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



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Go to Agenda:
Preconference | Day 2

Agenda: Day I
Thursday, July 21, 2016

7:00 am Registration Opens

OPENING PLENARY SESSION
8:00 am

Welcome and Introduction
Audience Response System Poll


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.
    Presentation Material (Acrobat)
8:10 am Regulations, Readmission Penalties, RADV -- "He Who Has the Gold Makes the Rules."

Learning Objectives:
  1. Learn about updates regarding recent Medicare regulations and guidance.
  2. Understand the changes to the CMS readmission reduction program.
Ronald Hirsch, MD, FACP, CHCQM
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 completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA.

    He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012 and served on the Medical Executive Committee. He was Chairman of the Board of Health for the City of Elgin, IL from 1997 to 2012.

    Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, on the Advisory Board of the American College of Physician Advisors, and a Fellow of the American College of Physicians. He is the co-author of The Hospital Guide to Contemporary Utilization Review, which was published in 2015. In 1996 he was a guest on the Jerry Springer Show.
    Presentation Material (Acrobat)
8:40 am Finding the Lost Inpatients with the 2 MN Rule, Plus Other Observation Confusion

Learning Objectives:
  1. Clarify the two types of inpatient.
  2. Find lost inpatients with risk.
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.
    Presentation Material (Acrobat)
9:15 am The Evolving Role of the Physician Advisor as a Member of the Leadership Team

Learning Objectives:
  1. List five major areas of influence of the modern day Physician Advisor.
  2. List three main categories of a Physician Advisor's role within an organization.
Ronald J. Rejzer, MD, CHCQM-PHYADV
Senior Vice President and Chief Physician Advisor, Parkland Health & Hospital System; Past President, ACPA, Dallas, TX

    Speaker Bio

    Dr. Ronald J. Rejzer is a native of Northwest Pennsylvania and received his medical degree in 1980 from the Hahnemann Medical University in Philadelphia followed by a residency at the Medical College of Virginia/VCU in Family Medicine. Dr. Rejzer practiced full time Emergency Medicine in the Tidewater area of Virginia for over eighteen years and was Board Certified in both Family Medicine and Emergency Medicine. For the past 15 years, Dr. Rejzer has held various Physician Executive roles, including VPMA and Chief Medical Officer positions for several prominent healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. Additionally, Dr. Rejzer has served as a consultant for Hospitalist programs, Utilization Management development and Physician Advisor programs and participated on several hospital boards and was elected President of a local medical society in Virginia. He has participated in Physician Advisor roles either part time or fulltime, for over twelve years. He currently serves full time as the SVP, Chief Physician Advisor at Parkland Hospital in Dallas, Tx, overseeing case management, utilization management, appeals and denials, and coding documentation improvement initiatives. As a founding member of ACPA, Dr. Rejzer served as the President of the American College of Physician Advisors, Inc. from 2014-2016. Dr. Rejzer is also a Diplomat of the ABQAURP with a subspecialty certification as a Physician Advisor.
    Presentation Material (Acrobat)
9:45 am Effective C-suite and Physician Advisor Collaboration -- Get to Common Goals through Shared Knowledge and Collaborative Approaches

Learning Objectives:
  1. Understand roles and challenges between C-Suite and PA.
  2. Learn ways for C-suite and PAs to manage as a team towards goal achievement.
Elizabeth Lamkin, MHA
CEO/Partner, PACE Healthcare Consulting, LLC, Bluffton, SC

    Speaker Bio

    Elizabeth Lamkin has over 25 years of experience in executive hospital administration. She has served as Chief Executive Officer and regional CEO for acute and post-acute hospitals and has served in teaching hospitals, and non-profit and investor owned sectors of healthcare. Ms. Lamkin consults on operational effectiveness and is a national speaker and author on operations, quality, utilization, and billing compliance. During her career she has achieved numerous awards for quality.

    Ms. Lamkin now has her own firm, PACE Healthcare Consulting, LLC offering strategy, operations, analytics and software solutions to hospitals, physicians and other sectors of healthcare.

    Ms. Lamkin holds a Master's in Healthcare Administration, from the University of South Carolina, Columbia, an ACHESA accredited Program and; BA Cum Laude, Core in Business Administration, from the University of South Carolina.
    Presentation Material (Acrobat)
Michael Salvatore, MD, FACP, CHCQM
Physician Advisor, Beebe Medical Center, Lewes, DE

    Speaker Bio

    Michael Salvatore, MD, FACP 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 45 years and has 2 daughters. When not working as a PA, he is watching birds or walking the dog with his wife.
    Presentation Material (Acrobat)
10:15 am Break
10:45 am UR: 1st Point of Contact -- ER and Direct Admit Bad Habits with Surgery

Learning Objectives:
  1. Identify the strength of 1st point of contact -- avoiding the place and chase bad habit.
  2. Learn the power of the connection between UR and PAs.

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.
    Presentation Material (Acrobat)
11:15 am Daily Rounding -- PA

Learning Objectives:
  1. Learn the economic, quality, and utilization benefits of well-organized, interdisciplinary rounds.
  2. Understand how the Physician Advisor role in interdisciplinary rounds leads to a decline in denials and permits more effective appeals.
Michael Salvatore, MD, FACP, CHCQM
Physician Advisor, Beebe Medical Center, Lewes, DE

    Speaker Bio

    Michael Salvatore, MD, FACP 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 45 years and has 2 daughters. When not working as a PA, he is watching birds or walking the dog with his wife.
    Presentation Material (Acrobat)
Howard Stein, DO, MHA
Associate Director of Medical Affairs & Physician Advisor Case Management, Centrastate Medical Center, Freehold, NJ

    Speaker Bio

    Howard A. Stein D.O. M.H.A. is the Associate Director of Medical Affairs and Physician Advisor at Centrastate Medical Center, Freehold, New Jersey. He is a board certified family physician who served as an Assistant Clinical Professor of Family Medicine at Robert Wood Johnson Medical School, New Brunswick, NJ and at the University of Medicine & Dentistry, Newark, NJ. He is board certified by the American Board of Quality Assurance & Utilization Review Physicians. Howard is an executive board member of the American College of Physician Advisors. Howard performs bioethics consultations and serves as a leader on the Readmissions Task Force. He served as a physician in the United States Air Force. He is married for 31 years with 5 children.
    Presentation Material (Acrobat)
11:45 am Daily Work Flow -- PA

Learning Objectives:
  1. Learn how to impact length of stay.
  2. Learn how to educate staff and prevent denials.
Jeannine Z. Engel, MD, FACP
Associate Professor of Medicine, Physician Advisor, Billing Compliance, University of Utah Health Sciences, Salt Lake City, UT

    Speaker Bio

    Jeannine Z.P. Engel, MD FACP is a General Internist and Associate Professor of Medicine at the University Of Utah School Of Medicine. She sees patients in Huntsman Cancer Institute's Acute Care Clinic, teaches in the Medical School and is the Physician Advisor to the Billing Compliance Office. Dr. Engel received her Medical Degree from the University of California, San Diego. She completed her Internal Medicine Residency and a Chief Resident year at Vanderbilt University in Nashville, TN. She served on the Vanderbilt faculty for 15 years prior to moving to Salt Lake City in 2010. She sits on several national committees through the Society of General Internal Medicine and The American College of Physicians. In her role at the university, she translates the clinical and regulatory worlds, represents the medical center in federal audits, delivers education to providers and engages in process improvement related to documentation and billing.
    Presentation Material (Acrobat)
Maria Johar, MD
System Physician Advisor and Medical Director, Promedica Health Network, Promedica Health System, Toledo, OH

    Speaker Bio

    Dr. Maria Johar is the System Physician Advisor at ProMedica Health System and Medical Director for the Promedica Health Network.

    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 has recently been recognized with an " Inventor of the year " for a software solution that will help healthcare systems across the nation have compliant billing.

    She lives in Toledo with her husband, two boys and three 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)
12:15 pm Faculty Panel and Q&A
All Morning 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.
12:35 pm Case Studies: "Finding Your Lost Inpatients" -- Luncheon Work Session with Faculty

1:35 pm Present the Case Studies

Table Leaders
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.
    Presentation Material (Acrobat)
2:20 pm What is Going on with the Payers? Traditional Medicare, Part C Medicare, and Managed Care Commercial

Learning Objective:
  1. Understand the current landscape regarding payer activity.
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.
    Presentation Material (Acrobat)
2:30 pm The MAC Landscape: Current Audits & Understanding the MACs Role in Appeals

Learning Objectives:
  1. Understand the MACs' role in inpatient reviews.
  2. Understand the initial levels of Medicare Appeals.
K. Cheyenne Santiago, RN
Clinical Manager - Medical Review, WPS GHA, Omaha, NE

    Speaker Bio

    Cheyenne Santiago is the Clinical Manager for Part A Medical Review at WPS GHA, a Medicare Administrative Contractor (MAC). Throughout her 10 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)
    Handout Material (Acrobat)
3:30 pm Break
3:50 pm Bundled Payments: Living with the Comprehensive Joint Replacement (CJR) Initiative

Learning Objectives:
  1. Learn how to manage the 90-day timeframe.
  2. Understand the keys to educating providers. Maria Johar, MD, System Physician Advisor and Medical Director, Promedica Health Network, Promedica Health System, Toledo, OH
Maria Johar, MD
System Physician Advisor and Medical Director, Promedica Health Network, Promedica Health System, Toledo, OH

    Speaker Bio

    Dr. Maria Johar is the System Physician Advisor at ProMedica Health System and Medical Director for the Promedica Health Network.

    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 has recently been recognized with an " Inventor of the year " for a software solution that will help healthcare systems across the nation have compliant billing.

    She lives in Toledo with her husband, two boys and three 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)
4:10 pm Medicare Dis-Advantage and Mis-Managed Medicaid -- Profits over Patients

Learning Objectives:
  1. Correlate Medicare and Medicare Advantage regulations.
  2. Understand common commercial insurer denial tactics.
Ronald Hirsch, MD, FACP, CHCQM
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 completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA.

    He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012 and served on the Medical Executive Committee. He was Chairman of the Board of Health for the City of Elgin, IL from 1997 to 2012.

    Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, on the Advisory Board of the American College of Physician Advisors, and a Fellow of the American College of Physicians. He is the co-author of The Hospital Guide to Contemporary Utilization Review, which was published in 2015. In 1996 he was a guest on the Jerry Springer Show.
    Presentation Material (Acrobat)
4:30 pm Payer Contracting -- Get it Right Through a Team Approach

Learning Objectives:
  1. Learn how to bring the clinical and financial silos together to work as a team.
  2. Understand the power of monitoring and reporting contract activity to improve contract compliance and negotiations.
Elizabeth Lamkin, MHA
CEO/Partner, PACE Healthcare Consulting, LLC, Bluffton, SC

    Speaker Bio

    Elizabeth Lamkin has over 25 years of experience in executive hospital administration. She has served as Chief Executive Officer and regional CEO for acute and post-acute hospitals and has served in teaching hospitals, and non-profit and investor owned sectors of healthcare. Ms. Lamkin consults on operational effectiveness and is a national speaker and author on operations, quality, utilization, and billing compliance. During her career she has achieved numerous awards for quality.

    Ms. Lamkin now has her own firm, PACE Healthcare Consulting, LLC offering strategy, operations, analytics and software solutions to hospitals, physicians and other sectors of healthcare.

    Ms. Lamkin holds a Master's in Healthcare Administration, from the University of South Carolina, Columbia, an ACHESA accredited Program and; BA Cum Laude, Core in Business Administration, from the University of South Carolina.
    Presentation Material (Acrobat)
5:00 pm Panel for Q&A
All 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.
5:30 pm Adjournment

Meet at 6:15 pm No Host/Dutch Dinner (Restaurants will be identified prior)


Go to Agenda:
Preconference | Day 2




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