2022 Revenue Integrity Symposium

Monday, September 19 – Tuesday, September 20, 2022 | Hilton Phoenix Resort at the Peak | Phoenix, Arizona

Agenda subject to change

Conference Day 1

September 19, 2022
7:00 a.m.–8:00 a.m.
Registration and Continental Breakfast in the Exhibit Hall
8:00 a.m.–9:00 a.m.
Living and Working With Passion and Purpose
9:10 a.m.–10:10 a.m.
CDM Guru: What Would You Do?

CDM operations are often fraught with difficult dilemmas that are not easily resolved. Join the CDM Gurus (John Settlemyer, Valerie Rinkle, John Settlemyer, Angela Simmons, and Denise Williams) for this roundtable session, where they’ll discuss your challenging, complex, or troublesome CDM charging and billing issues along with options for actionable resolution. The team has more than a century of combined hands-on, practical experience with chargemaster operations. Opportunities will be available for attendees to pre-submit or ask live questions.

The Yin and Yang of Denials and Appeals

Navigating denials and appeals effectively is not easy. Learn useful and practical information of what you need to know to better position an appeal for victory covering contract provision, regulations, laws and more. This session will also cover denial strategy and tactics that can help prevent reoccurring denials.

10:10 a.m.–10:40 a.m.
Networking and Refreshment Break in the Exhibit Hall
10:40 a.m.–11:40 a.m.
OIG Audits: What Are the Key Areas OIG Is Targeting?

Understanding the Office of Inspector General's (OIG) focus areas for its enforcement efforts will help you tailor education and internal auditing to ensure your organization does not become a post-payment statistic. Additionally, it will assist with structuring internal audit programs so you can find, correct, and (where necessary) disclose errors in advance of any OIG or Integrity Contractor inquiry. You will learn the new, updated, and ongoing target areas applicable to Medicare Part A and B that have been selected for elevated enforcement in 2022. New target areas will be specifically discussed, along with recommendations for assessing and reducing post-payment risk associated with these target areas.

Rules Round Robin: IPPS, OPPS, and MPFS

Learn all you need to know about the latest finalized IPPS changes for FY 2023 and the major proposed changes for OPPS and MPFS for CY 2023. Ensure your hospital is prepared from a reimbursement and compliance perspective!

11:40 a.m.–12:40 p.m.
Networking Lunch in the Exhibit Hall
12:40 p.m.–1:10 p.m.
Sponsored Session
1:20 p.m.–2:20 p.m.
NCCI Edits and Strategies for the Chargemaster

National Correct Coding Initiative (NCCI) edits matters to both inpatient and outpatient claims. Payers are increasingly adopting bundling policies that reflect NCCI edits, and the NCCI rules do not always line-up with Current Procedural Terminology (CPT®) coding guidance. This session will cover NCCI nuances that impact reimbursement but are often overlooked, as well as the interplay between NCCI edits and the chargemaster. The session will also discuss differences between NCCI rules and CPT coding guidance and how to navigate them for reimbursement.

The “Art” of Chargemaster Management

Gain a better understanding of the structure of a charge description master (CDM) and common reimbursement methodologies. This session will offer tips on the "art" of maintaining an up‐to‐date and compliant CDM, provide guidance on identifying charge capture strategies for typical ancillary services, and describe best-practice methods for managing the chargemaster. This session is basic to intermediate and will include real-life examples and audience participation.

2:20 p.m.–2:50 p.m.
Networking and Refreshment Break in the Exhibit Hall
2:50 p.m.–3:50 p.m.
Prior Authorization for Hospital Services: Utilization Control or Compliance Initiative

This session will cover the ins and outs of the prior authorization program for hospital outpatient services. Understand changes over time to the Operations Guide for prior authorizations and how CMS is using the program more like a compliance initiative than a prior authorization process. Details of the exemption process allowing hospitals to “test out” of the requirements will be discussed. The presentation will also cover use of ABNs related to services requiring prior authorization, identify when they are needed, when they may not be needed, and how to bill based on CMS guidance from the operations guide.

Observation—Medical or Surgical—Ordering It Right, Billing It Right

Observation remains commonly used but seldom understood. Different payers have different interpretations of the usage while doctors just want to take care of their patients. But as a health system recently learned when they paid a $4.3 million settlement with the Office of the Inspector General, getting it right is critically important. While inpatient care is billed by the day, observation care is billed by the hour, which exponentially increases the billing complexities. This presentation will be an A to Z review of observation, including its use for Medicare, Medicare Advantage, and commercial payers. Dr. Hirsch will address its use in medical and surgical patients and how rebilled claims should be prepared. Examples of compliantly prepared claims to accurately report observation services will be presented.

4:00 p.m.–5:00 p.m.
New Technologies, New Payment Opportunities, and New Models: Spotlight on Cell and Gene Therapies

The rapid pace of new technologies is upon us. The product pipeline of costly cell and gene therapies will explode over the next three to five years, with price tags unlike what the provider community is used to seeing, especially under buy-and-bill models. This session will provide an overview of where we are today, what is coming down the pike, and how patients, providers, payers, and manufacturers are thinking about all of this, including topics such as care delivery, coverage, coding and billing, reimbursement, and patient outcomes. We’ll explore tough questions related to how Medicare Part A will afford these therapies given the trust fund is on pace to run out even faster than expected due to COVID-19, how state Medicaid programs won’t have enough funds to treat all patients in need, what private payers are doing, what government payers can learn, and much more. This important session is for any hospital that is already providing a cellular therapy such as CAR-T or gene therapies for Beta-Thal and sickle cell disease or plans on doing so.

Optimizing Your Revenue Integrity Program: Objectives, Leadership, and Skill Sets

This session will provide guidance on how to develop a revenue integrity program within a healthcare provider organization, with considerations for prioritizing efforts, size of facility, and staffing. Presenters will provide their experience and perspective from small and large hospitals and health systems. Presenters include those who authored NAHRI’s recommended job descriptions and staffing algorithm. Participants will receive a copy of the NAHRI-recommended job descriptions along with a quick-start guide to developing a revenue integrity program. This session is part one of two. The second session applies the guidance on structuring your program to operationalizing your program based on analytics.

5:00 p.m.–6:30 p.m.
Networking & Exhibits Reception
6:30 p.m.
Day 1 Concludes

Conference Day 2

September 20, 2022
7:00 a.m.–8:00 a.m.
Continental Breakfast in the Exhibit Hall
8:00 a.m.–9:00 a.m.
Is a Frictionless, Denial-Free Relationship With Your Payers the Right Approach for Your Hospital?

One of the central tenets of utilization management is that “denials are bad.” Hospitals have developed a myriad of key performance indicators that reflect this—denial rate, total number of denials, etc.—so anything that avoids denials seems like a panacea. Yet, in the quest for no denials, hospitals agree to relationships that work well for payers but not for providers. During this session, we will review the payer business model, the tactics deployed by payers to reduce healthcare spending beyond denials, and what providers should do to combat these tactics.

The No Surprises Act: Key Components and Operational Considerations

This session will review the No Surprises Act, part of the Consolidated Appropriations Act issued December 2020. It will discuss regulatory requirements related to surprise billing and highlight operational considerations for compliance.

9:10 a.m.–10:10 a.m.
Crucial Leadership: Managing Staff Burnout, Retention, and Recruitment

Crucial leadership is necessary for preventing and managing burnout, improving staff retention, and recruiting and attracting top talent. In this session, you will gain a better understanding of burnout and learn how to approach and act against it. In addition, the presenters will examine the recruitment process, best practices, and turnover. You will gain a better knowledge of how to attract top talent and drive employee retention.

Adding Value to the CDM: Advice From a CFO, Coordinator, Consultant, and Vendor

Get an inside look at best-practice strategies for maintaining an up-to-date and accurate CDM and promoting collaboration among CDM professionals, financial leadership, and consulting experts. This intermediate-level panel session will use case studies and real-life examples to explain the roles of the CDM coordinator, CFO, and outside consultants and vendors. Attendees will take away key tips for addressing CDM challenges and promoting revenue integrity in the facility setting.

10:10 a.m.–10:40 a.m.
Networking and Refreshment Break in the Exhibit Hall
10:40 a.m.–11:40 a.m.
Master the Provider Chargemaster

The physician practice's fee schedule, the prices, the chargemaster... regardless of what the physicians and staff call it, this tool is the basis for the revenue of a business, and it needs attention! In this presentation, participants will learn critical success factors for managing a physician practice chargemaster, including how to analyze an existing fee schedule, how to make improvements, how to avoid regulatory errors, and why updating the chargemaster must be an annual priority.

Optimizing Your Revenue Integrity Program: Analytics, KPIs, and Performance Metrics

This session will provide guidance on how to operationalize your revenue integrity program using data analytics to highlight and measure performance. Presenters will provide their experience and perspective on key performance indicators, benchmarking methodologies, interdependencies, and troubleshooting. This session will also cover various types of revenue integrity initiatives that will help your organization produce a strong value capture program. This session is part two of two. The first session provides guidance on the structure of the revenue integrity program to support the use of analytics to measure performance.

11:40 a.m.–12:50 p.m.
Networking Lunch—Exhibit Hall Finale
12:50 p.m.–1:50 p.m.
Denials Prevention and the Value of 835 Data

Understanding the story behind a denial is the first step in developing prevention strategies. The story begins with identifying what the organization did, or didn’t do, that caused the denial and what strategies must be addressed to prevent the denial from occurring going forward. Many organizations lack insight on the cause of their denials. Often, neither the revenue cycle team nor the utilization review committee have access to the objective information needed to impact change, or they fail to act on the data they have. This presentation will discuss the data contained in 835 remittances and how to access this information, thereby helping to unravel the codes associated with each transaction.

Split/Shared Service Changes for 2022

CMS changed the documentation and coding requirements for split/shared services in 2022. Along with the changes, there is a new modifier to use. This session will review the documentation requirements and present scenarios for the appropriate coding of split/shared services.

2:00 p.m.–3:00 p.m.
Navigating Today’s World of Audits

In this session, we will present an update on all of the current audit activity, from government as well as commercial payers. We’ll discuss what to do when notified of an audit, who should be involved in the entire audit management process, how to best prepare the most complete and appropriate response, and how to best utilize the offered or included education. This session will also include best practices for appealing audit results when there might be unfavorable findings and developing educational opportunities and possible process improvements.

On- and Off-campus Provider-based Departments

In this session we will define and identify the Medicare requirements for both on- and off-campus provider-based departments. Provider-based status permits hospitals to receive separate payment under Part B for the facility component of most hospital outpatient services. We will also discuss the payment differences for on- and off-campus departments, depending upon whether they are “excepted” or “nonexcepted” departments. Finally, we will review the process for Medicare designation of provider-based status, including the role of attestation by hospital administrators.

3:00 p.m.
Symposium Adjourns
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