Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit
Medicare RAC Summit



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Preconference | Day 2

RAC SUMMIT PRESENTATIONS
Speaker presentations are password protected for 90 days from the start of the Summit. Registrants may log in by clicking here. For further information, email registration@hcconferences.com or call 800-503-0510.

Agenda: Day I
Thursday, July 23, 2015

THE 2015 BOOT CAMP: EXPLORING THE FOUR KEY AREAS FOR SUCCESS
WITH PHYSICIAN ADVISORS AND UR STAFF:
    I. The First Point of Contact
    II. Concurrent and Daily Review
    III. Denial Prevention
    IV. Ongoing Education
7:00 am Registration Opens

Welcome Coffee

OPENING PLENARY SESSION -- INTRODUCTION AND THE FIRST POINT OF CONTACT
8:00 am

Welcome and Overview of the Boot Camp
Audience Response System -- Learning about the Attendees


Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Chair)

    Speaker Bio

    Day Egusquiza is President of AR Systems, Inc. and brings over 30 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance - both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA's ANI rated her in the top 25% for each year she has presented, earning her the 'Distinguished Speaker' award. She received her college degree at Lewis & Clark College in Portland, OR.
    Presentation Material (Acrobat)
8:15 am

Regulatory Update and Operational Impact

Ronald Hirsch, MD, FACP
Vice President, Accretive Physician Advisory Services (AccretivePAS), Chicago, IL

    Speaker Bio

    Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at AccretivePAS Clinical Solutions. He graduated from UCLA with a degree in psychobiology. He received his medical degree from the Chicago Medical School in North Chicago, IL, and completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA.

    Dr. Hirsch is a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, IL. He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012, where he was Chairman of the Medical Records Committee from 1995 to 2012, and also served on the Medical Executive Committee. He also served on the Sherman Home Care Board of Directors from 1999 to 2012 He was Chairman of the Board of Health for the City of Elgin, IL from 1997 to 2012 and was medical director at two area nursing facilities in the 1990's.

    Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, is a member of the American Case Management Association, the American College of Physician Advisors, and a Fellow of the American College of Physicians. In 1996 he was a guest on the Jerry Springer Show.
    Presentation Material (Acrobat)
8:45 am

What is a Physician Advisor? How Can a PA Influence Engagement of an Organization?

Howard Stein, DO
Physician Advisor, Centrastate Medical Center, Freehold, NJ

    Speaker Bio

    Dr. Howard Stein is the Associate Director of Medical Affairs and Physician Advisor at Centrastate Healthcare System, Freehold, New Jersey. He graduated from Nova Southeastern College of Osteopathic Medicine and is Board Certified in Family Medicine. Dr. Stein graduated with his Masters in Health Administration from the University of Maryland. He served as an Emergency Room Physician in the U.S. Air Force. He practiced Family Medicine in New Jersey for 13 years. He is a Fellow in the American Board of Quality Assurance and Utilization Review Physicians. He has worked in the Physician Advisor Role since 1993 and is an Executive Board Member of the American College of Physician Advisors.
    Presentation Material (Acrobat)
9:15 am I. THE FIRST POINT OF CONTACT

UR in the ER -- Getting Patient Status Right the First Time
Pamela Foster, APSW, MBA, ACM
Director, Care Coordination, Case Management & Social Services, Mayo Clinic Health System, Eau Claire, WI

    Speaker Bio

    Pamela Foster is the Coordinator of the Care Coordination Program at Mayo Clinic Health System, Northwest WI region. She has over 20 years of experience and leadership in case management and utilization review in community, academic, tertiary and critical access hospitals. She currently serves on the American Case Management Association's National Board of Directors as well as the National Quality Forum's Care Coordination Steering Committee.
    Presentation Material (Acrobat)
Linda Gomes, RN
Clinical Reimbursement Manager, Bridgeport Hospital, Bridgeport, CT

    Speaker Bio

    Linda Gomes has more than thirty years of nursing experience, including clinical pediatrics, nursing management, and nursing informatics, before transitioning to her present position as Clinical Reimbursement Manager at Bridgeport Hospital in Connecticut. In addition to her nursing degree, she holds a BS in Business Management from Post College in Waterbury, CT. and an MS in Health Systems Management from Sacred Heart University in Fairfield, CT. Linda's interests outside of her career include a passion for the game of golf and a passion for spoiling her grandchildren.
    Presentation Material (Acrobat)
Delana Knupp, RN, CRRN
Integrated CDI/Case Management Director, Wise Regional Health Systems, Decatur, TX

    Speaker Bio

    Delana Knupp is an Integrated CDI/Case Management Director at Wise Regional Health Systems in Decatur, TX. She is a nurse with approximately 18 years in the healthcare field -- everything from helping her younger brother open up his own Physical Therapy practice, to becoming an EMT Paramedic with four small children at home, to obtaining her ASN from Excelsior University in Albany, NY. She has experience in a wide variety of clinical areas, CDI, audit analyst and UR. She has over seven years in leadership positions bringing about electronic documentation, CDI and now, in the last year, Integrated CDI. Under her umbrella of Integrated CDI she has UR, traditional CDI, and audit analysis. Delana feels passionate about effective communication and loves this journey of being the bridge that holds together the clinical and revenue side of the house.

UR and Surgery Scheduling -- Addressing Inpatient-Only Best Practices PLUS UR Joined at the Hip with Surgery Daily Activity -- Bad Habits Attacked
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID

    Speaker Bio

    Day Egusquiza is President of AR Systems, Inc. and brings over 30 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance - both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA's ANI rated her in the top 25% for each year she has presented, earning her the 'Distinguished Speaker' award. She received her college degree at Lewis & Clark College in Portland, OR.
    Presentation Material (Acrobat)
Pamela Foster, APSW, MBA, ACM
Director, Care Coordination, Case Management & Social Services, Mayo Clinic Health System, Eau Claire, WI

    Speaker Bio

    Pamela Foster is the Coordinator of the Care Coordination Program at Mayo Clinic Health System, Northwest WI region. She has over 20 years of experience and leadership in case management and utilization review in community, academic, tertiary and critical access hospitals. She currently serves on the American Case Management Association's National Board of Directors as well as the National Quality Forum's Care Coordination Steering Committee.
    Presentation Material (Acrobat)
10:10 am Break
10:30 am How to Handle Difficult Situations ?-- POINT-COUNTERPOINT
  • Outpatient in a Bed
  • Transfer pending but No SNF Available
  • After-Hour and Weekend Admits
Pamela Foster, APSW, MBA, ACM
Director, Care Coordination, Case Management and Social Services, Mayo Clinic Health System, Eau Claire, WI

    Speaker Bio

    Pamela Foster is the Coordinator of the Care Coordination Program at Mayo Clinic Health System, Northwest WI region. She has over 20 years of experience and leadership in case management and utilization review in community, academic, tertiary and critical access hospitals. She currently serves on the American Case Management Association's National Board of Directors as well as the National Quality Forum's Care Coordination Steering Committee.
Jessica L. Gustafson, Esq.
Founding Shareholder, The Health Law Partners, Southfield, MI

    Speaker Bio

    JESSICA L. GUSTAFSON is a founding shareholder with The Health Law Partners, P.C. She graduated cum laude from Miami University in 2002. Ms. Gustafson graduated from Wayne State University Law School in 2005. While in law school, Ms. Gustafson served as a member of the Wayne Law Review Editorial Board as a Senior Articles Editor. She also served as a judicial intern to the Honorable Robert H. Cleland, United States District Court, Eastern District of Michigan.

    Ms. Gustafson practices in all areas of health care law and devotes a substantial portion of her practice to representing providers in the Recovery Audit Contractor ("RAC") and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters.

    Ms. Gustafson is a member of the American Health Lawyers Association, American Bar Association (Health Law Section) and Michigan Bar Association (Health Care Law Section). She currently serves as the Vice-Chair of the Physician Issues Interest Group for the ABA Health Law Section.
Maria Johar, MD
Administrative Director, ProMedica, Toledo, OH

    Speaker Bio

    Dr. Maria Johar is the System Physician Advisor at ProMedica Health System.

    ProMedica was acknowledged for being an integrated health system that serves more than 4.4 million patients across its 13 hospitals, four ambulatory surgery centers and more than 300 other facilities each year.

    She joined the Promedica family in Oct 2012. She comes with over fifteen years of experience in the fields Of Utilization Review, Quality, Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.

    Prior to working with ProMedica Health System, she worked with Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals as well as writing a book called DRG Tools.

    She lives in Toledo with her husband, two boys and two dogs.

    She is sits on the Lucas county suicide prevention board, and is associated with the National Physician Advisors Association, national and state case management associations and the National Association of Healthcare Quality.
Michael A. Salvatore, MD, FACP
Physician Advisor, Beebe Medical Center, Lewes, DE

    Speaker Bio

    Dr. Michael Salvatore received his MD from the University of Arizona in 1977. His post-graduate training 1977 - 1982 was at Duke University. He practiced Critical Care Medicine for 30 years before becoming a full time PA at Beebe Healthcare in 2012. He has been married for 43 years and has 2 daughters. When not working as a PA, he is watching birds with his wife.
Ernie de los Santos
Founder and Faculty Chair, Appeal Academy, San Antonio, TX (Moderator)

    Speaker Bio

    Ernie de los Santos is Faculty Chair and Founder of Appeal Academy, and the popular online talk show, "Finally Friday!", and TopGun Audit School. He writes regularly for Appeal Academy, and provides marketing strategy and lead generation for vendors and consultants. Before entering the healthcare industry in 2006, he spent over 20 years in research and development of marketing and production, working on projects for Fortune 100 corporations, including Coca-Cola, Kodak, and the International Olympic Committee. Before that, he spent 10 years in B2B sales and marketing for Sony and Panasonic. He holds a BA in Anthropology and Computer Science, and an MBA in Marketing.
11:10 am Q&A Session with Faculty
11:45 am Working Lunch with Hosted Case Study Discussions
1:00 pm Presentation of Case Studies
Audience Response System Voting re Correct Status
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Moderator)
2:15 pm II. CONCURRENT AND DAILY REVIEW

Daily Work Flow for UR Staff
  • 1MN and Still in Bed?
  • Direct Admits?
Pamela Foster, APSW, MBA, ACM
Director, Care Coordination, Case Management & Social Services, Mayo Clinic Health System, Eau Claire, WI

    Speaker Bio

    Pamela Foster is the Coordinator of the Care Coordination Program at Mayo Clinic Health System, Northwest WI region. She has over 20 years of experience and leadership in case management and utilization review in community, academic, tertiary and critical access hospitals. She currently serves on the American Case Management Association's National Board of Directors as well as the National Quality Forum's Care Coordination Steering Committee.
    Presentation Material (Acrobat)
Linda Gomes, RN
Director of Case Management, Bridgeport Hospital, Bridgeport, CT

    Speaker Bio

    Linda Gomes has more than thirty years of nursing experience, including clinical pediatrics, nursing management, and nursing informatics, before transitioning to her present position as Clinical Reimbursement Manager at Bridgeport Hospital in Connecticut. In addition to her nursing degree, she holds a BS in Business Management from Post College in Waterbury, CT. and an MS in Health Systems Management from Sacred Heart University in Fairfield, CT. Linda's interests outside of her career include a passion for the game of golf and a passion for spoiling her grandchildren.
Daily Work Flow for PAs
  • Referral Process
  • Interaction with Providers
  • Full-time or Part-Time
Maria Johar, MD
Administrative Director, ProMedica, Toledo, OH

    Speaker Bio

    Dr. Maria Johar is the System Physician Advisor at ProMedica Health System.

    ProMedica was acknowledged for being an integrated health system that serves more than 4.4 million patients across its 13 hospitals, four ambulatory surgery centers and more than 300 other facilities each year.

    She joined the Promedica family in Oct 2012. She comes with over fifteen years of experience in the fields Of Utilization Review, Quality, Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.

    Prior to working with ProMedica Health System, she worked with Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals as well as writing a book called DRG Tools.

    She lives in Toledo with her husband, two boys and two dogs.

    She is sits on the Lucas county suicide prevention board, and is associated with the National Physician Advisors Association, national and state case management associations and the National Association of Healthcare Quality.
    Presentation Material (Acrobat)
Michael A. Salvatore, MD, FACP
Physician Advisor, Beebe Medical Center, Lewes, DE

    Speaker Bio

    Dr. Michael Salvatore received his MD from the University of Arizona in 1977. His post-graduate training 1977 - 1982 was at Duke University. He practiced Critical Care Medicine for 30 years before becoming a full time PA at Beebe Healthcare in 2012. He has been married for 43 years and has 2 daughters. When not working as a PA, he is watching birds with his wife.
    Presentation Material (Acrobat)
Daily Rounding Concepts
Howard Stein, DO
Physician Advisor, Centrastate Medical Center, Freehold, NJ

    Speaker Bio

    Dr. Howard Stein is the Associate Director of Medical Affairs and Physician Advisor at Centrastate Healthcare System, Freehold, New Jersey. He graduated from Nova Southeastern College of Osteopathic Medicine and is Board Certified in Family Medicine. Dr. Stein graduated with his Masters in Health Administration from the University of Maryland. He served as an Emergency Room Physician in the U.S. Air Force. He practiced Family Medicine in New Jersey for 13 years. He is a Fellow in the American Board of Quality Assurance and Utilization Review Physicians. He has worked in the Physician Advisor Role since 1993 and is an Executive Board Member of the American College of Physician Advisors.
    Presentation Material (Acrobat)
CDI Interaction with the PAs
Kathy Shumpert, RN
Chief Quality Officer, Dukes Memorial Hospital, Peru, IN; Former Clinical Documentation Improvement Specialist, Community Howard Regional Health, Kokomo, IN

    Speaker Bio

    Kathy Shumpert's passion is to do purposeful worthwhile work by utilizing her 7 years of experience as a Clinical Documentation Improvement Specialist to educate physicians, CDI staff and coders to prevent revenue loss and improve physician documentation. Not only has she been a registered nurse for 18 years, but Kathy has recently earned a Master's degree in Nursing Administration from Indiana University. She has a strong background in long-term care administration, surgery, case management, and home health care. Kathy has conceptualized and created an Integrated CDI model. She is an expert CDI trainer providing ongoing education. Additionally, she successfully writes coding and medical necessity appeals. Kathy Shumpert has spoken at the national ACDIS conference and the National RAC/MAC Summit in 2014. In fact, she speaks as often as she can in hopes to find someone who is as passionate about CDI as she is. She is still looking for that individual.
    Presentation Material (Acrobat)
3:15 pm Break
3:45 pm III. DENIAL PREVENTION
Lessons from the Probe and Educate Findings
K. Cheyenne Santiago, RN
Medical Review Clinical Manager, WPS Medicare, Omaha, NE

    Speaker Bio

    Cheyenne Santiago is the Medical Review Clinical Manager for WPS Medicare, a Medicare Administrative Contractor (MAC). Throughout her 8 years in Medicare, she has had a passion for educating providers on the complexities of Medicare regulations and speaks frequently on topics directly affecting acute care hospitals. She is currently responsible for overseeing WPS Medicare's Medical Review program and draws on her experience as a Senior Nurse Analyst where she spent 5 years as a Medicare facility educator. Mrs. Santiago holds an Associate of Science in Nursing (RN/A.S.N.) degree from Excelsior College School of Nursing, in Albany, New York.
    Presentation Material (Acrobat)
4:35 pm

Beyond Filing Appeals -- Proven Success Strategies using PAs

Jessica L. Gustafson, Esq.
Founding Shareholder, The Health Law Partners, Southfield, MI

    Speaker Bio

    JESSICA L. GUSTAFSON is a founding shareholder with The Health Law Partners, P.C. She graduated cum laude from Miami University in 2002. Ms. Gustafson graduated from Wayne State University Law School in 2005. While in law school, Ms. Gustafson served as a member of the Wayne Law Review Editorial Board as a Senior Articles Editor. She also served as a judicial intern to the Honorable Robert H. Cleland, United States District Court, Eastern District of Michigan.

    Ms. Gustafson practices in all areas of health care law and devotes a substantial portion of her practice to representing providers in the Recovery Audit Contractor ("RAC") and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters.

    Ms. Gustafson is a member of the American Health Lawyers Association, American Bar Association (Health Law Section) and Michigan Bar Association (Health Care Law Section). She currently serves as the Vice-Chair of the Physician Issues Interest Group for the ABA Health Law Section.
Abby Pendleton, Esq.
Founding Shareholder, The Health Law Partners, Southfield, MI

    Speaker Bio

    ABBY PENDLETON is a founding partner of The Health Law Partners, P.C. She graduated Magna Cum Laude from Wayne State University Law School in 1996 and is a member of the Order of the Coif. Ms. Pendleton was a member of the Wayne State Law Review and served on its editorial board as a Senior Articles Editor. While at Wayne State, she was a recipient of the American Jurisprudence Book Awards in Contracts and Criminal Law as well as the Deloitte and Touche LLP Award for her achievement in tax law.

    Ms. Pendleton has been practicing healthcare law since 1996. She regularly provides counsel to healthcare providers and organizations in a number of areas, including but not limited to: compliance, Recovery Audit Contractors ("RAC"), Medicare and other payor audits, fraud and abuse, reimbursement matters, and HIPAA Privacy and Security, and physician staff privilege and licensure matters. Ms. Pendleton also specializes in legal issues impacting billing and management companies, anesthesia and pain management providers, hospice providers and mental health agencies.

    Ms. Pendleton is a member of the State Bar of Michigan (Member, Health Care Law Section) and State Bar of New York (Member, Health Law Section); the American Bar Association; the American Health Lawyer's Association; the Health Care Compliance Association; the Medical Group Management Association and the Michigan Medical Group Management Association.
    Presentation Material (Acrobat)
5:15 pm

Q&A Session with Afternoon Faculty

Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Moderator)

    Speaker Bio

    Day Egusquiza is President of AR Systems, Inc. and brings over 30 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance - both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA's ANI rated her in the top 25% for each year she has presented, earning her the 'Distinguished Speaker' award. She received her college degree at Lewis & Clark College in Portland, OR.
5:45 pm Adjournment

6:30 pm Optional Dutch Treat Dinners Hosted by Faculty

Go to Agenda:
Preconference | Day 2




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