Mastering Utilization Review and Patient Status: A NAHRI Virtual Event

On-Demand

Virtual Conference - Day One Virtual Conference - Day Two

Virtual Conference - Day One

March 30, 2021
12:00 p.m. - 12:45 p.m. ET	The Importance of Outpatient Services in the 2-Midnight Rule Benchmark Kimberly A. Hoy, JD, CPC, Director of Medicare and Compliance - HCPro Outpatient services, including observation, are often provided before inpatient admission. This session will review coverage of outpatient and observation services and how they are counted toward the 2-midnight benchmark. Transfers and delays in care in relation to the 2-midnight benchmark will also be discussed.
12:55 p.m. - 1:40 p.m. ET	The Ins and Outs of Condition Code 44 and Self-Denial Kimberly A. Hoy, JD, CPC, Director of Medicare and Compliance - HCPro Have you made the move from condition code 44 processes to self-denial after patient discharge? Learn when and why self-denials may make more sense than condition code 44, including differences in efficiency and reimbursement. Be informed to deploy your utilization review resources where they can do the most for your organization.
1:40 p.m. - 2:10 p.m. ET	Demo: How to Master Medicare Rules for Utilization Review with Powerful Training Solutions Join HCPro as we explore our line of Utilization Review training solutions. We’ll explore how our clients leverage virtual and in-person intensive boot camps, Medicare Watchdog service, and more through available year-round training and education programs. Attendees will gather valuable information about available solutions, as well as qualify for session-only discounts!
2:10 p.m. - 2:55 p.m. ET	Utilization Management Committee: The Needs and the Wants Edward P. Hu, MD, CHCQM-PHYADV, System Executive Director of Hospital Physician Advisor Services - UNC Health Care System This session will review the regulatory basis of utilization management (UM) committees, including composition and required activities. Learn how to use the UM committee to go beyond the basic requirements and create greater healthcare value for your hospital.
3:05 p.m. - 3:50 p.m. ET	Out With the Inpatient-Only List, In With the Inpatient-Probably List Kimberly A. Hoy, JD, CPC, Director of Medicare and Compliance - HCPro CMS is phasing out the inpatient-only list and replacing it with a list of procedures that will be subject to the 2-midnight rule but will not be subject to denial for failure to meet the 2-midnight rule. CMS adopted new standards for removing procedures from this new list and plans to update it annually, similar to the inpatient-only list. Learn the details of CMS’ new rules for procedures formerly on the inpatient-only list and how to deal with the transition period.
4:00 p.m. - 4:30 p.m. ET	Live Q&A Kimberly A. Hoy, JD, CPC, Director of Medicare and Compliance - HCPro Edward P. Hu, MD, CHCQM-PHYADV, System Executive Director of Hospital Physician Advisor Services - UNC Health Care System Join Kimberly A. Hoy, JD, CPC, and Edward P. Hu, MD, CHCQM-PHYADV, for a Q&A session and have all your questions answered.

Virtual Conference - Day Two

March 31, 2021
12:00 p.m. - 12:45 p.m. ET	Equipped for Success: What Support Do Physician Advisor Programs Need to Deliver on C-Suite Expectations? Kurt Hopfensperger, MD, JD Physician advisors can immediately and significantly strengthen revenue integrity while also contributing to quality and documentation improvement. Despite this potential, implementing an effective program is challenging. Most hospitals struggle to find enough qualified physician advisors. Even when appropriately staffed, a physician advisor program faces four significant challenges that prevents them from delivering this value. This presentation will review the four kinds of support physician advisors must have to deliver the value hospital leadership expects.
12:55 p.m. - 1:40 p.m. ET	Observation Services: A Guide to Proper Use and Billing Ronald L. Hirsch, MD, FACP, CHCQM, CHRI The compliant use and billing of observation services has baffled many for years. Errors in observation billing can result in lost revenue and audit scrutiny. This session will review the proper application of observation status and the intricacies of billing to ensure that all regulations are followed and all compliant revenue is captured. Observation for medical and surgical patients will be discussed.
1:40 p.m. - 2:10 p.m. ET	NETWORKING BREAK
2:10 p.m. - 2:55 p.m. ET	Prior Authorization: Complying With Expanded Guidance Ronald L. Hirsch, MD, FACP, CHCQM, CHRI What started as an attempt to avoid Medicare paying for cosmetic surgery on its beneficiaries is now morphing into a program to reduce the utilization of procedures where CMS feels growth has exceeded need. This session will review the prior authorization program, including newly approved procedures and the rules and processes necessary to ensure success.
3:05 p.m. - 3:50 p.m. ET	Utilization Review and Clinical Documentation Integrity: A Yin to Your Yang! Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CDI Education Director - HCPro Clinical documentation integrity (CDI) has evolved over the last decade to address not only working to obtain the highest DRG payment based on patient acuity, but also assisting with quality measures, denials prevention, and capture of severity of illness and risk adjustment. These efforts require collaboration with other departments to ensure success. CDI efforts to obtain accurate DRG assignment/patient complexity will allow for capture of the most applicable GMLOS and will work to support medical necessity of treatment. These efforts support utilization review functions, which means utilization review and CDI must collaborate to ensure consistent provider education and messaging as well as long-term organizational success.
4:00 p.m. - 4:30 p.m. ET	Live Q&A Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, CDI Education Director - HCPro Kurt Hopfensperger, MD, JD Ronald L. Hirsch, MD, FACP, CHCQM, CHRI Join Kurt Hopfensperger, MD, JD, Ronald Hirsch, MD, FACP, CHCQM, CHRI, and Laurie L. Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, for a Q&A session and have all your questions answered.

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