We cordially invite physician advisors to a Physician Advisor Leader Symposium presented by AccretivePAS®. As hospitals are under increased scrutiny by a growing number of auditing agencies regarding level of care and medical necessity, it is crucial that facilities have experts trained in understanding the rules, regulations and guidelines that serve as the roadmap for these audits. This course will train physician advisors to be expert resources for their hospitals and allow them to guide the development of operational improvements at their facilities to reach best practices. Attendees will receive 11.5 AMA PRA Category 1 Credit(s)™.
This activity has been designed to meet the educational needs of physician advisors and other physician leaders involved in utilization review excellence.
After completing this activity, the participant should be better able to:
· Summarize Medicare regulations governing hospital admission, use of outpatient beds and observation
- Explain the importance of physician documentation of medical necessity and how it can protect hospitals from payment denials
- Describe the role of the physician advisor in assisting physicians and hospitals in determining proper admission status and obtaining the required documentation
- Differentiate the various Medicare auditors reviewing hospital billing practices including their target areas, powers and tactics
- Explain the role of case management in hospital compliance
- Describe the administrative hearing process specific to Medicare
- Advocate for maximal reimbursement while maintaining integrity using principles of compliance and fairness
- Explain what is allowed, what is merely tolerated, and what will get you in trouble when taking a case before the ALJ
Continuing Medical Education Credits
The Postgraduate Institute for Medicine designates this live activity for a maximum of 11.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine and Accretive PAS. The Postgraduate Institute for Medicine is accredited by the ACCME to provide medical education for physicians.
8:00 a.m. – 8:30 a.m. - Welcome, Industry Overview, and Introductions (Complimentary Breakfast Served)
8:30 a.m. – 9:45 a.m. - Managing Compliance Challenges in Today’s Complex Regulatory Environment
9:45a.m. – 10:00 a.m. - Break
10:00 a.m. – 11:00 a.m. - The Role of the Physician Advisor in the RAC Era - Opportunities and Limitations
11:00 a.m. – 11:45 a.m. - Regional and National Hot Topics in Compliance and Denials Management
11:45 a.m. – 12:30 p.m. - Working Lunch - The Link Between LOS and Discharge Time
12:30 p.m. – 1:30 p.m. - The 2014 IPPS Final Rule - What You Need to Know
1:30 p.m. – 2:15 p.m. - Medical Necessity - The Sequel - Beyond Observation and Inpatient
2:15 p.m. - 3:15 p.m. - HINN, ABNs, and CC 44
3:15 p.m. - 3:30 p.m. - Break
3:30 p.m. - 4:30 p.m. - OIG: What is New and What is Old
4:30 p.m. - 5:00 p.m. - Wrap Up and Q&A
7:00 a.m. – 8:00 a.m. - Breakfast, Introduction, Review, and Q and A
8:00 a.m. – 9:00 a.m. - Appeals 101: A Campaign That Wins
9:00a.m. - 10:00a.m. - The 21st Century PA: Moving Beyond LOC and Appeals
10:00 a.m. - 10:15 a.m. - Break
10:15 a.m. -11:15 a.m. - Bridging the Gap: Case Management and Revenue Cycle
11:15 a.m. - 12:00 p.m. - Lunch
12:00 p.m. - 1:00 p.m. - An ALJ Trial: What you Need to Know
1:00 p.m. - 1:30 p.m. - Evaluations and Send off
Steven J. Meyerson, MDserves as Vice President of Physician Advisory Services (AccretivePAS®) in the Regulation and Education Group (“the REG Specialists”) where his role includes physician education on RAC activities and the latest Medicare guidelines. Dr. Meyerson is board certified in internal medicine and geriatrics. Prior to his employment at AccretivePAS®, Dr. Meyerson served as Medical Director of the hospitalist program at Baptist Hospital of Miami and then for four years was full time Medical Director and Physician Advisor for Care Management at that hospital.
Ronald Hirsch, MD serves as Vice President of Physician Advisory Services (AccretivePAS®) in the Regulation and Education Group (“the REG Specialists”). Prior to his employment at Accretive Health, Dr. Hirsch, a board certified internist and HIV specialist, practiced and served as president at a multispecialty practice in Illinois and Medical Director of Case Management at Sherman Hospital in Elgin, IL.
Arlene Ritzen, MD, JD, MPH, works for Physician Advisory Services (AccretivePAS®) in the Appeals department’s Administrative Law Judge or ALJ team. Dr. Ritzen is board certified in pediatrics and public health and maintains active medical licenses in Washington and California and an active law license in Washington. Prior to her employment at AccretivePAS®, Dr. Ritzen worked in forensic pediatrics in Portland, Oregon, and Seattle, Washington, and community health in Washington.
Paul Simmons, MD, MA is the innaugural Physician Advisor to Case Management at the Massachusetts General Hospital. He is a practicing general internist in the General Medicine Division at the MGH. He is also active in both peer and resident education. Prior to coming to the MGH, Dr. Simmons helped found the hospital medicine group at the University of Colorado.
Postgraduate Institute for Medicine (PIM) requires instructors, planners, mangers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by PIM for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.
Americans with Disabilities Act
Event staff will be glad to assist you with any special needs (ie, physical, dietary, etc). Please contact Joe Evans prior to the live event at 312.462.6219.
Guest rooms have been reserved at the W City Center - Chicago for the nights of November 6th and 7th at a discounted of $219/night. The hotel is located less than 1 block from the Symposium venue. To book your room, please call (877) WHOTELS and reference Accretive Health or click here to open the online booking page.
The discounted rate will expire on October 15th so please book early!
When & Where
Best Practices in Medical Necessity Compliance brought to you by the Regulation and Education Specialists at AccretivePAS®