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OVERVIEW
RAC Certificate Program
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The burden of hospital audits by both government contractors and commercial health plans continues unabated, notwithstanding the "pause" in the RAC program. There is still confusion over interpretation and implementation of the "two midnight rule". States are ramping up their own Medicaid RAC contractors, and Medicare Advantage plans and now commercial insurers are adopting aggressive auditing tactics to compound the burden on hospitals. Hospitals' rightful appeals of this growing body of denials in turn has completely overwhelmed an understaffed collection of Administrative Law Judges, and hearings are taking two years when they are even able to be scheduled. Members of Congress have heard hospital complaints loud and clear and demanded reform and even MedPAC has now weighed in. Never has it been more important for hospitals to "get it right the first time" when it comes to proper documentation of medically necessary patient care and proper decisions regarding whether a patient meets the criteria for an inpatient admission or should be placed into Observation status or treated in an outpatient setting.
This is where the Third National Physician Advisor and UR Team Boot Camp comes in. Over the course of three days, in a highly interactive learning environment, the Boot Camp will teach participants:
- how to develop a Physician Advisor program whether internal, external or hybrid, and how the PA roles are evolving
- how to construct an effective partnership between the PA and UR functions to ensure proper patient status and documentation
- best practices on documentation, certification, rounding, and physician education strategies
- how to design and implement an integrated CDI program, with case studies from three successful hospitals
The focus will be on the four key steps in a successful process for "Getting it Right the First Time" -- (1) The First Point of Contact; (2) Concurrent and Daily Review; (3) Denial Prevention; and (4) Ongoing Education. We will touch on appeal strategies, but the focus of the Boot Camp is to prevent denials in the first place.
The Boot Camp will also include two in-depth preconferences on the first day, followed by the opening networking reception -- one on the evolving role of the Physician Advisor and one highlighting three successful programs of integrated CDI. Especially now, when it is so important to "get it right the first time," this is a must event for hospital staff, and highly discounted rates for hospital teams make it possible for all of the right people to attend.
WHO SHOULD ATTEND
The PA-UR Team Boot Camp is designed as a very practical, hands-on, highly interactive experience for hospital physician advisors, clinical leaders, coding and billing managers, and other key staff involved in the critical decisions about patient status and patient flow. No just sitting around listening to talking heads. We will use an Audience Response System to do some polling and ask some questions as we go along, give everyone a short fun quiz at the end of each day, arrange for hosted informal dinners with faculty and colleagues at the end of Day II, set up single issue breakfast table topics on the morning of Day III, and assign homework in the form of case studies about inpatient vs. observation status for discussion over lunch on Day II and presentation later. Plus there are faculty panels and audience Q&A throughout.
So who should attend? Here is a non-exclusive list:
- Chief Executive Officers (a good PA-UR program will save money from avoidable denials)
- Chief Financial Officers (a good PA-UR program will save money from avoidable denials, maybe lots of money)
- Chief Medical Officers (if you don't have a PA, learn how to recruit and train one, whether internal or external; if you do have one, learn how to make him/her more effective in partnership with your ER staff, your UR staff, your hospitalists, and your nursing staff)
- Corporate Compliance Officers (learn how to make the ROI case to the three people listed above)
- Hospital Corporate Counsel (learn what and when to challenge, and what works...and what doesn't)
- External Affairs/Government Affairs Manager (if you have one -- you should be meeting with your Member of Congress on this stuff)
- And of course all of the following:
- RAC liaisons
- staff nurses
- physician advisors
- utilization review committee members
- case managers
- emergency room clinicians
- medical coding and billing staff
- CDI staff
- ICD10 staff
- patient accounts managers
- other financial and auditing personnel
But don't just send one rep. We have reduced the group discount rate for hospitals and health systems in the first Early Bird period. Send your RAC liaison, your PA, and a nurse/case manager (or any combination or 3 or more) before May 8 for $595 each. Estimate the cost of registration, travel, and a hotel group rate of $169 against the cost of one denied inpatient claim. (See the word “ROI” above.) Join us on the River Walk in San Antonio. This might be your best hospital investment in 2015.
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