Baltimore Convention Center, Baltimore, MD 2016 Annual Clinical Coding Meeting, Day One, October 15, Implementation

Transcription

1 2016, Day One, October 15, :30 8:30 a.m. Registration and Coffee Service 8:30 10:00 a.m. ICD-10 Policy Update 10:00-10:30 a.m. BREAK By participating in this session, attendees will learn about the key updates to the Official ICD-10- CM and ICD-10-PCS Guidelines for Coding and Reporting. The speakers will share an overview of the FY 2017 ICD-10-CM and ICD-10-PCS code changes will be presented. Attendees will understand highlights from the FY2017 Inpatient Prospective Payment System changes. Sue Bowman, RHIA, CCS, FAHIMA, MJ, American Health Information Management Association (AHIMA), Chicago, IL and Nelly Leon-Chisen, RHIA, American Hospital Association, Chicago, IL 10:30-11:30 a.m. CPT Policy Update Forthcoming 11:30 a.m. - 12:30 p.m. Lianne Stancik, American Medical Association, Chicago, IL LUNCH Physician Practice ICD-10 Post- Implementation Reimbursement/payment methodologies 12:30-1:30 p.m. Compliant Chronic Care Management Coding/Billing The Centers for Medicare & Medicaid Services (CMS) recognizes care management as one of the critical components of Primary Care that contributes to better health and care for individuals, as well as reduced spending. Medicare made possible a monthly reimbursement to coordinate care for Medicare First Year Post go Live What ICD-10 Data Reveals Organizations were warned to expect decreases in productivity due to the ICD-10 transition. But now that ICD- 10 is in effect, what do the real numbers say? What are the most effective organizations doing to code successfully in ICD-10? After more than nine months of post-compliance data gathering, this presentation will compare pre-icd-10 Advancing CMS Pay-For- Performance: The HIM Connection Attendees of this program will receive practical information that will enable them to immediately possess a fundamental understanding of the CMS quality programs directly tied to revenue. The programs are Value-Based Purchasing, Hospital- Acquired Condition Reduction, and Readmission Reduction. The content will include details on each of these programs; program Page 1 Agenda as of: 10/3/2016 4:19:00 PM

2 beneficiaries who have multiple chronic conditions starting in This change expands Medicare payment policy to include non-face to face management services that were not previously reimbursed. The reimbursement policy is called Chronic Care Management (CCM). Attend this session to learn more about how to set up the necessary policies and procedures to correctly bill for these services. Kathleen Bailey, CPA, MBA, CCS-P, CPMA, CPC- I, Practice Management Solutions, Tampa, FL 1:30-2:30 p.m. A Strategic Approach to HCCs and Risk Adjustment Risk Adjustment, related specifically to the provider s documentation and coding, is now a required component for Medicare Advantage programs. This presentation will review the complexities of the risk adjustment program and the role of hierarchical condition categories (HCCs) in this process. Discussion will include the process for provider education, auditing and the expectations with experiences of dual coding organizations as well as a larger cohort of health systems. Attendees will also be given data with which to compare their own post-icd- 10 experience. Brian Potter, PhD, Optum360, San Diego, CA and Anwen Fredricksen, MA, NLP Innovation, Optum360, San Diego, CA MS-DRG Year in Review What are the MS-DRG changes that are coming October 1, 2016? Have you had struggles over the past year? Learn what next steps your facility should take to ensure proper reimbursement for FY2017. Learn how with the implementation of ICD-10 your hospital was affected by MS-DRG assignment and the consequences of coding errors that may have resulted in the assignment of extensive and non-extensive O.R. procedures. Wendy Deaton, RHIT, CCS, associated penalties or bonuses; measure numerator exclusions; denominator exclusions; risk adjustment factors; how to trend and benchmark data; how to conduct chart reviews against the technical specifications for each measure; and common HIM process issues identified in measures. Attendees will acquire the knowledge necessary to apply their knowledge in educating executive staff, peers, and hospital staff. Elaine King, MHS, RHIA, CHP, CHDA, CDIP, FAHIMA, Nuance Communications, Franklin, NC and Catherine Gorman- Klug, RN, MSN, CPM, Nuance Communications, Inc., Wall Township, NJ Denials Management: Moving from Denials Management to Denials PREVENTION (8643) As audit and denial activity are on the rise, it feels like there is an all-out assault to many providers' bottom line. Stop reacting to denials and turn data into meaningful information. Begin exploring your options to prevent denials from happening in the first place. Attendees will learn how to move from a reactive approach to denials (denials management) to a more proactive model (denials prevention). Review what a

3 2:30-3:00 p.m. BREAK role of outpatient CDI. Finally, case examples will be reviewed for both documentation improvement opportunities as well as specificity of code assignment. Kathryn DeVault, MSL, RHIA, CCS, CCS-P, FAHIMA and Melissa Hawkins, CCS, CPC, CRC, HIM, UASA, Cincinnati, OH 3:00-4:00 p.m. Key to Physician coding & Billing - Using the MCR Phys Fee Schedule Database Do you have trouble understanding and using the Medicare Physician Fee Schedule Database? Attend this session and learn: where to find the Medicare Physician Fee schedule Database; identify which payers the information applies to; review each column to understand what the information means and its application; determine when a modifier is appropriate for each code and use the relative value units (RVU) to determine physician fee schedule. Kim Garner Huey, MJ, CCS-P, AHIMA Approved ICD-10-CM/PCS Trainer, Consulting, SourceHOV LexiCode, Irmo, SC ICD-10 the first year Attendees will learn the top 15 coding errors for both ICD-10- CM and ICD-10-PCS based on data from a mixture of all hospital patient types from over 100 hospitals gathered over the first year of ICD-10 implementation. There will be a focus on commonly missed guidelines and official coding guidance as well as the realized financial impact on MS-DRGs. Kelly Canter, RHIT, CCS, AHIMA Approved ICD-10- CM/PCS Trainer, Optum360, Roscommon, MI typical denial management program may look like in today's environment and then explore options for building a denial prevention program. Identify the barriers to communication, staffing issues, possible system limitations and explore a three phase approach to developing a proactive denial prevention program with continued process improvement and necessary leadership support that works! Tracey Tomak, RHIA, Revenue Cycle Operations, St. Vincent Health - Indianapolis, IN HCC's HCC s and risk adjustment models are changing the way healthcare payments are being viewed and processed. Attendees will review the history and terminology of HCC s; specific coding errors and omission codes and what data elements are required in the clinical documentation. Examples of coding and documentation strategies will be discussed as well as a review of the CMS HCC model and guidelines which will include revisions to the methodology and the concept of risk adjustment as a healthcare tool; how these models can affect payment and reimbursement and how

4 CCS-P, CHC, CPC, PCS, CPCO, KGG Coding & Reimbursement Consulting, Alabaster, AL and Sandra Giangreco, RHIT, CCS, PCS, CPC, CPC-H, CPC-I, COBGC, PriceWaterhouseCoopers (PWC), Loveland, CO 4:00-5:00 p.m. Bridging the Gap between Administrative and Clinical Data Session participants will gain a better: Understanding of the value of terminology standards and the current usage of various code sets in a clinical setting. Appreciation for the uses of aggregated data in clinical and administrative settings. Understanding of how a standardized ontology will bring efficiencies to data analytics. Attendees will also learn about how CPT can link to other code sets and define relationships between diagnostic, interventional and laboratory data. Matt Menning, American Medical Association, Chicago, IL and Lisa Brooks Taylor, RHIA, Independent Consultant ICD-10 - Lessons Learned: Implementing & Maintaining an ICD-10 "hotline" postimplementation We all recognize the teaching of a new classification system is much different from operationalizing the new coding system. This session will help attendees to understand the resources required to implement and manage a coding hotline as well as the common questions from coders in the field postimplementation. Ongoing development of educational programs in the next year will be critical for coding professionals to be comfortable with and operationalize the day to day coding functions. Reliance on an Encoder has its pitfalls and this will also be discussed. Melissa McLeod, CCDS, CDIP, CCS, CPC, CPC-I, AHIMA Approved ICD-10- CM/PCS Trainer and Kathleen Wall, MS. RHIA, AHIMA Approved ICD-10- these risk adjustment models aim to increase quality of care. Brenda Watson, RHIA, CCS, CCS-P, CPC, AHIMA Approved ICD-10 trainer, Clinical Economics, BRG, Eldersburg, MD Promoting Mid-Revenue Cycle Efficiency Attendees will learn to distinguish the role of coding, CDI and DRG validation/auditing based on CMS and industry guidance. There will be discussion of how a mid-revenue cycle integrated CAC platform can promote efficiency and collaboration and why current key performance indicators i.e., query response rates, query agreement rates, reconciliation rates, etc., that are departmental specific may be insufficient to support continuous improvement. Cheryl Ericson, RN, MS, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, ezdi, Louisville, KY

5 CM/PCS Trainer, QA Compliance, Himagine Solutions, Inc., Tampa, FL DAY 1 CEUs: , Day Two, October 16, 2016 Time Physician Practice CDI Industry Hot Topics Compliance with Rules for 8:30-9:30 a.m. NPP (Mid-Level Provider) Services This presentation will provide details on how to correctly code and bill for NPP providers and address compliance issues that must be considered. Attendees will also enhance their knowledge about information regarding the many items that must be considered to comply with state and federal services, including Scope of Service considerations. This program will outline the following topics: Medicare approved Non- Physician Practitioners (NPPs) Billing methods & supervision issues Billing for incident to Clinical Documentation Improvement: An Imperative for Managing your Revenue at Risk The audience will gain practical knowledge in the healthcare reimbursement and quality initiatives that are influencing how CFO's prepare budgets for their organizations. Audience members will become conversant in how their organization can prepare for assuming more risk in their third party contracts. This presentation will discuss new metrics for a contemporary CDI program, and ways to be able to compare and contrast an MS-DRG focused CDI program to a Pay-for-Value and outcome focused CDI Program. It will also discuss practical approaches to identify gaps in a CDI program Understanding the Relationship between Coded Data & CMS Quality Programs CMS has been changing reimbursement methodologies to reward the quality of care over the quality of services. This session will explore how coding and CDI staff should revise their efforts to support the changing CMS reimbursement models to support industry best practice. Attendees will understand how outcome measures are impacted by coded data to ensure organizational alignment. Failure to change coding and CDI practices can have detrimental effects as many CMS quality measures are comparative so those who maintain the status quo will be surpassed by those that embrace the changing environment.

6 Time Physician Practice CDI Industry Hot Topics services Michelle Wieczorek, RHIT, Compliant claims for RN, CPHQ, DHG Healthcare, Cheryl Ericson RN, MS, direct billing Waterford, PA CCDS, CDIP, AHIMA Scope of Practice - What Approved ICD-10-CM/PCS is it? How does it impact Trainer, ezdi, Louisville, KY employment of a NPP as well as coding and billing? Kathleen Bailey, CPA, MBA, CCS-P, CPC, CPMA, CPC-I, Practice Management Solutions, Tampa, FL 9:30-10:30 a.m. Developing & Implementing an Audit Program for Physician Services Why is an audit plan necessary? In this presentation, attendees will be able to identify the essential elements of a formal audit program and plan. The speakers will discuss how a formal audit program can identify and mitigate potential risks as well as educate the physicians to keep them at a low risk. Kim Garner-Huey MJ, CCS- P, CHC, CPC, PCS, CPCO KGG Coding & Reimbursement Consulting, Alabaster, AL and Sandra Giangreco RHIT, CCS, PCS, CPC, CPC-H, CPC-I, COBGC, Pricewaterhouse Coopers, Loveland, CO Conquering Queries If you are a coder or CDI Specialist, you will query. Understanding how and when to query, as well as effective formatting and wording of queries is critical. This session will serve as a refresher on queries, as well as providing tips for compliant and effective queries. Attendees will understand the basics of Why, When, Who, and How to query effectively. Connie Calvert, RHIA, CCS, CCDS, RMC, Inc., Hampton, SC FY2016 CC/MCC List: Tools for Capturing Accurate Clinical Documentation The program will provide succinct clinical indicators which define the FY2016 CC/MCC list allowing for appropriate physician query. Additionally, the guidelines for reporting additional diagnoses will be addressed along with a detailed discussion of some of the clinically complex conditions such as; types of malnutrition, acuity levels of DVT, obesity/hypoventilation syndrome, and AKI William Haik, MD, DRG Review, Inc., Fort Walton Beach, FL 10:30 11:00 a.m. BREAK 11:00 a.m.- In a Nutshell: The world of E/M Coding Physician Documentation Issues Just Don't Go Away New ABCs of Coder Productivity & Accuracy -

7 Time Physician Practice CDI Industry Hot Topics 12:00p.m. Resulting your KPIs This E/M presentation will walk you through the E/M coding process from start to finish. Attendees will review E/M guidelines, communicating with providers, current hot topics and more. Attendees will walk away with useable tools and new ideas to freshen up their daily E/M coding experience. 12:00-1:00 p.m. Crystal Clack, MS, RHIA, CCS, Director HIM Practice Excellence, Coding & Data Standards, AHIMA, Chicago, IL LUNCH Physician documentation, a most critical part of the medical record, has been a problem for many years and continues to be a major problem especially with the implementation of ICD-10 where documentation now requires much more specificity than with ICD-9. This presentation will review in detail the many areas of physician documentation that still remain a major problem and must be addressed for ICD-10 to be successful. This presentation will also discuss the all-important query issues especially when there is no response to the query and how this should be managed. Mark Michelman, MD, MBA, Consulting, MSM Health Care Consultants, Belleair, FL 1:00 2:15 p.m. Moving Coding to the Next Generation Part I & II Coding audits and coder assessments are a critical part of ICD-10 success. As more audits have been performed and training conducted in 2016, the HIM industry has redefined coder productivity and accuracy benchmarks. New KPIs have been established and new coding guidelines have been written. The objective of this session is to explore the new language of measuring coding productivity and accuracy in ICD-10. Paul Strafer RHIA, CCS, Coding Education, H.I.M. ON CALL, Allentown, PA and Joseph Gurrieri RHIA, CHP, HIM ON CALL, Allentown, PA The evolution of the health care industry has increased the need for coding professionals to review and examine quality metrics. It is also important for these professionals to understand what coding practices would be appropriate to explore and redefine to ensure that the quality scores that have been calculated are a true and accurate reflection of the care and services provided. This session will provide an overview of the FY 2018 Value Based Purchasing Program and what information is important for coders to understand for these measures. Suzanne Drake, RHIT, CCS, Coding Quality and RAC Coordinator and Christina Brown, RHIA, CCS, CCSP, CCDS, Coding Compliance and DRG Coordinator, Bon Secours Richmond Health System, Shared-Services Coding, Richmond, VA

8 2:15-3:15 p.m. Filling the Auditing Gap Transforming Coders to Auditors This session will allow attendees to understand both the soft and technical skills needed to become an auditor. To be a skilled auditor, it is important to have a strong coding background. This presentation will explain how to transform coders into auditors by showing lessons learned and other key points needed for coders and management teams. Renee Petron, Coding Quality Director, Health Information Management, Parallon Business Performance Group and Laurie McBrierty, MLT, ASCP, VP Product Management, Career Step 3:15-3:45 p.m. BREAK 3:45-5:00 p.m. Get PSST! Big Thinking for Even BIGGER Relationships The future brings not only new technology and procedures, but also an even greater ability to build better, stronger, and BIGGER relationships. Every organization is desperate to do more with less, especially in healthcare, an industry filled with change and uncertainty. The best informal and formal leaders know that an engaged culture translates into loyal customers a crucial piece in today s complex marketplace puzzle. If you can t reduce your workload or increase your staffing budget, you have to tap into your employees discretionary efforts. But how? Scott Carbonara will teach you how to Get PSST! That is, get Personal, Strengths-based, Social, and Targeted with each employee to maximize engagement and performance! Learn how to inspire your team to want to give their best, through the practical and often fun principles in Scott s book A Manager s Guide to Employee Engagement. Learn ways to tap into employees personal strengths Discover how to position people into their areas of strength for maximum performance Become equipped with tools for getting targeted with employeesre passions and interests Scott Carbonara, MA The Leadership Therapist, Spiritus Communications, Hillsborough, NC DAY 2 CEUs: 6 TOTAL CEUS for the MEETING : 12