HCC Coding Best Practices Workshop (3 CEUs*)

(Health Plan Exclusive!)
Tackling the Encounter Reporting Challenge: A Strategy Session for Recovering Your Revenue

Pre-Conference Optional Workshop (Free)

• "MEAT" - the record must demonstrate the management, evolution, assessment and treatment of the condition
• Do not make assumptions - the diagnosis must be addressed - black & white
• No coding from past medical history unless addressed elsewhere in the record
• Common mistakes in HCC coding (ICD-9 categories 430-437, cancer, fracture, MI, etc.)
• Problem lists. They are just that, a problem.
• Case Studies

Note: You will need to bring your ICD-9 2011 Coding Book for hands-on practice

Speakers:
CPC, Sr. Clinical Quality Auditor, Senior Risk & Recovery, WellPoint, Inc.
CCS, CCS-P, CPC, CPC-I, CPC-H, CEMC, CCDS, PCS, FCS, Director of Education ad Consulting Services, The Coding Source, LLC
AHIMA Academy ICD-10-CM/PCS Trainer Certificate Holder

*This program has the prior approval of AAPC for three (3) continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Expert agree, the transition from RAPS to Encounter Reporting will have an enormous impact on the future of MA Plans. Without a clear understanding of the unique challenges, complexities, and necessary steps to ensure the accurate, timely and complete submission of encounter data to CMS, many MA plans face significant risk.

Long story short: MA plans will have one year to close a variety of gaps in their data. Only those MA plans that succeed in encounter reporting will ensure they receive the revenue they deserve. Are you ready?

This comprehensive workshop will go in-depth into what is involved with encounter reporting, and the complexities around the issue. This shift will have an enormous impact on plans' operations, finances, etc. This workshop will cover:

• Encounter reporting background: Claims do not equal Encounters
• Encounter reporting complexity: Organization of encounters, timing, definitions (accepted, rejected, void, replace)
• Beyond submission: Four critical components of a sound encounter reporting platform
• Accepted encounters: The only thing that matters
• Financial implications
• Update from CMS user groups
• Updates on chart reviews and assessments: Identifying the unique challenges that go along with the CMS process currently being discussed
• What MA Plans must do now and in 2012

Practical take-aways:

• Build versus Buy Checklist: 10 critical questions that should be answered prior to building or buying an Encounter Reporting Platform
• Four critical components of a sound encounter reporting platform
• Transition Strategy for 2011 and 2012

Bonus:
This session will also include a brief demonstration of DCA's Encounter Reporting Infrastructure (ERI™).

Speakers:
Founder & President, DCA
Director, Medicare/Medicaid Solutions, DCA, former CFO of Molina of Michigan and Cape Health Plan

Over 20 years of health plan experience specifically with encounter reporting, finance, claims , and IT.

Conference Chair:
Senior Compliance and Audit Services, INDEPENDENT CONTRACTOR

• Role of providers in improving star ratings
• How to obtain provider cooperation and attention
• Strategies for successful provider outreach
• Data: Medical management, risk adjustment
• Staff model approach
• IPA w/ percent of premium approach
• IPA-flat capitation approach
• Fee for service approach

Overview of the Healthcare Industry's ICD-10 Readiness

• National survey of readiness
• Areas of concern
• Strategies for catching up
• Contingency plans to meet the Oct. 1, 2013 deadline
• Creating achievable objectives

Speaker:
Principal, YOUNG MEDICAL CONSULTING, LLC

• 4 critical components of an encounter reporting platforms/system that enable a MA Plan to ensure the accurate, complete and timely submissions of encounters to CMS:
• Financial Analysis
• Data Collection Discrepancy Analysis
• Operational Controls
• Submission & Reconciliation
• The critical link between the submission of complete and accurate encounter data to the risk adjustment process

Speakers:
Founder & President, DCA

• Part 1: Creating strategic team solutions to improve workflow
• Part 2: Developing a Payer/Provider Relationship Best Practices Checklist
  • Know who to contact at each facility
  • Know the request process for each provider
  • Minimize the time impact on the provider
  • Provide feedback on diagnostic coding
• Offer training and incentives for proper coding

Speaker:
Healthcare Analytics, WellCare Health Plans, Inc.
Chief Operations Officer, CENTRAL FLORIDA INPATIENT MEDICINE

• Efforts to enhance the accuracy of HCCs provide data for medical management and risk stratification
• How to work with prospective vendors to enhance data collection for Quality Stars
• How to leverage data from prospective assessments to reduce the risk of unfavorable RADV audit discovery
  

Speaker:
Chief Medical Officer, VNSNY Choice health plans

• Perform baseline assessment that combines specific data streams to assess historical trends and root cause analysis
• Determine individual and synergistic Star Rating, risk adjustment and care coordination intervention strategies
• Foster collaboration across the provider network leveraging member-specific gap closure focus
• Create transparent mechanisms to review monthly progress versus plan, update intervention strategy and measurable ROI

Speaker:
SVP, Quality & Care Management, MedAssurant

• Prospective assessments: The current state-of-the-art science
• Impact of PPACA health reform and HITECH EHR stimulus funding
• HCCs in a broader context of integrated patient information and managing population health
• Prospective assessments: Creating value along the path from insight to action
• What will care management "networks" look like in the future

Speaker:
Sr. VP of Product Development, MATRIX MEDICAL NETWORK
Principal, BETTER HEALTH TECHNOLOGIES

• Discuss payment reform and focus on quality
• Discuss need to build information integration and exchange platform
• Discuss need to develop new relationships with payors and other providers
• Case Study

Speaker:
Medical Director, Community health network of central florida
Director, Service Line Development, PARISH MEDICAL CENTER

• Revenue enhancement
• RADV protection

Panelists:
Associate Medical Director, FAMILY PHYSICIANS GROUP
President Medical Affairs, FAMILY PHYSICIANS GROUP
Director, MRA, FAMILY PHYSICIANS GROUP

Moderator:
Chief Medical Officer, LEPRECHAUN

• How to incorporate staff, education, etc. to learn how the system is being used, how they are billing, etc.
• Case Studies: Precision Healthcare Systems‘ take on prospective reviews
• Technology and optimization

Panelists:
Coding Analyst, Precision Healthcare Systems
Medical Billing Auditor, HENRY FORD HEALTH SYSTEM / HEALTH ALLIANCE PLAN

Moderator:
Clinical Documentation Analyst, Precision Healthcare Systems

• Impact on the clinicians workflow
• How does a clinical observation, patient examination or procedure result in the proper ICD-10 coding of that diagnosis or procedure?
• What if documentation is not adequate to allow for proper coding using ICD-10?
• How is the patient's medical history affected by ICD-10 coding?

Conference Chair:
Senior Compliance and Audit Services, INDEPENDENT CONTRACTOR

RAC audits are finding a large percentage of improper payments due to admitting patients that did not meet inpatient criteria. Distinguishing between inpatient admissions and outpatient observation services continues to be a billing problem for many physicians, and hospitals are now starting to report observation services more frequently after having inpatient claims denied for medical necessity. CPT issued new instructions for observation codes in 2011, but many physicians are still not aware of the correct way to code for these services.

• Physicians: This session will demonstrate how hospital denials impact physicians -- and how to correctly code for these services
• Health plans: This session will cover what the RACs are finding and provide take-away audit tools to assess provider compliance

• Self-staring: Bonuses subject to star rating

Part 2:

• Using examples based on costs
• Road map for success
• EHR tips

Speakers:
VP Healthcare Analytics, WellCare Health Plans, Inc.

Speaker:
Medical Billing Auditor, HENRY FORD HEALTH SYSTEM / HEALTH ALLIANCE PLAN
Senior Compliance and Audit Services,INDEPENDENT CONTRACTOR

• Integrating medical management and risk adjustment in management of senior members can enhance delivery of quality care, establish return on investment for medical management, and enhance STAR ratings
• HCC and RAF scores can help you actively identify and manage your senior membership by acuity
• Medical management moves risk adjustment from a retrospective model to prospective model of chronic illness management

• It is a paper chase
• How fast can you retrieve records?
• Where do you go?
• How do you validate diagnoses and HCC codes?

Speaker:
Chief Executive Officer & Chief Medical Officer, PARSES, INC.

• Client case studies
• Professional integrated care
• Benefit to patients and insurance plans

Speakers:
Chief Executive Officer, VERVE WELLNESS CENTER, LLC
Chief Medical/Clinical Officer, VERVE WELLNESS CENTER, LLC