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



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Agenda: Preconference
Thursday, November 13, 2014

Preconference registration optional; required for RAC Certificate Program
7:00 am Registration Opens
Welcome Coffee

PRECONFERENCE: CREATING AN INTEGRATED CDI SYSTEM
8:00 am

Welcome and Overview

Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Co 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.
8:15 am

Exploring a Three-Legged Integrated CDI Program -- Patient Status, Coding & ICD 10, and Charge Capture

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)
9:00 am

Case Study 1: the Mercy Network Story -- A 14-Hospital Implementation One Year Later

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)
9:30 am Networking Break
10:00 am

Case Study 2: The Community Howard Regional Health Story -- A 150-bed Hospital's Journey to Making Integration Work

Kathy Shumpert, MSN, RN, CCDS
Clinical Documentation Improvement Specialist, Community Howard Regional Health, Kokomo, IN

    Speaker Bio

    Kathy Shumpert is a Clinical Documentation Improvement Specialist with Community Howard Regional Health in Kokomo, IN. Her 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. She speaks as often as she can in hopes of finding someone who is as passionate about CDI as she is. She is still looking for that individual.
    Presentation Material (Acrobat)
10:30 am

The ICD-9 to ICD-10 Shift: Strategies and Steps to Successful Transition

E.G. "Nick" Ulmer, Jr., MD CPC
Vice President, Clinical Services and Medical Director for Case Management, Spartanburg Regional Health System, Spartanburg, SC

    Speaker Bio

    Dr. Nick Ulmer has been a practicing family medicine physician since 1991. His medical school training was at MUSC in Charleston, SC and Residency was at Self Regional Healthcare's Family Medicine Residency in Greenwood, SC. He became a certified professional coder (CPC) in 2002, making him one of only 16 physicians in America at that time with such credentials. He joined Spartanburg Regional in 2010 and became the Vice President for Clinical Services and Medical Director of Case Management in 2012. He has developed and implemented an internal Physician Advisor Team, spearheaded the clinical redesign of the primary care network through a 23 site PCMH project, helped initiate a non-oncology research arm of the Regional Physician Group, and is currently navigating an enhanced focus with Regional's Corporate Health Division. He holds academic appointments as an Assistant Professor of Family Medicine at both Self Regional and at Wake Forest University's Family Medicine program in Winston-Salem, NC. His clinical practice is at Village Family Medicine in Simpsonville, SC.
    Presentation Material (Acrobat)
11:15 am Faculty Panel and Audience Q&A

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.
12:00 pm Adjournment and Lunch on Your Own

Agenda: Day I
Thursday, November 13, 2014

DAY I OPENING PLENARY SESSION -- THE CURRENT LANDSCAPE
1:00 pm Welcome and Overview
Larry Hegland, MD, MMM
System Medical Director for Recovery Audit and Appeal Services, Chief Medical Officer, Ministry Saint Clare's Hospital, Weston, WI (Co Chair)

    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.
1:15 pm AHA Update on Policy Issues and RACTrac Data
Melissa Jackson, JD
Senior Associate Director for Policy, American Hospital Association, Washington, DC

    Speaker Bio

    Melissa James Jackson is senior associate director for policy at the American Hospital Association (AHA), managing AHA's policy initiatives on program integrity and physician issues. She came to AHA from private health care legal practice. She previously worked at the national Children's Hospital Association, where she focused on policy issues related to implementation of the Affordable Care Act, Medicaid financing and provider reimbursement, hospital tax-exempt status, and children's health care coverage. In addition, she worked on Medicaid eligibility and provider reimbursement policy at Ohio's Medicaid agency. Melissa holds a J.D. from the Georgetown University Law Center and a Master of Public Administration and Bachelor of Arts in political science from The Ohio State University.
    Presentation Material (Acrobat)
2:00 pm

State of the RAC Union

Arika L. Pierce, JD
Vice President, Federal and State Government Relations, HMS Holdings Corp., Washington, DC

    Speaker Bio

    As Vice President of Government Relations, Arika Pierce is responsible for overseeing HMS' Federal and State Government Relations program. This program serves as a vehicle for supporting legislation and policies that promote healthcare program integrity and efficient government healthcare spending. In addition, Ms. Pierce works closely with CMS, Federal and State legislators, and other health policy stakeholders to develop and promote policy and legislation that furthers the reach and effectiveness of public healthcare programs. Prior to joining HMS, Ms. Pierce worked in the Federal Affairs Department of the American Academy of Pediatrics where she advocated on child health issues before members of Congress and Federal agencies. She also worked on Capitol Hill for Senator John Breaux and the Senate Special Committee on Aging. Ms. Pierce holds a JD from the George Washington University Law School and an undergraduate degree from Louisiana State University.
    Presentation Material (Acrobat)
2:30 pm

The View from the MAC

Debra Patterson, MD
Vice President of Clinical Affairs and Executive Medicare Medical Director, Novitas, Mechanicsburg, PA

    Speaker Bio

    Dr. Debra Patterson is Vice President, Clinical Affairs and Executive Medical Director for Novitas Solutions, Inc., the Medicare Administrative Contractor for Part A & B services in Jurisdiction L (Pennsylvania, Maryland, DC, New Jersey, and Delaware) and Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas). She is responsible for oversight of Novitas Medical Directors, Policy, and Education departments. She joined Novitas in 2012, following employment by TrailBlazer Health Enterprises and its predecessor, Blue Cross and Blue Shield of Texas. From 1997 until 2012, she served as Contractor Medical Director for the Jurisdiction 4 (Texas, Colorado, New Mexico, and Colorado) Medicare Administrative Contract and the TrailBlazer legacy contract prior to its transition to the J4 MAC.

    She graduated from the Texas Tech University School of Medicine and completed a residency in Internal Medicine at the Methodist Health System in Dallas, where she remained as an active attending physician. She is a Diplomate of the American Board of Internal Medicine, earned a graduate certificate in Healthcare Management, and is a Fellow of the American College of Physicians and a member of Alpha Omega Alpha.
    Presentation Material (Acrobat)
K. Cheyenne Santiago, RN
Senior Nurse Analyst, WPS Medicare-Provider Outreach & Education, Omaha, NE

    Speaker Bio

    Cheyenne Santiago is a Senior Nurse Analyst in the Provider Outreach and Education (POE) department of WPS Medicare. She is responsible for clinical education for the Part A provider community including training on Medicare rules, regulations and clinical coverage criteria, as well as current health care practice trends. 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)
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.
3:15 pm Networking Break
3:45 pm

The 2MN Rule and QIC Review

Janice H. Eidem, JD, PMP
Senior Vice President and CMS-QIC Lead, MAXIMUS Federal Services, Inc., Pittsford, NY

    Speaker Bio

    Janice Eidem is Senior Vice President and CMS-QIC Lead for MAXIMUS Federal Services, Inc., based in Pittsford NY. Supporting CMS for more than 16 years, she has extensive knowledge of all aspects of the Medicare appeals programs. As Senior Vice President at MAXMUS, Ms. Eidem provides oversight of all MAXIMUS Federal Services and Q2Adminstrators QIC projects. She has successfully driven innovative processes and technological solutions to permit cost effective, high quality appeal processing. Ms. Eidem draws on her experience as a Part C Project Director where she spent than 14 years serving the Medicare managed care community. She holds an undergraduate degree in Economics from Brandeis University and a Juris Doctorate from the Dickinson School of Law at Pennsylvania State University.
    Presentation Material (Acrobat)
4:15 pm

Report from the Field -- A Hospital Association Panel

Current Region A
Stewart Presser
Vice President, Greater NY Hospital Association, New York, NY

    Speaker Bio

    Stewart Presser is Vice President for Patient Financial Resources with the Greater New York Hospital Association (GNYHA), a trade association representing more than 250 not-for-profit hospitals and continuing care facilities, both voluntary and public, in the metropolitan area and throughout the State, as well as in New Jersey, Connecticut, and Rhode Island. He is responsible for advocacy in the areas of health finance, accounts receivable management, Medicaid eligibility issues, HIPAA, and RAC. He is a member of both the National and New York State Uniform Billing Committee and has served on various CMS workgroups. Prior to joining GNYHA, Mr. Presser was Director of Patient Accounts at both Presbyterian Hospital and Beth Israel Medical Center in New York City. He is an Adjunct Professor at New York University Wagner School of Public Service where he teaches Health Finance. He is also an NYU graduate with a BS in accounting.
Current Region B
Joe Schindler
Vice President of Finance, Minnesota Hospital Association, St. Paul, MN

    Speaker Bio

    Joe Schindler is Vice President of Finance for the Minnesota Hospital Association and has over two decades of experience in health care finance policy. He advocates for fair and equitable hospital reimbursement policies, provides leadership for hospital industry financial standards, and analyzes the financial impact of state and federal mandates and regulations. He is a board member of the Minnesota chapter of HFMA, provides support for the Minnesota Account Managers Association (MAMA) to keep track of billing and collections issues, and provides hospital representation on the state?s Administrative Uniformity Committee (AUC) to develop standardized electronic eligibility, claims and reminttance transactions between payers and providers. He has a BA degree in Business Administration from the University of St. Thomas.
Current Region C
Keri Conley
Associate General Counsel, Georgia Hospital Association, Marrietta, GA

    Speaker Bio

    Keri Conley is Associate General Counsel for the Georgia Hospital Association (GHA). She advocates on behalf of hospital members at all levels and branches of state and federal government, conducts regular meetings of hospital compliance officers and in-house legal counsel, and acts as a resource and liaison for hospital members on state regulatory matters as well as Medicare and Medicaid compliance issues. She is a member of the State Bar of Georgia, the Georgia Academy of Healthcare Attorneys (GAHA) and the American Health Lawyers Association (AHLA). Ms. Conley has a B.S. degree from the University of Florida and a Master in Physical Therapy with Honors from the University of St. Augustine in 2000. She was a practicing physical therapist before returning to the University of Georgia, School of Law where she received her law degree with Honors in 2005.
Current Region D
Alyssa Keefe
Vice President, Federal Regulatory Affairs, California Hospital Association, Washington, DC

    Speaker Bio

    Alyssa Keefe is Vice President, Federal Regulatory Affairs for the California Hospital Association, responsible for policy development and analysis of federal regulation impacting California hospitals and health systems, and serves as a liaison between CHA and federal agencies, including the Centers for Medicare & Medicaid Services. Prior to joining CHA, Alyssa was managing director of the Hospital Quality Alliance, a national public/private collaboration committed to making meaningful, relevant and easily understood information about hospital performance accessible to the public, and to informing and encouraging efforts to improve quality. She also has served as senior associate director for policy at the American Hospital Association, and held senior policy positions at the Catholic Health Association of the United States and the National Coalition on Health Care. Alyssa holds a bachelor's degree in speech communications and public policy from Syracuse University and a master's of public policy from Georgetown University.
Melissa Jackson, JD
Senior Associate Director for Policy, American Hospital Association, Washington, DC

    Speaker Bio

    Melissa James Jackson is senior associate director for policy at the American Hospital Association (AHA), managing AHA's policy initiatives on program integrity and physician issues. She came to AHA from private health care legal practice. She previously worked at the national Children's Hospital Association, where she focused on policy issues related to implementation of the Affordable Care Act, Medicaid financing and provider reimbursement, hospital tax-exempt status, and children's health care coverage. In addition, she worked on Medicaid eligibility and provider reimbursement policy at Ohio's Medicaid agency. Melissa holds a J.D. from the Georgetown University Law Center and a Master of Public Administration and Bachelor of Arts in political science from The Ohio State University.
5:15 pm Adjourn and Networking Reception in the Exhibit Hall

Go to Agenda:
Day 1 | Day 2




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