how to obtain medical coding software at an inexpensive price. The webinar will also help dental practices understand what types of procedures are medically necessary and why implementing medical coding can both help the patient and also really help the practice with greater case acceptance and an increased bottom line.

Areas Covered in the Session:
  • Learn why it is so beneficial for a dental practice to implement medical coding
  • Identify what types of dental procedures can be submitted to medical insurance plans
  • Understand the importance of learning how to accurately use the medical code-sets
  • See how a medical claim form is completed
  • Discover that most dental practices already have the tools to complete medical claims
  • Find out about other medical coding software if your software won't cross code
  • Learn how to determine what medical necessity means
  • Discover sources of medical code sets including an actual cross coding manual
  • Evaluate your practice forms to determine if they are asking the correct questions
  • Learn the importance and best methods of documentation
  • See actual examples of cross coded medical claims
Who Will Benefit:
  • Dentists
  • Dental Office Managers
  • Dental Insurance Billing Personnel
  • Dental Hygienists
  • Dental Practice owners
  • Dental Business Office Staff
  • Dental Assistants
Marianne Harper's career in dentistry spans almost thirty years. Instrumental in her founding of “The Art of Practice Management”, a dental practice management consultancy company, was the fact that Marianne was always considered “the problem solver” and, in her years in practice administration, she discovered the secrets to practice success. Marianne now helps other dental practices achieve her levels of success by sharing her techniques. Marianne’s consulting specialties are: dental business office systems, dental business forms, the implementation of systems to lower accounts receivable, and the implementation of a dental-medical cross coding system. In addition, Marianne is the author of a dental-medical cross coding manual and eBook, is a published author of dental practice management articles that have appeared in dental journals and on dental websites, and is a well respected speaker and trainer. Marianne is a member of the Speaking Consulting Network, The Academy of Dental Management Consultants, The Professional Management Consultants Association, and CareerFusion. In addition, Marianne has a Lioness Principle Certification.