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2019 Revenue Integrity Symposium (BLR)

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Renaissance Orlando at SeaWorld®

6677 Sea Harbor Drive

Orlando, FL 32821

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2019 Revenue Integrity Symposium


Coming October 15–16, 2019 | Renaissance Orlando - Orlando, FL

Save the Date: Join us October 15–16, 2019, at the Renaissance Orlando for the 2019 Revenue Integrity Symposium.

The Revenue Integrity Symposium brings together training on Medicare billing and compliance, patient status, revenue integrity, case management, coding, and clinical documentation improvement (CDI), helping attendees ensure compliance and accurate billing and reimbursement across the revenue cycle. Unlike any other, this conference offers a wide range of exciting sessions on critical revenue integrity topics and the chance to learn from and network with trusted industry experts and revenue cycle professionals of all varieties.

Our expert speakers will cover critical topics essential to revenue integrity, such as IPPS and OPPS annual updates, chargemaster maintenance, patient status, denials management, appeals and Medicare Fair Hearings, payer audits, value-based purchasing, utilization review (UR), revenue cycle management strategies, and much more!

Benefits from the 2018 Revenue Integrity Symposium:

Return to your facility armed with the tools to enhance revenue integrity and develop strategies for accurately documenting, coding, and billing patient encounters and stays
Gauge the financial and operational impact of the 2019 OPPS proposed rule
Develop strategies for enhancing your UR committee, using PEPPER and other analytics to strengthen internal audits and defend against external audits, and creating a revenue integrity workplan
Gain insight into billing and coding hot topics that may impact your facility’s financial performance, including injections and infusions, claim edits, and the inpatient-only rule
Discover best practices for maintaining an up-to-date and compliant charge description master and learn to identify charge capture strategies for typical ancillary services
Explore the role of physician advisors and compliance in the overall revenue cycle and in a value-based model landscape
Get the latest information on external auditors and learn new strategies for dealing with claim denials and appeals
Learn strategies for designing a revenue integrity program, defining leadership, and setting and meeting revenue integrity goals

2018 Highlights

Highlights of the 2019 OPPS proposed rule
Properly addressing National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits
Fundamentals of managing a compliance investigation and Medicare’s 60-day overpayment provision
Impact of value-based reimbursement models on revenue
Reimbursement, documentation, and coding strategies for new technologies, laboratory tests, cardiac procedures, and joint replacements
PEPPER implications for audit, reimbursement, and denial management
Current payer audit targets and strategies to protect revenue
Links between ICD-10 and revenue integrity
Best practices for reducing payer denials using targeted data analytics
Understanding the impact of patient status and navigating payer regulations

Pre-Conference and Post-Conferences

Medicare Boot Camp® — Utilization Review
Pre-Conference: October 13–14, 2019 | Renaissance Orlando

Medicare Boot Camp®—Utilization Review Version is an intensive two-day course focusing on the Medicare regulatory requirements for patient status and the role of the utilization review (UR) committee.

Medicare Boot Camp® — Audits, Appeals, and Denials Version
Post-Conference: October 17–18, 2019 | Renaissance Orlando

Get expert guidance on preventing denials and focusing appeals efforts for success. The evolution of reimbursement models and uncertainty regarding healthcare laws mean that to keep the doors open, organizations can’t afford write off appealable denials. Organizations need sound, practical information on overturning denials. Medicare Boot Camp®—Audits, Appeals, and Denials Version is your key to proven strategies for success and will answer all of your questions on denials management and appeals processes.

Medicare Boot Camp® — Provider-Based Departments Version
Post-Conference: October 17–18, 2019 | Renaissance Orlando

The Medicare Boot Camp—Provider-Based Departments Version provides education on attestations, on- and off-campus determinations, enrollment, billing, and reimbursement. This Boot Camp will provide brand new insight for understanding hospital outpatient department billing and reimbursement in an ever-changing regulatory landscape.

Acute Care Regulatory Changes and Hot Topics
Using Your Performance Data to Maximize Revenue
Acute Care Coding and Documentation
Chargemaster and Charge Capture Strategies
Denials, Audits, and Appeals
Patient Status and Utilization Review Strategies
Professional Development
Long-Term Care — Brought to you by AMBR

Day 1—Tuesday, October 15, 2019
Registration and Continental Breakfast (Provided – Exhibit Hall Open)
7:00 a.m. – 8:00 a.m.

General Session 1
8:00 a.m. – 9:00 a.m.
Great Balls of Fire! How To Stay Motivated No Matter What
Denise Ryan
One of the greatest challenges we all face is keeping ourselves motivated. This is particularly difficult and extremely important with our fast-paced high responsibility jobs. It’s easy to lose enthusiasm and get burned out, stressed out, and finally – checked out. This high-energy session will give you six steps for keeping your fire burning both professionally and personally. It’s not just a motivational speech; it’s a method you can apply long after the conference is over.

Breakout Session 1
9:10 a.m. – 10:10 a.m.

Round the Rule Merry-Go-Round: IPPS, OPPS, and MPFS
Jugna Shah, MPH, and
Valerie A. Rinkle, MPA, CHRI
Learn the major policy changes for both hospital and professional services that were promulgated in 2019 and are finalized or expected for 2020, including key aspects of the 2020 IPPS final rule and major provisions of the 2020 OPPS and MPFS proposed rules. Highlights of related regulations and rules, such as drug pricing and price transparency, will also be covered. PEPPER: An Integral Tool for Revenue Integrity
William L. Malm, ND, DNP, CRCR, CMAS
With ongoing audits, and reimbursement tied more closely to patient outcomes, creating a benchmark for audit measures can help you focus on internal audits and proactively address areas that might come under scrutiny in payer audits. PEPPER will show you how your facility measures up against your peers and where you can take action to prevent continued revenue leakage. This session explains how to utilize PEPPER proactively and provide a plan of action to take back to your facility. It demonstrates how to use the report to audit, monitor, and support revenue integrity functions. Revenue Integrity: A Team Approach to Compliant Revenue Retention
Tracey Tomak, RHIA PMP and Dawn Crump, CHC, SSBB, MA
Are you ready to centralize your appeal efforts around audit and denial activity but don't know where to start? This session will begin with the basics of building the team by selecting the right mix of staffing and expertise. We will then discuss tools to put in place for operational efficiency as well as how to create an effective data analytics platform. From there we will discuss real-world potential process improvement that can lend itself toward an effective denial prevention program. PDPM Implications for Senior Management
Stefanie Corbett, DHA
Providers don’t want to miss this session on PDPM, which will be in full swing after October This session will discuss how to optimize revenue under the new model’s clinical categories and how to operationalize PDPM requirements with a thorough prescreening process, effective resident goal setting, accurate coding, IDT involvement, astute therapy contract negotiation, and more.

Networking Refreshment Break (Exhibit Hall Open)
10:10 a.m. – 10:40 a.m.

Breakout Session 2
10:40 a.m. – 11:40 a.m.

Background and History of the 2 Midnight Rule and the Importance of Patient Status Issues
Marc Hartstein, MA
Hear former CMS Senior Executive Marc Hartstein speak on the history and background on the 2-midnight rule. Hartstein was responsible for drafting and leadership of CMS' 2 midnight rule through the agency, the Department of Health and Human Services, and the White House.
The CDM: Tales from a CFO, Coordinator, and Consultant
Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, Kay Larsen, CRCR, and Linda J. McCray, CPA, MBA
Get an inside look at best practice strategies for maintaining an up-to-date and accurate chargemaster and promoting collaboration amongst CDM professionals, financial leadership, and consulting experts. This session will use case studies and real-life examples to explain the role of the CDM coordinator, CFO, and outside consultants in maintaining an up-to-date chargemaster and addressing common CDM and charge capture issues. Attendees will take away key tips for promoting revenue integrity in the facility setting.

The ABCs of HCCs
The use of the Hierarchical Condition Category (HCC) methodology is expanding among governmental and commercial payers. Understanding the initiatives of this program will be important for the attendee to ensure that the practices at their organization are compliant and supportive of receiving entitled reimbursement through this reimbursement methodology. The session will provide foundational information about HCCs and discuss where there is potential risk for misrepresenting HCCs for reimbursement purposes and compliance pitfalls revenue integrity leaders must avoid. Tracking and Analyzing Therapy Utilization To Minimize Claim and Denial Risk
Megan Reavis, MBA, BS, COTA/L
Even though therapy minutes no longer drive reimbursement under PDPM, these services and the way they are documented still impact revenue integrity. During this session you’ll learn how to avoid scrutiny from CMS and how to analyze therapy utilization in order to minimize risk for claim audits and denials. Reavis will also review tracking therapy utilization patterns using PEPPER reports, how to maintain your current business model for therapy staffing and contract therapy services while optimizing reimbursement and quality, and effective collaboration strategies for billing and therapy personnel to maximize reimbursement.

Networking Lunch (Provided – Exhibit Hall Open)
11:40 a.m. – 12:40 p.m.

Sponsored Session
12:40 p.m. – 1:10 p.m.

Breakout Session 3
1:20 p.m. – 2:20 p.m.

Seeing Through Pricing Transparency
Caroline Rader Znaniec, MBA, MS-HCA
This session will provide a review and discussion of pricing transparency requirements. In addition, the session will provide discussion and review of strategies utilized nationally, and pros and cons to the various approaches. At the completion of the session, attendees will be better versed and prepared for pricing transparency discussions at their individual organizations. Drug Administration Review and Refresher: Testing Your Knowledge Through an Interactive Dialogue
Jugna Shah, MPA
This session will help participants challenge their coding, billing, documentation, and reimbursement knowledge related to facility reporting of drug administration (injection/infusion) services, including hydration, therapeutic, and chemotherapy services. We will also review any new codes and/or reporting requirements for CY 2020 and cover more detailed issues, such as the financial implications of series billing, as well as reviewing the most frequently asked questions from 2019. This will be an interactive session, so come ready to participate! Evolution of Utilization Review and the Role of Physician Advisors
Kurt Hopfensperger, MD, JD, and Kimberly AH Baker, JD, CPC
This session will explore the challenges involved in elevating the effectiveness of utilization review (UR). Attendees will learn how to rethink UR processes and leverage artificial intelligence to apply expertise at the most appropriate points in the UR process, achieving appropriate reimbursement and avoiding clinical denials Implementing Revenue Cycle Management for SNFs
Kim Cusson, CCS, CPC
Revenue cycle management (RCM) has traditionally been a term used in the acute-care world; however with PDPM’s new requirements, this process is catching on in long-term care. This session will explain what RCM is and how the accounting model’s best practices can be utilized to optimize revenue under the new payment model.

Networking Refreshment Break (Exhibit Hall Open)
2:20 p.m. – 2:50 p.m.

Breakout Session 4
2:50 p.m. – 3:50 p.m.

Success and Leadership: Panel Conversation with Four Women Leaders
Kim Garriott; Stacey McCreery; Angela Walker; Tiffany Walls
Join us for a panel discussion featuring tenured women leadership in healthcare. They will share best practices, successes, opportunities, and challenges. During this event, the panelists will draw upon their personal career experiences and offer insights on leading and how they pushed past the barriers. It will be an invigorating panel with open discussion and questions from the audience. Prepared to be inspired. Value-Based Care: A Comprehensive Look at MIPS, Bundles, and Recent Changes
William L. Malm, ND, DNP, CRCR, CMAS
The decrease in fee-for-service reimbursement has changed the landscape to evidenced-based care and cost management. Beginning with an overview of CMS’ major value-based care programs, this session will define bundles and explore risks associated with value-based care.

Let’s Own Our Revenue Integrity: Using Revenue Cycle Principles to Maximize Reimbursement
Sheldon A. Pink, MBA, FHFMA
A revenue integrity program resonates at the core of revenue cycle and financial outcomes to ensure that clinical and financial expectations are met from a payer and provider perspective. This session will demonstrate how to take charge of revenue integrity by identifying areas of opportunity for charge capture, developing practices to ensure departments charge appropriately, implementing daily charge reconciliation procedures, measuring the value of incorporating revenue cycle principles, and sustaining a revenue integrity program through transition. Using Your Performance Date to Maximize Revenue
Reginald M. Hislop III, PhD
LTC facilities have recently been introduced to various reimbursement and incentive programs. To thrive under this new environment, providers must understand how their quality data metrics are determined and how they can be translated into various revenue optimization strategies. This session includes cases and examples for Value-Based Purchasing, bundled payment programs, narrow provider networks, accountable care organizations, Medicare Advantage negotiation, and hybrid risk-sharing models, as well as marketing strategies that center on attracting the most rewarding patients under PDPM.

Breakout Session 5
4:00 p.m. – 5:00 p.m.

Pricing Hospital Services: Anything but Transparent
Valerie A.Rinkle, MPA, CHRI,
Dapo Akanbi, MBA, and John D. Settlemyer, MBA, MHA, CPC
Review the do’s and don’ts for pricing hospital services and the rationale behind the guidelines as well as recent requirements to post prices online. We will review any new updates related to pricing transparency requirements.

Today’s World Of Audits And Reviews: A Look at Cms’ Audit Programs, Their Contractors, and Other Federal Oversight
Diane Weiss, CPC, CPB, CCP
In today's healthcare industry, we can no longer operate under a strategy of "IF we get audited." We must now work with a daily assumption of "WHEN we get audited." Knowing who can request documentation, and why, for audits and reviews is an area that deserves everyone's attention throughout the entire revenue cycle process and is a necessary component of any successful revenue integrity program. This session will provide an overview of the audit related contractor types that are utilized within Medicare's Program Integrity scope of work. Strategies to Implement the Self-Denial Process and Bill Successfully with Condition Code W2
Kimberly AH Baker, JD, CPC
Condition code W2 is not just for “failed condition code 44” cases. Self-denials and billing correctly with condition code W2 is an important strategy to ensure payment for all patients admitted to the facility. Learn the UR and billing requirements to make this process work effectively and receive helpful handouts to get you started or improve your processes, including a letter to patients and a form to document UR decisions. Consolidated Billing: Impacts on Reimbursement Under PDPM
Stefanie Corbett, DHA
Under PDPM, SNFs can expect to receive greater reimbursement for residents with greater clinical complexity, higher acuity, and multiple comorbidities. This session will explain the role of consolidated billing requirements in properly anticipating the projected revenue and costs of care with the advent of this new model, including how to properly assigned reimbursement rates through preadmission screenings and MDS assessment accuracy.

5:00 p.m.

Networking Reception
5:00 p.m. – 6:00 p.m.

Day 2—Wednesday, October 16, 2019

Continental Breakfast (Provided – Exhibit Hall Open)
7:00 a.m. – 8:00 a.m.

Breakout Session 6
8:00 a.m. – 9:00 a.m.

Understanding and Applying New Lab Date of Service Requirements
Marc Hartstein, MA
Hear former CMS Senior Executive Marc Hartstein speak on the laboratory date of service rule. This session will provide an overview of the reason for the policy and changes made in recent years. Reduce MUE and NCCI Edits by Being Proactive
Denise Williams, COC
The National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUEs) can be difficult and time consuming to resolve. It is often unclear who is responsible for conducting research to resolve an edit, costing a facility valuable time in the appeals process. Without processes in place to effectively resolve edits across departments, hospitals risk duplicating efforts or losing edits, which can result in lost revenue. This session will address all of these concerns and provide real life examples and strategies to mitigate these edits on the front end, helping to decrease re-work. Safety Net for Revenue Capture
Suzanne Tschetter, CPA, Karen Giacomo, BA, CPC, CHA, and Jim Carlson
Want to increase revenue and build relationships between clinical and financial staff? Want to capture missing charges? Come learn how the Cleveland Clinic and RevInt implemented tools and strategies to improve charge capture. Avoiding Common Cost Report Mistakes: Implications for Compliance and Reimbursement
Kim Cusson, CCS, CPC
Learn how cost reports impact reimbursement in your SNF and how to avoid common mistakes that could lead to Medicare noncompliance or fraud. This session will include an overview of cost report elements and submission timelines, case studies, and guidance for using cost report data to help facilities improve their accounting process.

Breakout Session 7
9:10 a.m. – 10:10 a.m.

Target Probe and Extrapolate: A Concerning CMS Initiative
Alicia Kutzer, Esq., LL.M., MHA
Learn about the most serious and costly method CMS uses to calculate an overpayment for recoupment: the extrapolation method. Extrapolations have not been on the radar of most large facilities until now. This session is designed to teach participants how to shield their facilities from the potentially devastating consequences arising from the interplay between the target probe and educate initiative and the extrapolation process. Securing and Retaining the Best Talent: A Panel Discussion on Creating a Strategy and Culture to Attract and Retain Staff
Marijane Armbruster; Nicole Harper, PhD; Stacey McCreery; Patti Medvescek
This panel discussion will address how to secure the best talent and share strategies on creating a winning culture to attract and retain staff. Panelists will share best practices, successes, opportunities, and challenges of retaining star employees and reducing turnover costs. It will be a passionate panel with a focus on how people are the most important asset. Lean in and join us. Understanding Part A Hospital Benefits: Help Me Count the Days
Judith L. Kares, JD
Define the inpatient hospital Part A benefit, including both the 90 regular covered inpatient days that renew each time a new benefit period begins and the 60 lifetime reserve days (LRD) that do not. This session will cover the rules related to the beneficiary’s right to elect not to use LRDs and the consequences of that election to both the beneficiary and the hospital. It will also review the limitations that apply to the number of covered days available for inpatient psychiatric care, as well as limitations on availability of Medicare coverage when inpatient psychiatric care is provided by state or local government facilities. PDPM Crash Course for the Business Office
Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, DNS-MT, RAC-MTA
What do billers need to know about the new payment model? As under RUG-IV, members of the business office will still be the last line of defense against claim audits and denials before sending out claims. This session will help billers understand what new information they should look out for to ensure clinical documentation and what’s represented on the claim align, as well as reinforce traditional best practices to avoid denials and returns to provider.

Networking Refreshment Break (Exhibit Hall Open)
10:10 a.m. – 10:40 a.m.

Breakout Session 8
10:40 a.m. – 11:40 a.m.

Organizational Interdependence Strategies for Improved Revenue Integrity
Caroline Rader Znaniec, MBA, MS-HCA, and Stacie Smith, EMBA, RHIA
This session will describe how the various stakeholders within the revenue cycle, and their functions, are interdependent on the others to maintain organizational revenue integrity. The audience will be engaged in open discussion to share their approaches and experiences. Attendees will also walk away with a troubleshooting guide, including an interdependence chart and guide to revenue cycle key performance indicators and common root causes.
Managing Denials Processes: An Analytical Approach
Becky W. Cook, CPA, MHA, and Scott Everitt, MBA
Resolving denials is a task completed by some of the most highly trained staff. This session will help you learn how to increase the team's effectiveness with analytical techniques and reporting. Learn how to track statistics and KPIs for each step in the denials management process. Attendees will come away understanding how to prioritize improvements to registration and claims processes and appeals and report on the outcome by measuring resolution, including recovery of funds, outstanding balances, and potential unrecoverable balances.

Observation: Commonly Used, Poorly Understood, Frequently Billed Incorrectly
Ronald Hirsch, MD, FACP, CHCQM
The 2-midnight rule, RAC audits, and more aggressive insurer admission reviews have resulted in an increased use of observation services. But in many cases observation is being incorrectly ordered by physicians and improperly billed by hospitals, attracting the attention of the Medicare Administrative Contractors and the OIG. Understanding the proper use of observation, and what can and cannot be billed, is crucial to maintaining compliance and revenue integrity. Tracking Payer Correspondence to Prevent Lost Claims
John Larscheid
Understanding the flow of claim messaging between payers can have a bigger impact than denials on accounts receivable days in your SNF. This session will walk attendees through how to manage the different mediums through which providers and payers communicate and best practices for tracking and capturing correspondence when juggling multiple payer types to help the business office stay ahead of each billing cycle.

Networking Lunch (Provided – Exhibit Hall Open)
11:40 a.m. – 12:40 p.m.

Sponsored Session
12:40 p.m. – 1:10 p.m.

Breakout Session 9
1:20 p.m. – 2:20 p.m.

Leveling the Field: An Analytic Approach to Creating Individual Payer Strategies
Joseph Zebrowitz, MD, and Jay Ahlmer, CFA
Traditionally, revenue cycle and utilization review (UR) are siloed from each other. The disconnect between these functions offers payers an enormous opportunity to reduce payments. Join this session to understand the impact of UR on the revenue cycle, learn how Medicare Advantage and commercial payers have created strategies that leverage UR and coding metrics to undermine hospital revenue. Zebrowitz and Ahlmer will demonstrate how to create a unified set of financial performance goals for both revenue cycle and UR to achieve and how to use an approach similar to payers based on revenue and cost drivers. After participating in this session, you will have the skills to bridge the divide between revenue cycle and UR and take the lead in driving meaningful, measurable change. Appropriate Use Criteria for Advanced Diagnostic Imaging: Understanding the Requirements and Impact on Operations
Denise Williams, COC, and Angela Lynne Simmons, CPA
Appropriate Use Criteria is a new concept under the Medicare program. While CMS issued guidance in the Medicare Physician Fee Schedule, this applies to hospital providers and independent testing facilities. Providers will have to consult established criteria to support the ordering of advanced diagnostic imaging services, and provide this information with the order for the service. The providers who furnish the service will have to report this information on their claims – this includes hospitals and independent testing facilities, as well as the furnishing physician/clinician. While there are a few exclusions, most services will require this. This session will cover the basis for the establishment of these criteria, how to access them, what will be required from a process standpoint and some strategies for insuring that all information is available and reported on the claim. DRG Optimization: Why Current DRG Optimization Efforts May Be Coming Up Short
Solving diagnosis-related group (DRG) optimization continues to be a challenge for revenue cycle leaders. This session will look at the top revenue cycle management challenges facing hospitals, the disconnect between current solutions and achieving DRG optimization, key areas of vulnerability for lost or decreased revenue, and strategies to solve these problems. Attendees will leave with a comprehensive plan for improvement and an understanding of the key role revenue integrity plays in realizing it. Reinventing Your Triple Check and Medicare Meeting Processes for PDPM Success
Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, DNS-MT, RAC-MTA
The triple check process verifies claims for accuracy and compliance with Medicare regulations before billing. Learn how to shift the discussion during your Medicare and triple check meetings from rehab minutes to components under Section GG, return to provider codes, diagnosis coding specificity, and matching MDS documentation to the claim. This session will review ways to involve the entire interdisciplinary team to ensure maximum effectiveness.

2:20 p.m

NAHRI’s Certification in Healthcare Revenue Integrity Credentialing Exam
3:00 p.m. – 5:30 p.m.
View the CHRI Exam Candidate Handbook at nahri.org/certification to learn about prerequisites and apply today.

*Agenda and speakers subject to change

Keynote Speaker

Denise RyanDenise Ryan

Raleigh, North Carolina based professional speaker Denise Ryan is a motivational pyromaniac. Her infectious energy and enthusiasm will set a room ablaze.

A magna cum laude graduate of the University of South Carolina with a master’s degree in business, what she really specializes in is lighting fires.

After earning millions for clients in the corporate world, Denise realized she had a talent for firing people up. She parlayed this gift into FireStar, a company specializing in enthusiasm. Eleven years later, Denise motivates and energizes large corporations and small businesses across America at conferences, board retreats and annual meetings. Her no nonsense, direct delivery coupled with her astute business savvy and irreverent wit leave audiences not only laughing, but with actionable tips.

Not your typical “motivational speaker,” Denise is genuine and real. But also highly skilled – she holds the title of Certified Speaking Professional (CSP), a designation awarded to fewer than 10 percent of professional speakers. Denise is an author, keynote speaker and most notably, a fire starter extraordinaire. FireStar’s unique programs are relevant, uplifting and informative. Denise’s trademark interactive programs address myriad workplace issues such as dealing with change, getting along with others, staying motivated and the secrets of successful selling. She also offers customized training sessions. Denise’s infectious enthusiasm motivates the unmotivated and challenges the challenged. Consider yourself warned: FireStar programs are five-alarm scorchers.

Your Presenters

Jay Ahlmer, CFA Jay Ahlmer, CFA, is Senior Vice President of Strategic Accounts at Versalus Health. He has over 15 years in healthcare consulting, mergers and acquisitions, revenue cycle, and analytics. In his current role, Ahlmer collaborates with hospital management teams to improve operational and financial performance through data analytics and process optimization. Before joining Versalus, Ahlmer was a Senior Associate at TripleTree where he managed various sell-side merger and acquisition transactions within the healthcare market. While at TripleTree, he assisted executives in strategic planning, market sizing and analysis, and financial projections. Prior to TripleTree, Ahlmer was Director of Finance at Executive Health Resources where he supported multiple private equity recaps, a business divestiture, and ultimately, the sale of the company to a strategic acquirer through analytical support for marketing sizing/penetration, growth sustainability, operations management, and projected growth. Ahlmer has his bachelor’s degree from the Wharton School at the University of Pennsylvania. He is also a CFA Charterholder. Dapo Akanbi, MBA Dapo Akanbi, MBA, is implementation manager, net patient revenue with Craneware. He holds extensive experience in the healthcare pricing arena. Prior to joining Craneware, he worked as a pricing consultant guiding customers through numerous pricing engagements and contributing to the enhancement of other market net revenue solutions. He earned his undergraduate and graduate degrees in Business Administration from Georgia State University. Kimberly Anderwood Hoy Baker, JD, CPC, is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist and lead instructor for HCPro's Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. She is also an instructor for HCPro’s Medicare Boot Camp®—Critical Access Hospital Version. Baker is a former hospital compliance officer and in-house legal counsel, and has 10 years of experience teaching, speaking, and writing about Medicare coverage, payment and coding regulations and requirements. Jim Carlson Jim Carlson is currently the VP of Charge Capture services for Revint Solutions. He has over 25 years of experience in management consulting, technology, and start-up company operations. His recent focus has been building the leading revenue integrity charge capture solution with Acustream, now Revint Solutions. He specializes in optimizing value within revenue cycle to help clients recover revenue, create savings through root cause analysis, and process improvements across interdepartmental workflows. John Carter John Carter is senior vice president of clearinghouse operations at ABILITY Network’s Minneapolis, Minnesota location, a leading healthcare IT company and an Inovalon Company. In his role, John directs the day-to-day transaction operations supporting over 45,000 healthcare providers of all sizes, across the continuum of care. Becky W. Cook, CPA, MHA Becky W. Cook, CPA, MHA, isa former CFO for a large multispecialty group who was responsible for revenue cycle outcomes. Since changing careers, she has consulted on using analytics to improve performance of revenue cycle processes. Stefanie Corbett, DHAStefanie Corbett, DHA, is HCPro’s post-acute regulatory specialist, as well as a health policy educator, consultant, researcher, and author. She has a special affinity for seniors and enjoys leveraging her experience, education, and passion to healthcare professionals for the advancement of healthcare services rendered to the older adult population. Her professional experience also includes owning and operating a private healthcare consulting firm, Corbett Healthcare Solutions, LLC, in South Carolina, and serving as the Deputy Director of Health Regulation for the state of South Carolina, leading diverse healthcare organizations. She was licensed as a nursing home administrator in several states and has also worked as an Assistant Professor of Healthcare Administration. Dawn Crump, CHC, SSBB, MA, is the Senior Director, Revenue Cycle and Denial Managment Solutions, with Intersect Healthcare Crump has worked within the hospital environment within quality, compliance, or revenue integrity for the last 20 years. In addition, she managed the government audit and denial team and internal coding compliance for a large health system. Recently, she have worked with hospital providers nationwide to assist them in managing and mitigating their revenue risk using denial systems and analytics.

Kim Cusson, CCS, CPC

Kim Cusson, CCS, CPC, is the healthcare risk CBA manager in Crowe Horwath’s healthcare division.Cusson has more than 30 years of healthcare experience including more than 20 years of experience in auditing, hospital postacute care consulting, and physician coding and billing. She has also held positions as billing director, healthcare compliance manager, and outpatient coding manager. Cusson has served as board member of the local professional association.

Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA, is a past AHIMA president and recipient of AHIMA’s 1997 Distinguished Member and 2008 Legacy Awards. Dunn is chief operating officer of St. Louis-based First Class Solutions, Inc., a national health information management consulting firm providing coding compliance, SNF, and HIM operational consulting services. She is a prolific author of articles and texts and has spoken on a variety of health information management and compliance related subjects. Dunn is the author of the Revenue Integrity Manager’s Handbook published by NAHRI. She has held faculty appointments with St. Louis University, Stephens College, and the University of Minnesota. Her firm assists healthcare providers and organizations with their HIM and Coding operational concerns, coding and coding compliance requirements, HIPAA privacy and security readiness, and IRB activities. Dunn is a past president of AHIMA and chair of the AHIMA Foundation. In 2011, she served as the Interim CEO of AHIMA. In addition to AHIMA, she is active with HFMA, AICPA, and ACHE. Scott Everitt, MBA Scott Everitt, MBA, has worked for more than 20 years in healthcare, holding key leadership roles in finance, clinical operations, IT, and HR. He is currently the vice president of analytic solutions with Practical Data Solutions (PDS) where he assists clients with transforming their data into useful information and creating strategic solutions for performance improvement. Prior to his role with PDS, he held key leadership roles with the University of Utah Medical Group and Intermountain Healthcare in Utah. Karen Giacomo, BA, CPC, CHA Karen Giacomo, BA, CPC, CHA, has 29 years of experience in various aspects revenue cycle with a primary focus in revenue integrity, charge master and charge capture/reconciliation. Giacomo is currently the revenue assurance manager for the Cleveland Clinic and focuses on missed charge opportunities. Giacomo has performed revenue integrity audits at various healthcare systems that she has worked for, from first patient contact through to bill drop with a focus on leaning processes, a full charge master review, a charge accuracy audit, and the roll out of charge reconciliation. Giacomo has also been responsible for the build and/or maintenance of IT systems for scheduling, registration, and payer contracts. Giacomo reviews and disperse CMS and payer information to the RCM department. She has managed various teams within the revenue cycle, and she has assisted with the CDM build and charge reconciliation implementation in EPIC for Cleveland Clinic Akron General. Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, is president/CEO and principal consultant for SLG, Inc., in Raleigh, North Carolina. She is a nationally known speaker and author on the charge description master (CDM), outpatient facility coding, and billing compliance, and has more than 30 years’ experience in the healthcare industry. Goodman has been actively involved and held leadership roles in a number of professional organizations on the local, state, and national levels, including the National Association for Healthcare Revenue Integrity (NAHRI). Goodman serves as an advisory board member for NAHRI. Marc Hartstein, MA Marc Hartstein, MA, came to Health Policy Alternatives (HPA) in Washington D.C. after 26 years with the Centers for Medicare and Medicaid Services (CMS). Hartstein held several management and staff positions during his time at CMS, most recently as the director of the Hospital and Ambulatory Policy Group. At CMS, Hartstein was central to the development of the Medicare Severity DRGs, the 2-midnight rule, Medicare policy for off-campus hospital outpatient departments, the misvalued code initiative, and regulations to implement Medicare’s new clinical laboratory fee schedule among other policies. Hartstein’s experience not only gives him detailed knowledge of the workings of the executive branch of government, he also has worked extensively with the legislative branch. He has assisted in the drafting of legislation, working with the Congressional Committees that have subject matter jurisdiction over Medicare. Hartstein has a master’s degree in public policy from the University of Minnesota’s Hubert H. Humphrey Institute of Public Affairs and a bachelor’s degree in political science and economics from the University of Vermont. Reginald M. Hislop III, PhD Reginald M. Hislop III, PhD, is managing partner and CEO of H2 Healthcare, LLC, with locations in Kansas, Wisconsin, Illinois, and Nevada. Hislop has 30+ years of executive experience in the development, operations, and financing of all aspects of healthcare, with particular experience in postacute care. In addition to his work at H2, he serves as a consultant on health policy and reimbursement for the New York investment banking firm of DeMatteo Monness, provides policy and reimbursement guidance to the Transitional Healthcare Consortium and for clients of the Gerson Lehrman Group, and is a consulting member of the 10eqs knowledge network. Hislop holds a Bachelor of Science in Business Administration with a major in finance, a Master of Arts in Applied Mathematics and Quantitative Sciences, and a Doctor of Philosophy in Macro‐Economics. Ronald L. Hirsch, MD, FACP, CHCQM Ronald L. Hirsch, MD, FACP, CHCQM, is vice president of R1 RCM in Chicago. He is a general internist and HIV specialist. Dr. Hirsch was the medical director of case management at Sherman Hospital in Elgin, Illinois. He is certified in healthcare quality and management by the American Board of Quality Assurance and Utilization Review Physicians. In addition, he is a member of the American Case Management Association, a member of the American College of Physician Advisors, and a fellow of the American College of Physicians. Hirsch serves as an advisory board member for the National Association of Healthcare Revenue Integrity (NAHRI). Judith L. Kares, JD, is an expert in Medicare rules and regulations and is an instructor for HCPro's Medicare Boot Camp-Hospital Version®. She spent a number of years in private law practice, representing hospitals and other health care clients, and then as in-house legal counsel prior to beginning her current legal/consulting practice. She is also an adjunct faculty member at the University of Phoenix, where she teaches courses in business and health care law and ethics. Alicia Kutzer Esq., LL.M., MHA Alicia Kutzer Esq., LL.M., MHA, is an adjunct instructor for HCPro’s Medicare Boot Camp — Audits, Appeals, and Denials Version, Medicare Boot Camp – Hospital Version, Medicare Boot Camp – Utilization Review Version, and Medicare Boot Camp – Critical Access Hospital Version. Kutzer is a licensed attorney in the state of Pennsylvania and is a managing partner of Kutzer Law Firm, LLC, located in the Wilkes-Barre/Scranton area and founded in 2011. She served as an Administrative Law Judge in more than 1,000 Administrative Fair Hearings. Prior to that, Kutzer was a post-adjudication appeals officer, appeals officer, and subject matter expert for MAXIMUS, Inc., a Medicare Qualified Independent Contractor (QIC), from April 2012 through November 2015. Kay Larsen, CRCR Kay Larsen, CRCR, is a revenue integrity specialist at Glendale Adventist Medical Center (soon to be Adventist Health Glendale), Glendale, California. She has enjoyed 17 years working in healthcare, including many years as a CDM coordinator. Larsen’s favorite part of her job is working with departments maximizing revenue through education and charge review. In her years of work, she has experienced standardization projects, extensive price reviews and conversion of financial systems and still is passionate about revenue integrity. Larsen serves as an advisory board member for NAHRI. Laura Legg, RHIA, RHIT, CCS, CDIP Laura Legg, RHIA, RHIT, CCS, CDIP, is experienced as a leader, consultant, coding expert, speaker, trainer and auditor for acute care and critical access hospitals and major health systems. Legg is the director of revenue integrity solutions at BESLER where she lends her expertise to help clients improve operations, deliver education, and ensure compliant coding and billing. She is a member of HFMA, AHIMA, AAPC, and NAHRI. Legg speaks regularly at regional and national AHIMA events, and she is an advisory board member for Briefings for Coding Compliance and an AHIMA mentor. William L Malm, ND, DNP, CRCR, CMAS, is a managing director at Health Revenue Integrity Services. He is a nationally recognized author and speaker on topics such as healthcare compliance, chargemasters, and CMS recovery audits. Malm brings over 25 years of experience with a combination of clinical and financial healthcare knowledge that encompasses all aspects of revenue integrity. Previously, Malm played a key role in providing revenue integrity and data expertise for Craneware, Inc., the market leader in revenue integrity software solutions. He also serves as the secretary/treasurer for the Certification Council of Medical Auditors. He has extensive experience with all postpayment audits, having previously worked as a systems compliance officer at a large for-profit healthcare system. Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MTMaureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MT, is the President of Celtic Consulting, LLC, in Torrington, Connecticut, and the CEO and founder of Care Transitions, LLP, a post discharge care management service provider. Recognized as an industry leader in clinical reimbursement for long-term care, Maureen has been a registered nurse for over 30 years with experience as an MDS coordinator, director of nursing, rehab director, and a Medicare biller. Maureen and her associates at Celtic Consulting regularly provide consultation focusing on 5-Star quality improvement programs, quality auditing, clinical care management, PDPM/PPS/MDS/CMI services, and compliance solutions including Medicare compliance auditing and custom education, to meet any organization’s needs.

Linda J. McCray, CPA MBA, started her accounting career in a small public accounting firm in north west Washington. She started her journey in healthcare as an internal auditor for Adventist Health. She worked in several positions during her career with Adventist Health, such as director of fiscal services, CFO, and regional CFO. Since retirement, she has consulted with hospitals working to improve charge capture in electronic medical records. She also volunteers as treasurer for a private Christian school and assistant treasurer for her local church. She enjoys spending time with her family and working in the yard.

Stacey McCreery Stacey McCreery established ROISG following her extensive tenure as executive director of Indiana University Health, the largest healthcare system in Indiana. The scope of her work was broad and included the mergers and acquisitions of several hospitals, system-wide corporate budgeting and training, as well as the financial integrations of several hospitals and physician groups. McCreery’s previous engagements include financial responsibility for three Indianapolis, Indiana hospitals: Methodist Hospital, University Hospital, and Riley’s Hospital for Children. She was with the transformation team from inception at the largest healthcare system in Indiana, saving $54M through lean efforts. Sheldon A. Pink, MBA, FHFMA Sheldon A. Pink, MBA, FHFMA, is the chief of revenue cycle management for American Academic in Philadelphia. Hehas more than 18 years of experience in managing the mission, vision and purpose of Revenue Cycle Management activities and processes for multi-integrated health networks in not for profit and for profit health systems. Sheldon’s contributions have been critical to a variety of revenue cycle initiatives that improved reimbursement by over 150 million dollars in several organizations. He constantly provided strong support in fulfilling the companies’ collection responsibilities for both hospital and physician operations, meeting strategic goals and exceeding company objectives. Sheldon has experience leading national operational teams in the areas of Hospital & Physician Billing, Patient Access, Accounts Receivable, Revenue Integrity, System Implementations, Payor Contracting, Vendor Management and Performance Improvement. His prior positions focused on communicating a compelling and inspired vision and sense of core purpose to stakeholders of the organization; he talks beyond today; talks about possibilities; is optimistic; creates mileposts and symbols to rally support behind the organizational vision. He has inspired and motivated Revenue Cycle cultures in organizations. Sheldon has a Bachelor’s of Science in Accounting & Finance; and a Masters of Business Administration (MBA) in Healthcare Administration. Both degrees were acquired at Wilmington University in Delaware. He is a Certified Healthcare Financial Professional (CHFP) and Fellow of the Healthcare Financial Management Association (FHFMA). Other memberships include the National Association of Healthcare Revenue Integrity (NAHRI), American College of Healthcare Executives (ACHE), American Association of Healthcare Administrative Management (AAHAM) and the National Association of Healthcare Access Management (NAHAM). Sheldon was co-chair of the HFMA Philadelphia Chapter Revenue Cycle committee before joining American Academic Health System. He has presented at various industry conferences and groups across the country for HFMA & ACHE discussing the economic challenges & solutions in our healthcare environment. Megan Reavis, MBA, BS, COTA/L Megan Reavis, MBA, BS, COTA/L, is a national educator and has worked primarily in the geriatric setting as a clinician and in management, including as rehab director and area director, for the past 23 years. She started MCR Seminars out of Lansdale, Pennsylvania, as a platform for educating therapists and has written and taught numerous continuing education courses for the long-term care setting. For the past 10 years, Reavis has been teaching and designing workshops to address the needs of occupational, physical, and speech therapists in various settings focusing on the changing trends of how therapy is being provided in their work and community. Reavis is the author of The Fabulous Book of Functional Activities. Valerie A. Rinkle, MPA, CHRI, is a lead regulatory specialist and instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp as well as instructor for the Medicare Boot Camp®—Hospital Version, Medicare Boot Camp®—Utilization Review Version, and Medicare Boot Camp®—Critical Access Hospital Version. Rinkle is a former hospital revenue cycle director and has over 30 years of experience in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations. Caroline Rader Znaniec, MBA, MS-HCA Caroline Rader Znaniec, MBA, MS-HCA, is the owner and consulting lead of Luna Healthcare Advisors LLC in Denton, Maryland. In the past, she held various positions both within consulting and the industry. Znaniec was the national revenue integrity lead for Grant Thornton LLP (Baltimore), associate director of charge integrity at Navigant Consulting (Baltimore), corporate compliance officer at Anne Arundel Health System (Annapolis, Maryland), senior consultant of the national CDM practice of KPMG LLP (Baltimore), clinical operations manager at Children’s National Medical Center (Washington, D.C.), business operations manager of Halpern Eye Care (Dover, Delaware), and physician billing representative at Peninsula Regional Medical Center (Salisbury, Maryland). She holds a Bachelor of Science in Corporate Health as well as a Master’s in Business Administration and Masters of Science Management in Healthcare Administration. Jugna Shah, MPH, is the president and founder of Nimitt Consulting, Inc., a firm specializing in case-mix payment system design, development, and implementation. She has 15 years of experience working with providers on the ongoing clinical, operational, financial, and compliance implications of Medicare’s OPPS based on APCs. Shah has educated and audited numerous hospitals on their drug administration coding and billing practices. She has contributed to several books and numerous OPPS/APC articles and is a contributing editor of HCPro’s Briefings on APCs. Shah serves as an advisory board member for NAHRI. Angela Lynne Simmons, CPA, is the vice president of revenue and reimbursement at Vanderbilt University Medical Center. A Texas Certified Public Accountant, she brings more than 30 years of experience in healthcare operations and finance, and public accounting for healthcare entities. Simmons has expertise in healthcare policy, reimbursement principles from government programs (Medicare and Medicaid) as well as healthcare financial analysis and cost accounting. Much of her focus throughout her career has been on identifying revenue opportunities and pursuing those through improving hospital operations and by Medicare filings and appeals. Prior to relocating to Vanderbilt, she was the director of clinical revenue and reimbursement for U.T. M.D Anderson Cancer Center where she was responsible for Medicare and Medicaid reimbursement, cost accounting, revenue and rate-setting, financial analysis and clinical decision support reporting. Simmons serves as an advisory board member for NAHRI. Stacie Smith, EMBA, RHIA Stacie Smith, EMBA, RHIA, is the senior program manager of revenue integrity at Children’s National Medical Center in Washington, DC. Smith has over 30 years’ experience in HIM, revenue cycle and revenue integrity. Smith has a demonstrated history of working in hospitals, health organizations and other areas of the healthcare industry. She is skilled in healthcare consulting, software implementation, MC/MCD, healthcare operations, teaching, and team building among multiple other areas. She completed here undergrad work with an Associate of Science focused in Health Services/Allied Health/Health Sciences from Eastern Kentucky University, a Baccalaureate of Arts in Organization Management from Midway College, and graduate work in a Master of Business at Sullivan University. She is a member of AHIMA and assisted in the publication of articles in AHIMA and completed an audio seminar on revenue cycle with AHIMA. Tracey A. Tomak, RHIA, PMP Tracey A. Tomak, RHIA, PMP, is the director of project management and client engagement at Intersect Healthcare in Towson, Maryland. She has more than 20 years of experience in revenue cycle with a focus on hospital coding, charge capture, and denials management. In her current, Tomak is responsible for coordinating project implementation of Intersect Healthcare’s Veracity software. She works directly with clients to ensure that they are fully utilizing the Veracity software to effectively manage commercial and government audits and denials. Tomak is an active member of IHIMA, serving as the Nominating Committee Chair for the 2018–2019 year. Suzanne Tschetter, CPA Suzanne Tschetter, CPA, leads the Revenue Integrity department at the Cleveland Clinic. During her 27 years at the Cleveland Clinic, Tschetter obtained her MBA and actively engaged in a variety of roles from corporate finance to revenue cycle focusing on root cause analysis, process improvement and revenue verification. During her most recent 21 years in revenue cycle, she co-chaired the compliance committee giving her a deep appreciation for revenue integrity. The transition of the Revenue Assurance team under her leadership enhanced her involvement with the clinical departments to ensure optimal charge capture. Diane Weiss, CPC, CPB, CCP Diane Weiss, CPC, CPB, CCP, is the vice president, reimbursement, for RestorixHealth in Metairie, Louisiana. Weiss joined RestorixHealth in Metairie, Louisiana, in June 2011 which facilitated the formation of the New Orleans office revenue cycle team. Prior to joining RestorixHealth (formerly Wound Care Specialists), Weiss managed a general surgery practice for 10 years in the Greater New Orleans area where she served as practice manager and was also the surgeons in-office medical assistant. In 1995, her career moved to the payer side. She became the provider education representative for Pinnacle Medicare Services, providing CMS Medicare Part B provider education and denial management for providers throughout Louisiana and other states within the MAC jurisdiction. For those 12 years with Medicare, Weiss conducted provider education workshops, seminars, and spoke to a variety of specialty societies, coding groups and medical manager associations. She provided information and assistance with claims submission issues, denial management and effectively communicated CMS’ annual changes regarding reimbursement and coverage for Part B Providers. She also served as Ochsner Health System’s Internal Medicare Consultant for five years before joining RestorixHealth in a full-time capacity.Weiss serves as an advisory board member for NAHRI. Denise Williams, COC Denise Williams, COC, is senior vice president of the revenue integrity division and compliance auditor at Revant Solutions, Inc. She has more than 30 years of healthcare experience, including a background in multiple areas of nursing. For the past 25 years, Williams has been in the field of coding and reimbursement and has performed numerous E/M, OP surgical, ED, and observation coding chart reviews from the documentation, compliance, and reimbursement perspectives. She serves as a contributing author to articles published in HCPro’s Briefings on APCs and is a nationally recognized speaker on various coding and reimbursement topics. Williams serves as an advisory board member for NAHRI. Joseph Zebrowitz, MD Joseph Zebrowitz, MD, has focused his career on assisting hospitals in gaining a true picture of their compliance profiles through analysis and audit and advancing lasting solutions to provide enduring compliance and revenue integrity. Zebrowitz is FOUNDER AND CO-CHIEF EXECUTIVE OffiCER of Versalus Health where he has led the Versalus team in the development of an innovative approach to 2-midnight rule compliance and managed care performance. Before Versalus, Zebrowitz founded and was managing partner of Devon Hill Capital Partners. At DHCP, Zebrowitz identified and led investments in several successful healthcare startups. Before DHCP, Zebrowitz spent 12 years as executive vice president and senior medical director of Executive Health Resources (EHR), where he led the development of EHR’s compliance and revenue integrity products endorsed by the AHA as “Best in Class.” Zebrowitz regularly conducted educational sessions for EHR’s client and completed hundreds of regulatory assessment audits for EHR’s hospital clients. Prior to joining EHR, Zebrowitz was a founder and vice president of Strategic Alliances at eHealthContracts, now Concuity, Inc. Before Concuity, Zebrowitz was a practicing obstetrician/gynecologist at Abington Memorial Hospital in Pennsylvania.

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Renaissance Orlando at SeaWorld®

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