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MEDICARE RAC CERTIFICATE PROGRAM
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NATIONAL MEDICARE RAC SUMMIT AGENDA:
PRECONFERENCE SYMPOSIUM
Wednesday, March 9, 2011
Note, all times listed are Eastern Standard Time
(Registration optional; Choose one)
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12:00 p.m. |
Registration Opens
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PRECONFERENCE I: MEDICARE RAC BOOT CAMP FOR SMALL AND CRITICAL ACCESS HOSPITALS: Managing All Government Audit Risks -- MAC, RAC, Medicaid, and CERT (Registration optional)
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1:00 p.m. |
Welcome and Preconference Boot Camp Overview
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Co Chair)
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1:15 p.m. |
Fitting Audits into a Crowded Rural Hospital Agenda
Steve Griffin, MSN
Director, Central RAC Appeals Unit, Quorum Health Resources, Brentwood, TN
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1:45 p.m. |
At Risk Issues
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID
Presentation Material (Acrobat)
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2:30 p.m. |
Utilization Review and the Role of Nursing
Ann M. Brannan, RN, BSN
RAC Coordinator (Retired), Wallace Thomson Hospital, Union, SC
Presentation Material (Acrobat)
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3:00 p.m. |
Break
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3:30 p.m. |
CAH Stories from the Field - MAC, MIC, RAC, and CERT
Rita Ford, RHIA, CHC
HIM Manager, Paris Community Hospital, Paris, IL
Presentation Material (Acrobat)
Joanie Perkins
RAC Coordinator, Northern Sunflower Medical Center, Ruleville, MS
Presentation Material (Acrobat)
Ron Smith, CPA
Chief Financial Officer, Wickenburg Hospital, Wickenburg, AZ
Presentation Material (Acrobat)
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4:30 p.m. |
Faculty Q&A Panel
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Moderator)
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5:00 p.m. |
Preconference Adjournment
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PRECONFERENCE II: ADVANCED PRECONFERENCE ON CODING ISSUES IN PROGRAM INTEGRITY (Registration optional)
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1:00 p.m. |
Welcome and Preconference Overview
Barbara Flynn, RHIA, CCS
Vice President/Health Information and Denial Management Services, Florida Hospital Association Management Corporation, Inc., Orlando, FL (Co Chair)
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1:15 p.m. |
RAC Coding Issues and CDI
Margi Brown
RHIA, CCS, CCS-P, CPC, CCDS, Independent Consultant, Orlando, FL
Presentation Material (Acrobat)
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2:00 p.m. |
Query Composition Issues - From Obstacles to Efficacy
Andrew Rothschild, MD, MS, MPH, FAAP, CCDS
Associate Director, Navigant Consulting, Inc., Austin, TX
Presentation Material (Acrobat)
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2:45 p.m. |
Break
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3:15 p.m. |
ICD 10 Documentation Issues for Coders and Documentation Improvement Specialists
Barbara Flynn, RHIA, CCS
Vice President/Health Information and Denial Management Services, Florida Hospital Association Management Corporation, Inc., Orlando, FL
Presentation Material (Acrobat)
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4:00 p.m. |
Faculty Q&A Panel
Barbara Flynn, RHIA, CCS
Vice President/Health Information and Denial Management Services, Florida Hospital Association Management Corporation, Inc., Orlando, FL (Moderator)
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4:45 p.m. |
Preconference Adjournment
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PRECONFERENCE OUTLINE AND SESSION OBJECTIVES
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RAC Coding Issues and CDI
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- Inventory on current denials
- Coding and/or clinical
- Clinical aspect - what's missing?
- Different viewpoints from the coder, CDI, and the physician
- Successful appeal examples
- Prevention
After this session, the participant should be able to:
- Initiate a baseline for all denials and categorize the patterns/trends
- Differentiate the types of denials for timely assignment to as to "who does what"
- Substantiate the missing pieces of a medical necessity denial and/or validation of a clinical diagnosis
- Understand the different focus points from the different perspectives
- Review a few snapshot cases of actual appeals that were successful
- Define next steps moving forward in the process
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Query Composition Issues - From Obstacles to Efficacy
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- Defining Query Efficacy
- Addressing and Overcoming Query Obstacles
- Understanding and Anticipating Physician Behavior
- Physician Familiarity with the Querying Program
- Coding Logic vs. Clinical Logic
- Constraints of Query Compliance
- Query Terminology, Phrasing and Format
- Physician Perspective/State-of-mind
- Query Intent vs. Query Perception
- Balancing Query Individualization with Consistency
- Examples of Queries that Work…and Queries that Don't
- Query Strategies: Defensive/RAC, Educational, Verbal, Introductory, Targeted, Supportive, and Compliance-Focused Querying
After this session, the participant should be able to:
- Differentiate between query compliance and query efficacy
- Identify and avoid common triggers of obstructive physician responses
- Anticipate and proactively address expected perceptions of a query
- Construct physician-friendly queries
- Effectively communicate specific questions without leading to a response
- Compliantly individualize queries to address physician issues
- Recognize limitations of written queries
- Strategize queries to add on specific needs
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ICD 10 Documentation Issues for Coders and CDS
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- Introduction to difference in classification systems
- Deadlines for conversion to ICD-10
- Key documentation issues for ICD-10
- Preparing medical staff for ICD-10
- Preparing ancillary outpatient departments for ICD-10
- Preventing RAC denials in FY 2014
After this session, the participant should be able to:
- Identify the key differences between ICD-9 and ICD-10
- Identify the timetables for conversion to ICD-10
- Identify key documentation improvement opportunities for ICD-10
- Discuss the need for the medical staff and their office staff to prepare for ICD-10 to decrease the need for physician queries and assure accurate reimbursement
- Prepare ancillary outpatient departments for ICD-10
- Prevent or decrease RAC denials in under the ICD-10 classification system
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