| Topic : Charge Integrity (6)|
The implementation of new patient accounting systems, the creation of centralized billing office or newly consolidated management of facilities all are catalysts for a chargemaster standardization project. The benefits of a single chargemaster are many, including increased compliance, lower cost maintenance and enhanced comparability for operational monitoring. But the standardization journey is not without hazard and requires proper oversight to achieve its objectives.
Hospitals are typically large facilities with numerous departments and various reporting structures. Diminished resources, physical distance, traditional lines in the sand and focused work mentalities can lead to situations where everyone individually is doing their best, but overall efficiencies and coordination of efforts are not being achieved. Frequently there is a lack of awareness related to what each is accomplishing or what resources each department is utilizing. This session will provide you with insight related to getting the most out of coding intelligence tools by sharing information and coordinating efforts with all members of the revenue cycle team.
Whether you know it or not, cash is leaking out of your organization due to the lack of coordination between your supply chain and revenue cycle areas. The financial impact of this fragmentation can be substantial, particularly when it involves costly medical devices. This session will focus on identifying successful tactics for building supply transparency and the bottom line impact that can result from making this a priority!
Learning to balance coding, compliance and regulatory integrity of a chargemaster is crucial to the success of the hospital and can prove to be a challenge. Annual, quarterly, and other updates from published from CMS and others payers are the vehicles that ensure there is always a timely topic. This session will focus on impending changes and proactive actions.
With an increasing number of states legislating open-chargemaster laws and more patients opting for high-deductible insurance plans, consumers will be “price shopping” for healthcare. Hospitals are under increasing pressure to defend their charges. In today's market it is not enough to just have defensible prices - it is essential for hospitals to understand and control the bottom line impact of any new pricing strategy.
Managing revenue is challenging for every provider but there are unique hurdles for rural or small hospitals. The requirement for employees to fill multi-faceted roles makes charge integrity a significant challenge. Solutions that work well for large health systems can overwhelm an already-stretched revenue management team. This session focuses on effective methods to achieve first-class charge capture, chargemaster management and pricing defensibility despite limited resources
| Topic : Clinical Resource Management (5)|
Because of their nature, controlled clinical trials are often not comparable to real world practice. Many times these trials are designed to show efficacy of new therapies and do not consider if the therapy is cost effective. Further, in a world where post marketing analysis of pharmaceuticals is increasingly important, rapid access to information is required. Claims-based Pharmacoeconomic analysis offers an alternative to controlled clinical trials. Claims-based data is data that is abstracted from a facility’s electronic financial or medical record software. Advantages to claims-based research are that the data is easily available, often housed within the facility and searchable by any practitioner. This presentation will review the methodology for utilizing medical claims-based data to perform outcomes-based research including its advantages and disadvantages. Illustrative examples of claims-based data research that supports fiscal and clinical improvements in medical practice will also be reviewed.
This presentation will focus on Antimicrobial Stewardship programs in the hospital setting. Citing examples from the Fremont-Rideout Health Group, the presentation will review multi-disciplinary involvement between pharmacists, physicians, infection control, microbiologists, information technology and will discuss the benefits of different clinical decision support tools (Stellara, Theradoc, Quantifi and MedMinded).
National Patient Safety Goal for 2009 requires facilities to monitor and report on rates of Healthcare Associated Infections (HAIs) within their facilities. Good, ethical and medical practices suggest that once recognized, steps should be taken to reduce their incidence. This session will allow a facility to discuss its procedures and successes in reducing this unwarranted result of medical care. Topics include: Quantifying the human and economic burden of Healthcare Associated Infections, a discussion of procedures necessary to reduce the incidence of these infections and a facility’s ongoing experience.
CMS and many state and commercial payors have notified providers that it will no longer reimburse patients for never events, effective October 1, 2008. A never event is determine to be those medical conditions considered to be caused by preventable care errors. Healthcare providers are now burdened with assessing the costs of these events and the procedures they need to implement to prevent them from occurring. Additionally, third party payors are planning to pay hospitals for improved performance. What exactly is improved performance and how might it affect my hospital? This session will review current state of Never Events and Pay for Performance and put these programs into perspective for the procurement departments.
The days of fee-for-service are over and are being replaced by a quality-based federal initiative known as “Value Based Purchasing” (VBP). It incorporates the numerous Pay for Performance (P4P) initiatives- a quality measurement system focused on patient safety and satisfaction- and rewards for adoption of Commission for Certification of Healthcare Information Technology (CCHIT) approved IT products hosting other approved products and services such as Electronic Health Records (EHRs). This presentation will discuss alignment strategies that reveal where healthcare providers are exposed and need to remediate, such as Never Events, fines for patient safety practices, penalties on clinical protocols and missing out on bonus compensations. It will also describe the best approach to confronting these challenges and will share key strategies for success.
| Topic : Finance, Supply Chain Management (1)|
As reimbursement and supply cost trends force hospitals to stretch their healthcare dollars, hospital executives are increasingly looking to the supply chain for solutions. Leading healthcare systems view the supply chain as a change agent and a strategic opportunity to accomplish organization-wide goals and objectives. As healthcare supply chains learn to optimize their transactional and strategic roles, the ability to gain access to and effectively use data becomes essential. This session will address elements of a strategic supply chain and how effectively using sound data and metrics is critical to success. The misinterpretations and inadequacy of current supply chain metrics will be addressed, and a new methodology will be presented.
| Topic : Managed Care (1)|
The presentation will focus on the practical aspects of managed care negotiation in the future, the use of revenue and cost data, and the arguments for – and against – a corporate “exit strategy”. It will compare present approaches to those that will be required in the future and offer specific strategies for survival, when all else seems to fail.
| Topic : Managing Physician Relationships (1)|
Hospital executives struggle daily with razor-thin operating margins. Clinical practice patterns, especially by physicians in key specialty areas such as orthopedic surgery, neurosurgery, cardiac services and high-volume medical admissions, make the difference between profitable or unprofitable service lines. Whether these physicians are partners or adversaries can depend on how well and how often hospital management keeps them “in the loop” on hospital financial matters. This session will prepare participants to conduct productive discussions with their physicians that will enhance physicians' understanding and appreciation of the challenges and how they can help.
| Topic : Materials Management (1)|
This session will provide a better understanding of building a corporate standard within a decentralized hospital structure. This will include helping large IDNs better understand the operational/interdepartmental challenges associated with standardization and the forces that are driving this movement. It will also help hospitals better understand the challenges associated with supplies and why materials management participation is crucial to the process. Finally, this course will provide different ways in which technology can be leveraged in this process by sharing a success story/lessons learned (in their own words) with a large IDN that has under gone this type of transformation.
| Topic : Medicare (1)|
Over the past 44 years, the Medicare system has evolved from a simple per diem and percent of charges payment system to one of the most complex, convoluted and confounding payment systems in the country. With six inpatient programs and numerous outpatient systems, CMS has created a payment system so complex that achieving even a basic understanding of it all can consume an extraordinary amount of time. Someone new to healthcare finance, or to government reimbursement, often finds that merely being conversant with all these systems can consume the bulk of the first year or two on the job.
| Topic : Revenue Cycle, Audit, Coding (1)|
This session will provide attendees with ideas for identifying potential coding and billing problems and areas of compliance risk using MedAssets RevenueDashboard®. Learn how to focus your internal audit efforts to target the areas of greatest risk for your facility. Additionally, learn ways to effectively implement positive changes based on the findings and discuss best practices utilized by other facilities.
| Topic : Revenue Integrity (21)|
This session will provide an overall view of the ABN and its importance to facilities/offices.
The Tax Relief and Healthcare Act of 2006 made the RAC program permanent and authorized CMS (Centers for Medicare and Medicaid) to expand the program to all 50 states by 2010. RACs use automated software programs to identify potential payment errors, in areas such as duplicate payments, fiscal intermediaries’ mistakes, medical necessity and coding errors. RACs also conduct medical record reviews called complex reviews. With reimbursement going down and compliance issues taking the forefront, providers need intelligent solutions to identify and flag potential issues before they are identified by outside vendors. In addition to addressing the current state of RACs, we will examine the rest of the Medicare Claim Review Programs and their roles in the lifecycle of CMS claims processing.
With the increasing pressures affecting the financial forecast of healthcare organizations, providers are determined to tighten processes and procedures earlier in the revenue cycle to secure payment, reduce denials and bad debts, as well as decrease days in accounts receivable.
Attendees will learn how these health systems analyzed the issues, identified the opportunities and created a vision to operate in a “production environment” to obtain financial securitization and decrease, if not eliminate, errors on the back end. Attendees will also learn how to assess their current patient access workflow and identify areas for success.
To effectively implement a denials prevention program, identify the right payment sources, avoid bad debt and secure finances, these three organizations have creatively designed a visionary financial clearance/securitization program. By attending this session, you’ll gain industry insight and strategic recommendations to affect your financial clearance process while improving customer service.
This session will teach attendees how to establish systems and processes that provide pricing transparency and how to increase point of service collections and patient satisfaction at the same time; To teach how to establish a verification process that reduces denials, accelerates payments and establishes patients’ financial responsibility and payment upfront.
This session will focus on taking a proactive approach to Accounts Receivable management. Through improved billing processes, and automation of payer rejects, claims status, remittances and denials, hospitals can be more effective in staffing and managing their A/R. Improved workflow and reporting increases manager's ability to ensure the A/R is being addressed effectively.
Riding the Management Route 66 Highway can be done on two wheels (accurate billing and compliance), three wheels (accurate billing, compliance and quality), four wheels (accurate billing, compliance, quality and costing) or more (accurate billing, compliance, quality, costing, price transparency, audit defense, package pricing, joint ventures, diversification, strategic pricing, etc.)
Today, some hospitals still survive on two wheels, while many have moved to three, four or more.
Current initiatives by managed care, CMS, Congress and other parties with a vested interest will push all providers to four wheels if they are to survive, but “survival” is the best they can hope to achieve.
To really succeed and be a dominate force in their respective market, providers must move to more than four “wheels.” The “long haul” requires “long-haul trucking,” but transitioning to six, 10 or even 18 wheels will be impossible for some and difficult for all.
This program will discuss many of the initiatives which healthcare financial managers must grapple if they are to continue to succeed. This presentation will also offer tools and tips for filling the “potholes” along the way, perhaps even the means to resurface the road.
Pricing transparency is a complex terrain with many perspectives. Healthcare providers are struggling to comply with legislative requirements, meet the needs of the consumer and provide information that is sensible. Consumers are striving to understand what is important to them. They want to know what their out-of-pocket expenses will be and where they can get their questions answered. Since consumers are now beginning to demand answers in order to make educated informed decisions about healthcare tests, treatments and procedures, selection of physicians, hospitals and other providers, payors are also trying to accommodate their members and providers in supplying useful information regarding pricing and quality. During this session we’ll examine these three perspectives and learn how providers and payors can work together to meet the demands of the consumer.
Prepare your organization for an effective denial management program. Understand the importance of proper denial identification, appeal workflow and operational reporting. Implement appropriate procedures and tools to facilitate departmental accountability, improve denial recovery, and prevent future denials.
There is more to managing managed care contracts than just negotiation. Full revenue recovery demands continuous monitoring and modeling to ensure that the contract is yielding anticipated results. Underpayment identification and recovery continue to be a capstone for an effective, comprehensive accounts receivable function.
Economic pressures, rising healthcare costs, consumerism and an increase in self-pay patients, are increasing pressure to disclose cost prior to services being rendered. A patient estimation solution is critical to your ability to respond to customers’ needs as well as prepare them for their out-of-pocket expenses and to increase your ability to collect earlier in the revenue cycle.
This session will address standards related to determining the true cost of services, identifying insurance liability, obtaining valid eligibility and benefit information from the payor, presenting an accurate estimate of patient liability and collecting patient responsibility amounts.
In an age of shrinking margins, rising costs and increasing regulatory scrutiny, providers are finding that reducing write-offs while improving compliance is more important than ever. As gatekeepers to the system, patient access personnel are on the frontlines of the battle for financial stability. Attendees will learn to identify the doorways in their own organization and determine how and when to secure them, decreasing denials, increasing ABNs and ensuring compliance. The presentation will also give providers tools to help intake staff overcome logistical and emotional barriers to medical necessity verification.
It is estimated that most organizations can recoup 3 to 5 percent of annual revenues through effective denial management. This session explains the importance of a “Physician Advisor” within a healthcare organization, especially as it relates to reducing length of stay, managing resource utilization, and overturning denials through concurrent appeals. The faculty will share best practice strategies for denial prevention, including recommended case management processes, utilization of workflow technology plus related managed care contracting tips.
Economic pressures, rising healthcare costs, consumerism and an increase in self-pay patients, are increasing pressure to disclose costs prior to services being rendered. A patient estimation solution is critical to enable you to respond to customers’ needs as well as prepare them for their out-of-pocket expenses and to increase your ability to collect earlier in the revenue cycle. State specific legislation is driving many payors to react and develop systems and processes to provide patient estimates which incorporate benefits.
Consumers are striving to understand what is important to them. They want to know what their out-of-pocket expenses will be and where they can get their questions answered. Since consumers are now beginning to demand answers in order to make educated informed decisions about healthcare tests, treatments and procedures, selection of physicians, hospitals and other providers, payors are also trying to accommodate their members and providers in supplying useful information regarding pricing and quality. During this session we’ll examine these three perspectives and learn how providers and payors can work together to meet the demands of the consumer.
The revenue cycle – from the moment of scheduling to collection of that last owed penny from the payer – is an elaborate system with multiple points of failure. Success cannot just depend on software and people to perform perfectly. This presentation will define the process stages of the revenue cycle and problematic process junctions as a means to establish fail-safe backups. Implementing best practice methods for revenue integrity can seal every leaking pipe in the revenue flow.
This session will address standards related to determining the true cost of services, identifying insurance liability, obtaining valid eligibility and benefit information from the payor. It will also address presenting an accurate estimate of patient liability and collecting from alternative sources including Healthcare Savings Accounts.
This program will describe strategies and methods for education and interaction with physicians in order to improve compliance. The presentation will discuss topics such as physician education, methods to improve documentation and utilization using a WIIFM (What’s In It For Me?) strategy and the need for collaboration among key revenue cycle areas.
Whether you know it or not, cash is leaking out of your organization due to the lack of coordination between your supply chain and revenue cycle areas. The financial impact of this fragmentation can be substantial, particularly when it involves costly medical devices. This session will focus on identifying successful tactics for building supply transparency and the bottom line impact that can result from making this a priority
With the demand for greater pricing transparency, emphasis on pre-care bill estimates and collection, there is an accelerating demand for defensible and cost-based pricing. As health systems undertake projects to implement cost-based pricing, they are finding the process more complex and lengthy than originally anticipated. Working through one provider's case study, this session will highlight how to overcome the quality of currently available data to achieve net revenue positive cost-based pricing.
Learn how the rise of consumer-driven health plans and high patient deductibles impacts your front-end revenue cycle collection control points. Understand a proven methodology with executive-level concepts for breaking through perceived "barriers" to increasing POS collections. The session will include real world examples and strategies for combating revenue cycle leakage and maximizing realized revenue.
This presentation will provide a clear understanding of Coordination of Benefits (COB) rules in contracts and state statues as they apply to liability owed by secondary and tertiary payors. Attendees will learn how to get paid from non-primary payors for additional liabilities for both contracted and non-contracted payors and will gain insight on how to use measures or scorecards to track progress.
| Topic : Supply Chain (1)|
This session addresses increasing costs and decreasing operating margins faced by hospital executive across the country. Discover how one hospital executive decreased costs without eliminating staff or sacrificing quality of care. Determining where to focus within your supply chain can be a daunting task. This session will focus on key opportunities in clinical supply cost management, value analysis, contracting, e-sourcing, and distribution.
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| Topic : Supply Chain Management (1)|
As the complexity of the hospital supply chain has increased, more sophisticated methodologies and metrics are needed to successfully manage. As profit margins decrease and medical device costs spiral, healthcare professionals require better tools to analyze and monitor supply expense. This session will address the misinterpretations and inadequacy of current supply chain metrics and will propose a new metric to analyze, compare, and in large part, predict annual hospital supply expenses.
| Topic : Supply Chain/Service Line Metrics (1)|
Hospitals today struggle with how to gather accurate and reliable data with which to gauge service line performance, specifically in the area of cost containment. In addition, hospitals find it difficult to turn data into actionable intelligence stemming from a combination of problems including the lack of credible metric information and experience in evaluating data. Once hospitals understand the metrics that should be used to gauge service line performance they can use those metrics to quantify opportunities and can begin to engage physicians in conversations for change. Hospital executives attending this session will be able to take back to their facilities distinct recommended service line metrics, understand how to evaluate credible metric information and apply a variety of successful approaches to engage physicians.
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| Topic : Supply Management (2)|
As the complexity of the hospital supply chain has increased, more sophisticated methodologies and metrics are needed to successfully manage. As profit margins decrease and medical device costs spiral, healthcare professionals require better tools to analyze and monitor supply expense. This session will address the misinterpretations and inadequacy of current supply chain metrics and will propose a new metric to analyze, compare and, in large part, predict annual hospital supply expenses.
It is a well-known fact that if you buy anything in volume or you commit a percentage of your purchases to a vendor, pricing of a product typically goes down. This methodology works well for most industries but not for the hospital setting. The materials manager must not only satisfy the administrative leadership team by controlling costs but also an eclectic group of physicians who typically gravitate to the latest and greatest trend or technology.
| Topic : Technology Solutions (2)|
Healthcare institutions are facing monumental pressures to lower supply costs. Although pricing is important, the tracking and analytical support from the requisition to final reimbursement can hold the key to saving millions in the supply chain. This presentation will show how two hospitals have used key performance indicators, supply chain analytics along with revenue linking technology to reduce their supply expense.
Hospitals today find it difficult to quantify supply expenses, explain variances from one time period to another and prioritize savings that are credible and actionable. As a result supply costs are often ignored until the aggregate spend is in crisis. Most often while a hospital is in “crisis mode” decisions are made to reduce costs without the intelligence needed to understand where, why and how. Using meaningful metrics is critical to improving hospital supply chain performance. Many hospitals struggle with the ability to effectively measure and impact supply costs. This presentation will outline a new approach and present a case study of how a leading health system tackled their supply cost management challenges and moved from crisis mode to regain control.
by 1.5% to 5%.
Support hospitals and healthcare facilities in planning for, preparing for and responding to emergency and disaster situations.