2022 Mastering Utilization Review and Patient Status: A NAHRI Virtual Event On Demand

On Demand | Virtual

Conference Day 1

March 8, 2022
12:00 p.m. - 12:45 p.m.
Practical Solutions for Inpatient-Only Compliance

Confusion about the inpatient-only (IPO) list is a long-standing problem. With the IPO list here to stay, it’s crucial that hospitals address misconceptions and process issues and understand the list’s effect on reimbursement. Expert speaker Kimberly A. Hoy, JD, will dispel persistent misunderstandings of IPO list compliance and provide practical answers to common questions. She’ll also compare inpatient and outpatient reimbursement and patient coinsurance for typical procedures removed from the IPO list.

12:55 p.m. - 1:40 p.m.
Emergency Hospital Admissions: Is Your UR Focus Askew?

Most hospitals are very familiar with prior authorization processes, including standard and expedited time frames. This session will discuss different rules that apply to emergency hospital admissions for Medicare Advantage and Managed Medicaid enrollees, and how these rules offer additional protections for enrollees and providers over the more familiar authorization process.

1:50 p.m. - 2:20 p.m.
How to Master Medicare Rules for Utilization Review With Powerful Training Solutions (demo)

Join HCPro for a look at our line of utilization review training solutions. We’ll explore how our clients leverage virtual and in-person intensive boot camps, the Medicare Watchdog service, and more through year-round training and education programs. Attendees will gather valuable information about available solutions, as well as qualify for session-only discounts!

2:20 p.m. - 2:40 p.m.
Networking Break
2:40 p.m. - 3:25 p.m.
Understanding Revenue Cycle on the Front End for Denials Prevention on the Back End

Utilization review (UR) is typically a retrospective process, but that often puts UR professionals at a disadvantage. By adding UR and patient status checks to the front-end revenue cycle, UR professionals can get ahead of the curve and ensure patients are correctly statused from the start. In this session, learn how to apply UR principles to front-end processes and use key performance indicators to monitor programs.

3:35 p.m. - 4:20 p.m.
Breaking Down Prior Authorization Requirements for OPPS Departments

As Medicare applies prior authorization to a growing list of procedures, utilization review professionals are increasingly called on to coordinate these processes and include prior authorizations in their reviews. Prior authorization processes can be complex to implement and may call for additional scrutiny to ensure medical necessity is met. In this session, attendees will learn the ins and outs of Medicare’s OPPS prior authorization rules and how to apply them.

4:30 p.m. - 5:00 p.m.
Live Q&A

Join today’s speakers for a live question and answer session.

— All times are Eastern Standard Time. Agenda subject to change —

Conference Day 2

March 9, 2022
12:00 p.m. - 12:45 p.m.
Managing Capacity and Reimbursement at the Access Point During and After COVID-19

Learn new strategies to ensure that utilization review and case management teams support and positively influence clinical and financial outcomes. This session will review key opportunities to collaborate with emergency department (ED) physicians to ensure appropriate admissions, status, and implementation of alternative plans for patients who can discharge safely from the ED.

12:55 p.m. - 1:40 p.m.
Medicare Advantage and The 2-Midnight Rule: Level the Field with Medicare Advantage Payers

Misconceptions abound about how the 2-midnight rule applies to Medicare Advantage (MA) cases. Poor communication, insufficient processes, and misunderstandings of the rule and MA payers leave organizations at serious risk of lost revenue and compliance gaps. Clear up the confusion and get expert tips on process improvements in this session.

1:40 p.m. - 2:10 p.m.
Networking Break
2:10 p.m – 2:55 p.m
Prioritizing Patient Status Reviews

Is your utilization review team properly balancing inpatient and observation reviews? Although many teams focus on reviewing inpatients to convert to outpatient status before discharge to enable condition code 44, they may not be putting enough resources into reviewing outpatients that can be admitted to inpatient status, which are typically costlier and more complex. In this session, learn how to more effectively prioritize reviews of outpatient and inpatient admissions and better ensure that patient status is compliant with Medicare’s rules.

3:05 p.m – 3:50 p.m
From Insight to Action! Mastering Utilization Review Data

Measuring utilization review (UR) activities and programs is a must, but selecting the right metrics to track isn’t simple; neither is interpreting and communicating results. Clear, meaningful data is the key to achieving accurate performance evaluation and identifying opportunities for improvement. In this session, learn about essential UR metrics, data strategies, tips for creating a UR dashboard, and demonstrating return on investment.

4:00 p.m. - 4:30 p.m.
Live Q&A

Join today’s speakers for a live question and answer session.

— All times are Eastern Standard Time. Agenda subject to change —
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