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 1


Agenda: Day II
Friday, November 14, 2014

7:00 am
Registration Opens

Networking Breakfast in the Exhibit Hall

Optional Hosted Table Topics
  • Topic: ICD10: Impact on APR-DRGs and Quality Reports
    Host: Thomas Kravis, MD, Physician Executive, 3M Health Information Systems, Inc.

      Speaker Bio

      Dr. Thomas Kravis is currently Physician Executive at 3M Health Information Systems where develops and deploys Clinical Documentation Improvement solutions, and severity adjusted evidence based tools to measure costs quality and outcomes across the continuum of care. Previously he was the Lead Clinical consultant at Milliman USA San Diego and a contributing editor to the Milliman Care Guidelines, as well as having held senior positions at Andersen Consulting Chicago and United Health Care and Ingenix. He has published widely and founded and edited ?Emergency Medicine A Comprehensive Review,? a textbook of emergency medicine. He received the Edward Livingston Thoreau award from the American Thoracic Society and was appointed by the governor to serve as the physician representative on the California Board of Nursing. He received specialty training in Internal Medicine and Pulmonary Medicine at UC San Diego and conducted research at Scripps Clinic Research Foundation. He has served as the founder and CEO of a multi-specialty physician provider organization based in San Diego with clinical operations in seven states.
  • Topic: Audit challenges...Tears to Triumphs
    Host: Dawn Crump, Vice President, Audit Management Solutions, Healthport, Alpharetta, GA

      Speaker Bio

      Dawn Crump has been in the healthcare compliance industry for more than 18 years and joined HealthPort in 2013 as Vice President of Audit Management Solutions. Prior to joining HealthPort, Ms. Crump was the Network Director of Audit and Compliance for a Midwest Healthcare system. She has healthcare experience in education, organization development, quality improvement, revenue cycle and corporate compliance. Trained as a six sigma black belt, Ms. Crump used this holistic, fact-based approach to establish compliance and audit tracking (RAC) programs. Her expertise includes coding and billing compliance as well as HIPAA compliance and government audit programs for acute care facilities. She is a former board director of the Greater St. Louis Healthcare Finance Management Association chapter and is also a member of the Health Care Compliance Association (HCCA).
  • Topic: Understanding What Auditors Are Looking For
    Host: William Malm, ND, RN, CMAS, Craneware

      Speaker Bio

      William Malm ND, RN, CMAS, CRCR is Craneware?s Senior Manager of Revenue Integrity Communications, specializing in operations surrounding chargemasters and compliance. With extensive experience in all post-payment audits, he is a nationally known author and speaker on topics such as healthcare compliance, chargemasters, and CMS recovery audits. Malm has more than 25 years of experience in a com¬bination of clinical and financial healthcare. He has previously served as a systems compliance officer at a large for-profit healthcare system, and has conducted hundreds of pre-pay and post-pay audits. He serves as Secretary Treasurer of the Certification Council for Medical Audit Specialists, the certifying body of the American Association of Medical Audit Specialists. He was elected the 2014 Medical Audit Specialist of the year and is active in the Healthcare Financial Management Association and Association of Healthcare Internal Auditors.
      Presentation Material (Acrobat)
DAY II MORNING PLENARY SESSION -- THE ROAD AHEAD
8:00 am

Welcome and Overview

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

    Speaker Bio

    Jessica L. Gustafson is a founding shareholder with the health care law firm of The Health Law Partners, P.C. The firm represents hospitals, physicians, and other health care providers and suppliers with respect to their health care legal needs. She and Abby Pendleton co-lead the firm's Recovery Audit (RAC) and Medicare appeals practice group, and specialize in a number of areas, including: Medicare, Medicaid and other payor audit defense and appeals, health care regulatory matters, compliance, HIPAA privacy & security compliance matters, overpayment refunds, reimbursement and contracting matters, and payor de-participation matters. She can be reached at jgustafson@thehlp.com.
8:15 am

National Policies and Issues Regarding ALJs

The Honorable C.F. "Spike" Moore
Deputy Chief Administrative Law Judge, Office of Medicare Hearings and Appeals, U.S. Department of Health and Human Services, Arlington, VA

    Speaker Bio

    Judge C.F. (Spike) Moore was appointed Deputy Chief Administrative Law Judge for the Department of Health and Human Services, Office of Medicare Hearings and Appeals, effective November 6, 2011. In this capacity, he serves as the alter-ego to the Chief Judge for the federal agency whose ALJs preside over disputes involving coverage and payment issues under the Medicare Act and regulations, the second largest federal administrative adjudicative system in the nation.

    Judge Moore has extensive management experience having served not only as a Hearing Office Chief ALJ, but also in acting capacities as the Associate Chief ALJ and Deputy Chief ALJ in the Office of the Chief ALJ, for the Social Security Administration (SSA). As the acting Deputy Chief ALJ from December 2003 through July 2004, Judge Moore was the alter-ego to SSA's Chief ALJ and presided over SSA's administrative adjudicative system.
    Presentation Material (Acrobat)
9:00 am

Legal and Regulatory Update -- 2MN and Beyond

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

    Speaker Bio

    Jessica L. Gustafson is a founding shareholder with the health care law firm of The Health Law Partners, P.C. The firm represents hospitals, physicians, and other health care providers and suppliers with respect to their health care legal needs. She and Abby Pendleton co-lead the firm's Recovery Audit (RAC) and Medicare appeals practice group, and specialize in a number of areas, including: Medicare, Medicaid and other payor audit defense and appeals, health care regulatory matters, compliance, HIPAA privacy & security compliance matters, overpayment refunds, reimbursement and contracting matters, and payor de-participation matters. She can be reached at jgustafson@thehlp.com.
Steven Meyerson, MD
Senior Vice President of Regulations and Education Group Accretive Physician Advisory Services (AccretivePAS), Chicago, IL

    Speaker Bio

    Dr. Steven J. Meyerson is Senior Vice President of the Regulations and Education Group at Accretive Physician Advisory Services, also known as Accretive PAS®. Dr. Meyerson practiced internal medicine and geriatrics in Miami until 2003, after which he was employed as Section Chief for the Extended Care and Sub-Acute Units at the West Palm Beach VA Medical Center and then as Medical Director of the hospitalist program, and later full time Medical Director and Physician Advisor for Care Management at that hospital at Baptist Hospital of Miami. He graduated from Cornell University with a BA degree in Biological Sciences and obtained his MD degree at the Albert Einstein College of Medicine in New York. He did his medical residency in internal medicine at Montefiore Hospital and Medical Center in New York City. He is board certified in internal medicine and geriatric medicine. He is a member of the American Case Managers Association, the American College of Physicians, and the American Geriatrics Association.
    Presentation Material (Acrobat)
Abby Pendleton, Esq.
Founding Shareholder, The Health Law Partners, Southfield, MI

    Speaker Bio

    Abby Pendleton is a founding shareholder with the health care law firm of The Health Law Partners, P.C. The firm represents hospitals, physicians, and other health care providers and suppliers with respect to their health care legal needs. She and Jessica Gustafson co-lead the firm's Recovery Audit (RAC) and Medicare appeals practice group, and specialize in a number of areas, including: Medicare, Medicaid and other payor audit defense and appeals, health care regulatory matters, compliance, HIPAA privacy & security compliance matters, overpayment refunds, reimbursement and contracting matters, and payor de-participation matters. She can be reached at apendleton@thehlp.com.
    Presentation Material (Acrobat)
10:00 am Networking Break and Prize Drawing in the Exhibit Hall
10:30 am

Hospital Denials and Appeal Rights with Part C Medicare Advantage Plans

Maria Johar, MD
Administrative Director, ProMedica, Toledo, OH

    Speaker Bio

    Dr. Maria Johar is the System Physician Advisor at ProMedica Health System, with over fifteen years of experience in the fields Of Utilization Review, Quality, Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She joined the ProMedica family in Oct 2012 and 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 in Baltimore. She has worked with the Ohio State Medicaid board on several process improvement initiatives and as a private consultant to physician offices, Nursing Homes and Hospitals as well as writing a book called DRG Tools. She 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)
Lucy Ebel, RN, MSN, ACM
Care Management, Holland Hospital, Holland, MI

    Speaker Bio

    Lucy Ebel is a registered Nurse who works in Care Management at Holland Hospital, Holland, MI. The hospital has used a Computerized patient records (CPR) system since 1997.
    Presentation Material (Acrobat)
Michael Salvatore, MD
Physician Advisor, Beebe Medical Center, Lewes, DE (Moderator)

    Speaker Bio

    Michael Salvatore obtained his MD from the University of Arizona in 1977 and then trained at Duke University from 1977 to 1982. He practiced Pulmonary Medicine & Critical Care for 35 years before becoming the Physician Adviser at Beebe Medical Center in January, 2012. Beebe is a 150 bed acute care hospital located at the mouth of Delaware Bay in Lewes, DE. Michael and his wife, Judy, have been married for 41 years and have two daughters. When not dealing with quality and utilization issues he can be found RVing and bird watching with his wife.
    Presentation Material (Acrobat)
11:15 am

Congressional Interests and Initiatives (OFF THE RECORD)

Kimberly Brandt, CHC, JD
Chief Healthcare Investigative Counsel, Senate Finance Committee Minority Staff; former Counsel, Allston & Bird LLP; former Director, Medicare Program Integrity Group, CMS, Washington, DC

    Speaker Bio

    Kimberly Brandt is Chief Healthcare Investigative Counsel for the Senate Finance Committee Minority Staff. Previously she was Counsel at Allston & Bird LLP in Washington, DC. Prior to joining the firm she was Director of the Program Integrity Group for CMS. She had worked for over five years with the Office of the Inspector General (OIG) as Senior Counsel in the OIG's Office of Counsel, Special Counsel for External Affairs, and Director of External Affairs. In her position as Senior Counsel, she negotiated False Claims Act settlements, drafted Corporate Integrity Agreements and authored the OIG's Compliance Program Guidance for Physicians. She has worked in a variety of other health care related positions including serving as a health care policy staffer on Capitol Hill for three years and at both a large medical center and national law firm while in law school. Ms. Brandt received her BA in Political Science and History from Valparaiso University, a Master of Arts in Legislative Affairs from the George Washington University, and a Juris Doctor degree with a concentration in Health Law from the DePaul College of Law.
12:00 pm Lunch in the Exhibit Hall

Optional Hosted Table Topics
  • Topic: Best Practice UR Process for Commercial Payers and Managed Medicare/Medicaid
    Host: Marc Tucker, DO, Executive Health Resources

      Speaker Bio

      Dr. Marc Tucker currently serves as a Senior Director, Audit, Compliance and Education at Executive Health Resources (EHR), a national organization that provides technology-enabled, expert Physician Advisor teams concentrating on managing Medicare and Medicaid regulatory compliance, minimizing inappropriate medical necessity denials and achieving appropriate lengths of stay in acute care hospitals and health systems. Triple Board Certified in General Surgery, Advanced Practice Wound Care, and Hyperbaric/Diving Medicine, Dr. Tucker has more than two decades of surgical experience. Prior to joining EHR, he practiced surgery at Indiana Regional Medical Center in Indiana, Pa. Dr. Tucker is a Fellow of the American College of Osteopathic Surgeons and of the American Professional Wound Care Association and a member of American College of Osteopathic Surgeons, the American Osteopathic Association, the Society of American Gastroenterologic Surgeons and the Society of Laparoscopic Surgeons. He earned his Doctor of Osteopathic Medicine degree from the University of Medicine and Dentistry of New Jersey and his master of business administration degree from the Isenberg School of Business at the University of Massachusetts-Amherst. Dr. Tucker also holds a Certificate in business leadership skills from Cornell University Graduate School of Management.
  • Topic: Interpreting PEPPER in the Post-2MN Era
    Host: Ron Hirsch, MD, Accretive Physician Advisor Services

      Speaker Bio

      Dr. Ron Hirsch is Vice President of the Regulations and Education Group at Accretive Physician Advisory Services at Accretive Health, Inc. Dr. Hirsch graduated from medical school at Chicago Medical School in North Chicago, IL, and completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA . He was Medical Director of Case Management at Sherman Hospital and also a general internist and HIV specialist at Signature Medical Associates, a multispecialty practice located in Elgin, Ill., where he previously served as president.
  • Topic: Engaging and Educating Physicians around Transmittal 541 Issues
    Host: Edward Hu, MD, Rex Hospital, UNC Healthcare System

      Speaker Bio

      Dr. Edward Hu is Medical Director, Department of Case Management at Rex Hospital in Raleigh, NC, part of the University of North Carolina Health System. He completed his undergraduate education magna cum laude from the University of Delaware, then completed his medical education at Washington University School of Medicine. He completed his residency in Internal Medicine at Duke University Medical Center. Dr. Hu joined the Rex Hospitalist Team in 2002.
  • Topic: Hot Legal Issues
    Hosts: Jessica Gustafson, Esq. and Abby Pendlteon, Esq., The Health Law Partners

      Speaker Bio

      Jessica L. Gustafson is a founding shareholder with the health care law firm of The Health Law Partners, P.C. The firm represents hospitals, physicians, and other health care providers and suppliers with respect to their health care legal needs. She and Abby Pendleton co-lead the firm?s Recovery Audit (RAC) and Medicare appeals practice group, and specialize in a number of areas, including: Medicare, Medicaid and other payor audit defense and appeals, health care regulatory matters, compliance, HIPAA privacy & security compliance matters, overpayment refunds, reimbursement and contracting matters, and payor de-participation matters. She can be reached at jgustafson@thehlp.com.

      Speaker Bio

      Abby Pendleton is a founding shareholder with the health care law firm of The Health Law Partners, P.C. The firm represents hospitals, physicians, and other health care providers and suppliers with respect to their health care legal needs. She and Jessica Gustafson co-lead the firm?s Recovery Audit (RAC) and Medicare appeals practice group, and specialize in a number of areas, including: Medicare, Medicaid and other payor audit defense and appeals, health care regulatory matters, compliance, HIPAA privacy & security compliance matters, overpayment refunds, reimbursement and contracting matters, and payor de-participation matters. She can be reached at apendleton@thehlp.com.
  • Topic: CAH Issues
    Host: Day Egusquiza, President, AR Systems, Inc.

      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.
DAY II AFTERNOON CONCURRENT SESSIONS (Please select one)
CONCURRENT SESSION A -- Physician Advisor Issues
1:00 pm
  • Welcome
  • Overview of the American College of Physician Advisors
Ronald J. Rejzer, MD
Senior Vice President/ Chief Physician Advisor, Parkland Health and Hospital Systems; President, American College of Physician Advisors (ACPA), Dallas, TX (Chair)

    Speaker Bio

    Dr. Ronald Rejzer is Senior Vice President/Chief Physician Advisor at Parkland Health & Hospital System in Dallas, TX. He received his medical degree in 1980 from the Hahnemann Medical University in Philadelphia followed by a residency at the Medical College of Virginia in Family Medicine. He 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 CMO for several healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. Additionally, he has served as a consultant for Hospitalist programs, Utilization Management development and Physician Advisor programs. He has participated in Physician Advisor roles either part time or fulltime, for over ten years.
    Presentation Material (Acrobat)
1:20 pm

The Evolving Role of the Physician Advisor Today

Larry Hegland, MD, MMM
System Medical Director for Recovery Audit and Appeal Services, Chief Medical Officer, Ministry Saint Clare's Hospital, Weston, WI

    Speaker Bio

    Dr. Larry Hegland is currently System Medical Director for Recovery Audit and Appeal Services and Chief Medical Officer for Ministry Health Care's Saint Clare's Hospital and the Diagnostic and Treatment Center in Weston, Wisconsin. He also serves as the system medical director for Recovery Audit and Appeal Services for Ministry Health Care and the Affinity Health System. Previously, Dr. Hegland was Vice President of Medical Affairs at Beebe Medical Center in Lewes, Delaware. Dr. Hegland is also an anesthesiologist having completed his residency in anesthesiology at Northwestern University/McGaw Medical Center in Chicago. Most recently, Dr. Hegland received a Master's Degree in Medical Management from Carnegie Mellon University in Pittsburgh, Pennsylvania.
2:00 pm

Informal Panel and Audience Q&A on PA Roles

Larry Hegland, MD, MMM
System Medical Director for Recovery Audit and Appeal Services, Chief Medical Officer, Ministry Saint Clare's Hospital, Weston, WI

    Speaker Bio

    Dr. Larry Hegland is currently System Medical Director for Recovery Audit and Appeal Services and Chief Medical Officer for Ministry Health Care's Saint Clare's Hospital and the Diagnostic and Treatment Center in Weston, Wisconsin. He also serves as the system medical director for Recovery Audit and Appeal Services for Ministry Health Care and the Affinity Health System. Previously, Dr. Hegland was Vice President of Medical Affairs at Beebe Medical Center in Lewes, Delaware. Dr. Hegland is also an anesthesiologist having completed his residency in anesthesiology at Northwestern University/McGaw Medical Center in Chicago. Most recently, Dr. Hegland received a Master's Degree in Medical Management from Carnegie Mellon University in Pittsburgh, Pennsylvania.
    Presentation Material (Acrobat)
Edward Hu, MD
Medical Director, Department of Case Management, Rex Hospital, UNC Healthcare System, Raleigh, NC

    Speaker Bio

    Dr. Edward Hu is Medical Director, Department of Case Management at Rex Hospital in Raleigh, NC, part of the University of North Carolina Health System. He completed his undergraduate education magna cum laude from the University of Delaware, then completed his medical education at Washington University School of Medicine. He completed his residency in Internal Medicine at Duke University Medical Center. Dr. Hu joined the Rex Hospitalist Team in 2002.
Michael Salvatore, MD
Physician Advisor, Beebe Medical Center, Lewes, DE

    Speaker Bio

    Michael Salvatore obtained his MD from the University of Arizona in 1977 and then trained at Duke University from 1977 to 1982. He practiced Pulmonary Medicine & Critical Care for 35 years before becoming the Physician Adviser at Beebe Medical Center in January, 2012. Beebe is a 150 bed acute care hospital located at the mouth of Delaware Bay in Lewes, DE. Michael and his wife, Judy, have been married for 41 years and have two daughters. When not dealing with quality and utilization issues he can be found RVing and bird watching with his wife.
Daniel M. Zirkman, MD
Physician Advisor, Executive Health Resources, Freehold, NJ

    Speaker Bio

    Dr. Daniel Zirkman joined Executive Health Resources in 2012, where he has served as a Physician Advisor in the Government Appeals department handling all levels of Medicare and Medicaid denials including administrative law judge (ALJ) hearings, and most recently has been actively involved in a new Physician Clinical Documentation Improvement project. He has long been active in organized medicine, serving as the Chief of Medicine at Centrastate Medical Center in Freehold, New Jersey and as a member of the hospital's Medical Executive Committee and long-range Strategic Planning Committee. Dr. Zirkman is a graduate of Duke University in 1979 and the University of Texas Health Science Center at San Antonio, Texas where he received his medical degree in 1986. He completed a residency in Internal Medicine and fellowship training in Nephrology at Montefiore University Hospital in Pittsburgh, Pennsylvania.
Ronald J. Rejzer, MD
Senior Vice President/ Chief Physician Advisor, Parkland Health and Hospital Systems; President, American College of Physician Advisors (ACPA), Dallas, TX (Moderator)

    Speaker Bio

    Dr. Ronald Rejzer is Senior Vice President/Chief Physician Advisor at Parkland Health & Hospital System in Dallas, TX. He received his medical degree in 1980 from the Hahnemann Medical University in Philadelphia followed by a residency at the Medical College of Virginia in Family Medicine. He 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 CMO for several healthcare organizations and Administrative Director for a large Mid-Atlantic Hospitalist management company. Additionally, he has served as a consultant for Hospitalist programs, Utilization Management development and Physician Advisor programs. He has participated in Physician Advisor roles either part time or fulltime, for over ten years.
3:15 pm Adjournment


CONCURRENT SESSION B -- Hospital Operational Issues
1:00 pm
  • Welcome
Dawn Crump
Vice President, Audit Management Solutions, Healthport, Alpharetta, GA (Chair)

    Speaker Bio

    Dawn Crump has been in the healthcare compliance industry for more than 18 years and joined HealthPort in 2013 as Vice President of Audit Management Solutions. Prior to joining HealthPort, Ms. Crump was the Network Director of Audit and Compliance for a Midwest Healthcare system. She has healthcare experience in education, organization development, quality improvement, revenue cycle and corporate compliance. Trained as a six sigma black belt, Ms. Crump used this holistic, fact-based approach to establish compliance and audit tracking (RAC) programs. Her expertise includes coding and billing compliance as well as HIPAA compliance and government audit programs for acute care facilities. She is a former board director of the Greater St. Louis Healthcare Finance Management Association chapter and is also a member of the Health Care Compliance Association (HCCA).
1:15 pm

Report from National Survey of Hospital Best Practices

Terri Benskin, RHIA
Coordinator, Audit and Quality Monitoring, University of Missouri Health Care, Columbia, MO

    Speaker Bio

    Terri Benskin is the RAC Coordinator for University of Missouri Health System and a graduate student at University of Missouri. For her final graduate studies project, she is examining the proactive and corrective action strategies that are being employed by hospitals to mitigate the financial impact of the Recovery Audit Contractor (RAC) program. She will present the findings of her national survey at the Fall RAC (and MAC) Summit. Prior to joining the University of Missouri Health System she was an independent contractor Intersect Healthcare, Inc. and Health Information Management Director for the Mid-Missouri Mental Health Center. She received her Bachelor of Science degree in Health Information/Medical Records Administration from Stephens College and a Master of Health Administration from the University of Missouri - Columbia. In June 2011 she earned her credential as a Registered Health Information Administrator (RHIA).
    Presentation Material (Acrobat)
1:45 pm

Results from an Internal Probe & Educate Initiative

Teresa K. Hogue, MD
Medical Review Physician, St. Vincent Health System, Indianapolis, IN

    Speaker Bio

    Dr. Teresa Hogue is Physician Advisor, Revenue Cycle Operations Compliance at St. Vincent Health. A board certified Internist/Hospitalist, she has been a fulltime hospitalist for ten years. In addition to clinical practice, Dr. Hogue has served as the physician advisor for the Revenue Cycle Operations Compliance team, assisting with RAC denials and physician education. She also provides physician education in coordination with her hospital's clinical documentation improvement team. Dr. Hogue's strong interest in utilization management led her to become the Medical Director of a newly established Observation Unit at her hospital, which proved to decrease lengths of stay and assign proper patient statuses. In addition, she has experience with the development and implementation of the electronic health record, specifically with physician order entry and documentation.
Tracey Tomak, RHIA
System Manager, Revenue Cycle Operations Compliance, St. Vincent Health System, Indianapolis, IN

    Speaker Bio

    Tracey Tomak is System Manager of Revenue Cycle Compliance at St. Vincent Health in Indiana, which comprises six PPS facilities and eight Critical Access Hospitals. A Registered Health Information Administrator with over 17 years of experience in revenue cycle issues, she is responsible for overseeing all external charge capture, coding and medical necessity audit functions for St. Vincent Health on the hospital reporting side. This work includes oversight for the RAC process, response to both internal and external audits such as CERT, probe, OIG, and Medicaid audits, as well as chart to charge audits performed by third party payers for outlier claims. She has also served as an adjunct professor for the Health Information program at Ivy Tech Community College and is a regular guest speaker for the program and for the Indiana Health Information Management Association. Tracey is a member of the Indiana chapter of HFMA and has had her work published in their Hoosier Times newsletter.
    Presentation Material (Acrobat)
2:15 pm

How the CMS esMD Electronic Solution Can Simplify Your Audits

Greg Beech
Senior Revenue Cycle Analyst, eSolutions, Olathe, KS

    Speaker Bio

    Greg Beech has more than 20 years of experience in revenue cycle management and consulting. He's worked primarily in acute care facilities, but also has experience in practice management and managed care contracting. In his current position as Senior Revenue Cycle Analyst for eSolutions, he designs revenue cycle solutions, consults, and provides client training and education. Greg received his B.S. degree in Commerce and Business Administration from the University of Alabama.
    Presentation Material (Acrobat)
2:45 pm

Solving the Puzzle of Clinical Documentation Improvement

Marc Tucker, DO
Senior Director of Audit, Compliance and Education, Executive Health Resources, Newtown Square, PA

    Speaker Bio

    Dr. Marc Tucker currently serves as a Senior Director, Audit, Compliance and Education at Executive Health Resources (EHR), a national organization that provides technology-enabled, expert Physician Advisor teams concentrating on managing Medicare and Medicaid regulatory compliance, minimizing inappropriate medical necessity denials and achieving appropriate lengths of stay in acute care hospitals and health systems. Triple Board Certified in General Surgery, Advanced Practice Wound Care, and Hyperbaric/Diving Medicine, Dr. Tucker has more than two decades of surgical experience. Prior to joining EHR, he practiced surgery at Indiana Regional Medical Center in Indiana, Pa. Dr. Tucker is a Fellow of the American College of Osteopathic Surgeons and of the American Professional Wound Care Association and a member of American College of Osteopathic Surgeons, the American Osteopathic Association, the Society of American Gastroenterologic Surgeons and the Society of Laparoscopic Surgeons. He earned his Doctor of Osteopathic Medicine degree from the University of Medicine and Dentistry of New Jersey and his master of business administration degree from the Isenberg School of Business at the University of Massachusetts-Amherst. Dr. Tucker also holds a Certificate in business leadership skills from Cornell University Graduate School of Management.
    Presentation Material (Acrobat)
3:15 pm Adjournment

Go to Agenda:
Preconference | Day 1




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