Revenue Integrity Symposium: A NAHRI Virtual Event

August 17-18, 2021 | Virtual

All times listed below are Eastern Standard Time.


Main Conference Day 1

August 17, 2021
11:00 a.m. - 11:30 a.m. ET/8:00 a.m. - 8:30 a.m. PT
11:30 a.m. - 12:30 p.m. ET/8:30 a.m. - 9:30 a.m. PT
Track 1: Four Key Components to Revenue Integrity Success

Revenue leakage costs hospitals 1%–3% of revenue annually, and this figure has likely increased in the past year. In addition to new codes and changing regulations, revenue cycle management teams face tighter margins, furloughs and layoffs, and evolving work environments. This presentation will cover four components that serve as a foundation for successful revenue integrity programs in the post-COVID-19 world—helping to maximize reimbursement, ensure a streamlined workflow, and close ever-present gaps among revenue integrity analysts, billers, coders, and clinicians. Attendees will learn how to develop a comprehensive revenue integrity program that includes strategies for minimizing leakage, optimizing reimbursement, identifying COVID-19 revenue opportunities, and mitigating risk from compliance violations and external audits. The presentation will outline case studies with practical applications, offering tactics that have yielded significant ROI for hospitals and health systems.

Track 2: NCCI Edits in Depth: Make Them a Resource Instead of an Obstacle

This session will review the three types of NCCI edits: procedure-to-procedure edits, Medically Unlikely Edits, and add-on code edits. Learn how to find resource tables and manuals to research your edit and modifier questions. Understand appropriate use of modifiers for procedure-to-procedure edits. Medically Unlikely Edit rationale and applicability of add-on code edits will also be discussed.

12:35 p.m. - 1:35 p.m. ET/9:35 a.m. - 10:35 a.m. PT
Track 1: In the Trenches With the Chargemaster and Facility Charge Capture

Gain a better understanding of the structure of a CDM and common reimbursement methodologies. This session will offer tips for 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 COVID-19 changes related to the chargemaster.

Track 2: Halting the Elimination of the Inpatient-Only List: Proposed OPPS CY 2022

With the recent release of the anticipated CY 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS-1753-P), CMS is reverting to its previous approach on the inpatient-only list. Join this session to learn about the proposed rule, understand the implications of this reversal, and the proposed changes to medical review audits.

1:40 p.m. - 2:00 p.m. ET/10:40 a.m. - 11:00 a.m. PT
Developing a Targeted HCC Management Process; A Patient-Centric Approach

Sponsored by: 3M Information Systems

2:00 p.m. - 2:40 p.m. ET/11:00 a.m. - 11:40 a.m. PT
2:40 p.m. - 3:30 p.m. ET/11:40 a.m. - 12:30 p.m. PT
Track 1: Defensible Patient Status: Leveraging AI to Adapt to Payer and Regulatory Medical Necessity Developments

Medical necessity now accounts for 20% of all denials—a 66% increase over two years—and commercial payer appeal success has dropped to 45%. At the same time, regulatory pressure is increasing. This changing payer landscape has made effective utilization review more important than ever. Defensible patient status determinations can help prevent denials and raise the chances of successful appeals. During this session, Dr. Kurt Hopfensperger will discuss patterns in payer behavior, the consequences of regulatory changes, and how artificial intelligence (AI) can help hospitals keep ahead of these trends to maintain their revenue integrity.

Track 2: Effective Management of Commercial and Medicare Advantage Denials

Authorization and claims denials are one of the largest threats to revenue integrity. Hospitals must present a coordinated response and utilize all available tools to effectively combat denials. This session will cover how to monitor key performance indicators, establish a peer-to-peer process, coordinate and track denials, and highlight opportunities to improve communication among hospital departments including utilization management, case management, patient financial services, and contracting.

3:35 p.m. - 4:25 p.m. ET/12:35 p.m. - 1:25 p.m. PT
Track 1: Revenue Integrity and Your Medical Staff: Updates, Controversies, Keys to Success

Whether they realize it or not, hospital medical staff play a crucial role in revenue integrity. They hold the power in their pen and keyboard. Yet, no physician ever went into medicine with the goal of understanding the regulatory history of the 2-midnight rule, dissecting the inpatient-only list, delivering patient notices, or ensuring that hospital claims are submitted accurately. In this session, a veteran revenue integrity leader will moderate a discussion with two leading physicians in the regulatory realm to discuss keys to working with physicians to ensure compliance with regulations and documentation, touching on issues such as the compliant use of observation, the admission order, the 2-midnight presumption, medical necessity, and more.

Track 2: The CDM: Tales From a CFO, Coordinator, Consultant, and Vendor

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

4:35 p.m. - 5:00 p.m. ET/1:35 p.m. - 2:00 p.m. PT
Live Q&A with Speakers from Today's Sessions

Main Conference Day 2

August 18, 2021
11:00 a.m. - 11:30 a.m. ET/8:00 a.m. - 8:30 a.m. PT
11:30 a.m. - 12:30 p.m. ET/8:30 a.m. - 9:30 a.m. PT
Track 1: CDM Guru: What Would You Do?

CDM operations are often fraught with difficult dilemmas that are not easily resolved. Join our CDM experts in this roundtable-style discussion, where they’ll discuss complex or troublesome CDM charging and billing issues along with options for resolution. Listeners are encouraged to ask questions of the panel during this interactive session.

Track 2: Reducing Denials Using Targeted Data Analytics and Best Practices

This session will focus on identifying strong tools to manage denials and analyze trends. Topics will include understanding denial codes, using automated technology to flag denials, and reporting on denial trends. The session will also provide best practices in setting denial KPIs and creating standard metrics. Participants will learn how to utilize data, how to implement a denials program, and how to address the issues that most commonly arise, all through real-life examples.

12:35 p.m. - 1:25 p.m. ET/9:35 a.m. - 10:25 a.m. PT
Track 1: The Myth of Inpatient Level of Care for Medicare Patients

Misunderstandings abound regarding an inpatient level of care and the role of outpatient services, including observation, in the 2-midnight rule. Yet CMS has been clear from the beginning and continues to be clear about these issues. Through quotes from CMS, this session will provide you CMS’ real guidance and an understanding of what it means for inpatient admissions. Face auditors with CMS’ own words and guidance to defend care that is appropriate for payment under Part A.

Track 2: How to Effectively Comply With Payer Integrity Audits

The reprieve is over. All payers have resumed payment integrity audits in 2021. While these audits are useful to ensure compliance and proper reimbursement, they don’t always go smoothly. Early COVID-19 claims are also being reviewed and will have a significant impact on the large-dollar, aged accounts. With a deluge of audits ahead, this session will help attendees properly prepare their people, processes, and technology. The speaker will share proven strategies and tactics to quickly streamline Medicare and commercial payer integrity audits, reduce labor costs, and realize a higher return for the organization’s efforts.

1:30 p.m. - 1:50 p.m. ET/10:30 a.m. - 10:50 a.m. PT
Sponsored Lightning Rounds
1:50 p.m. - 2:35 p.m. ET/10:50 a.m. - 11:35 a.m. PT
2:35 p.m. -3:20 p.m. ET/11:35 a.m. - 12:20 p.m. PT
Track 1: Overview of Self-Administered Medications in 2021

This session will provide an overview of an operationally hard concept to implement for chargemaster, revenue integrity, and, ultimately, the patients: self-administered medications. Let’s go back in history and show the concepts, current source authority, and OIG guidance, then provide some plans for success.

Track 2: Effective Application of the I/OCE

Learn how to use the Medicare quarterly resources to keep your chargemaster updated throughout the year. This session will demonstrate downloading the I/OCE and how to use the included resources to update your chargemaster and billing edits to ensure smoother quarterly transitions to new codes and edits. Proactively prepare for changes instead of reacting to RTPs and denials.

3:25 p.m. - 4:25 p.m. ET/12:25 p.m. - 1:25 p.m. PT
Track 1: Best Practice Charge Capture Methods for Your Emergency Department

Facilities must ensure the basics and requirements of E/M, surgical coding, supplies, and pharmacy are appropriately captured to match facility resources to their charges. This session will cover high-failure areas, such as point systems, and demonstrate methods for optimization.

Track 2: In Plain Sight: CMS’ Policies to Influence Site of Care

A number of CMS coverage and payment policies are designed to influence site of service, including changes to the inpatient-only list, prior authorization, the ASC procedure list, and payments for high-cost therapies. This session will review which site-of-service options are valid for certain services and discuss likely reactions and impacts of these policies within the healthcare marketplace.

4:35 p.m. - 5:00 p.m. ET/1:35 p.m. - 2:00 p.m. PT
Live Q&A with Speakers from Today's Sessions
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