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ACDIS Workshop | The Physician Advisor’s Role in CDI Boot Camp (blr)

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Gaylord Palms Resort & Convention Center

6000 West Osceola Parkway

Kissimmee, FL 34746

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The Physician Advisor’s Role in CDI
ACDIS


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Pre-Conference: May 19-20, 2019 | Gaylord Palms Resort & Convention Center in Kissimmee, FL

CDI success hinges upon a successful partnership with physicians, with the CDI physician advisor the critical link between clinical documentation and clinical care. Join us for The Physician Advisor’s Role in CDI, the nation’s only event dedicated to the physician advisor to CDI.

Our most popular pre-conference session at the ACDIS National Conference returns for its eighth straight year, with all new content delivered by some of the best physician advisors and educators in the country. On day 1 attendees receive a heavy dose of critical coding, clinical, and regulatory updates by regulatory guru James Kennedy, MD, followed by a denials workshop by Trey LaCharite, MD, featuring effective appeals and denials prevention strategies. New this year is a hands-on, small group workshop reviewing actual denied cases.

On day 2 attendees have their choice to attend one of two tracks: our popular Physician Advisor 101: Core Skills and Responsibilities, or the all new Expanding and Innovating the Role of the Physician Advisor. This latter track features presentations by four physician advisors from the nations’ leading organizations, covering a wide range of topics including HCCs, surgical quality database improvement, malnutrition documentation initiatives, and measuring and driving success with analytics and metrics.

LEARNING OBJECTIVES

At the conclusion of this program, participants will be able to:

  • Explain the optimal role of the physician advisor in a CDI department

  • Identify critical coding, reimbursement, and regulatory changes pertinent to FY 2019 and beyond

  • Describe common reasons for payer denials and best practices for pre-emptive prevention and appeal

  • Define opportunities to improve organization-wide HCC assignment

  • Identify opportunities to expand the reach of a physician advisor, including malnutrition capture, palliative and hospice care, and surgical quality

Agenda
Day 1: Sunday, May 19, 2019

James Kennedy, Trey LaCharite

7:00 a.m. – 8:00 a.m.: Registration and Breakfast

8:00 a.m. – 10:00 a.m.: Critical CDI update: Top Plate Issues Requiring Immediate Attention

Proposed changes or published advice in the ICD-10-CM/PCS Index, Table, Guidelines, Coding Clinic for ICD-10-CM/PCS, and proposed IPPS rule impacting CDI and warranting the attention of the CDI physician advisor and leadership
Potential changes to the MS-DRG structure and CC/MCC list announced in the April 2019 IPPS rule with recommendations for comments due in June 2018
Clinical definitions affecting CDI critical thinking and workflow (e.g., updated definition of myocardial injury and myocardial infarction; evolution of sepsis-2 to sepsis-3)


10:00 a.m. – 10:15 a.m.: Break

10:15 a.m. – 11:00 a.m.: Impact of ICD-10-CM/PCS on Mortality/Readmissions/Quality Calculations

Review of how inpatient and outpatient ICD-10-CM/PCS codes affect CMS’ mortality/readmissions/ complication measures and those impacting APR-DRGs (e.g., 3M’s Potentially Preventable Complications and Potentially Preventable Readmissions)
Discussion on how to integrate quality measures in inpatient and outpatient CDI workflows


11:00 a.m. – 12:00 p.m.: Outpatient CDI Fundamentals Integrating Cost Efficiency and Quality

Outpatient ICD-10-CM/PCS rules and their differences with inpatient coding rules
Fundamentals of CMS-HCC and HHS-HCC risk adjustment
Fundamentals of MACRA/MIPS risk adjustment for physician-centric overall and episode-based cost efficiency
Immediate takeaways and implementation strategies


12:00 p.m. – 1:30 p.m.: Lunch (provided)

1:30 p.m. – 3:00 p.m.: Recovery Auditor Update: Spotlight on Clinical Validation Denials

Where we stand with healthcare recovery auditors
Review the most common clinical validation denial targets
Review the most recent changes/updates in diagnostic criteria
Review resources for appealing disease-specific clinical validation denials
How to approach and fight a recovery auditor denial


3:00 p.m. – 3:15 p.m.: Break

3:15 p.m. – 4:45 p.m.: Hands Off Our Cash! Small Group Exercise in Appeals Development

Review of actual cases where a recovery auditor has issued an MS-DRG downgrade
Understand the recovery auditor’s findings and the denial tactics employed
Appeal or not: All, some, or none?
Formulation of appeal strategies
Group review of the recovery auditor’s determinations and their appeal strategies with the class 4:45 p.m. – 5:00 p.m.: Open Q&A


5:00 p.m.: Adjourn


Day 2: Monday, May 20, 2019

Track 1: Physician Advisor 101: Core Skills and Responsibilities

Trey LaCharite

7:00 a.m. – 8:00 a.m.: Breakfast

8:00 a.m. – 9:00 a.m.: Achieving Medical Staff Buy-In

How to explain the goals of your CDI program
What your providers don’t know about their documentation and their data
What your providers don’t know about your facility
How to explain why CDI is crucial for your providers’ future and their facility


9:00 a.m. – 10:00 a.m.: Ready, Set, Intervene! Managing Problems, Pitfalls, and Personality Disorders

Understanding the obstacles you and your program will face
10 rules for ensuring CDI program success
Strategies to improve medical staff compliance
Practical suggestions for that difficult provider conversation


10:00 a.m. – 10:15 a.m.: Break

10:15 a.m. –11:00 a.m.: Well … What Should I Be Putting in the Chart?

Review the basic documentation practices every provider should routinely employ
Review best practices for operative note construction
Helpful documentation practices to ensure medical necessity and correct hospital status determinations
Learn strategies to encourage provider adoption of new documentation habits


11:00 a.m. – 12:00 p.m.: Stay Within the Lines! How to Conduct a Compliant CDI Program

Understand CMS’ “Double Jeopardy” for hospitals
10 rules to stay on the straight and narrow
Review acceptable CDI query construction practices
Review when provider queries are needed


12:00 p.m. – 1:30 p.m.: Lunch (on your own)

1:30 p.m. – 3:00 p.m.: Stop, Drop, and Roll! Managing the Unexpected Fires

The impact of your CDI program on other hospital departments
Review EMR-specific risks for your CDI program
Why your facility is a recovery auditor target
Learn specific recovery auditor tactics employed to issue denials
Handling other unanticipated problems in CDI


3:00 p.m. – 3:15 p.m.: Break

3:15 p.m. – 4:30 p.m.: Practical Considerations: CDI Team Structure and PA Position Development

Suggestions for CDI team composition, organization, and how to get them up to speed
The other roles of the active and involved CDI physician advisor
Who should be your CDI program’s physician advisor?
Review successful CDI physician advisor characteristics
Review potential physician advisor time requirements and how to get paid


4:30 p.m. – 5:00 p.m.: Open Q&A

5:00 p.m.: Adjourn


Track 2: Expanding and Innovating the Role of the Physician Advisor

Brett Senor, Beth Wolf, Megan Cortazzo, Sam Antonios

7:00 a.m. – 8:00 a.m.: Registration and Breakfast

8:00 a.m. – 10:00 a.m.: HCCs for the Physician Advisor. Brett Senor, Enjoin.

The importance of proper risk adjustment for
patient budget/resource allocation
provider reputation and reimbursement
system reimbursement
CMS-HCC risk adjustment model and how it is utilized by Medicare Advantage and MSSP-ACOs
Physician Advisor role in helping inpatient and ambulatory CDI in capturing HCCs
How health systems can optimize divisions of labor among PAs to improve capture of risk adjustment opportunity


10:00 a.m. – 10:15 a.m.: Break

10:15 a.m. – 12:00 p.m.: Surgical Quality Databases; Expansion to Palliative and Hospice Care. Beth Wolf, Roper St. Francis Healthcare.

Review thoracic, general, and vascular surgery quality database initiatives
Recognize differences in documentation requirements and risk adjustment
Support efforts to improve surgical care while retaining the codified health data integrity
Articulate the importance of palliative medicine in healthcare
Establish medical necessity and recognize key conditions impacting prognosis 12:00 P.M.—1:30 P.M.: Lunch (provided)


1:30 p.m. – 3:00 p.m.: Electronic Capture of Malnutrition; Preventing Physician Burnout. Megan Cortazzo, UPMC.

CDI/documentation requirements, and CMS probe and educate audits, for malnutrition diagnoses
How malnutrition diagnoses impact revenue, risk adjustments for CMS penalty programs (readmissions, mortality, HAC, PSI)
Leveraging dietitians’ documentation to supplement physician documentation, help with reduced paperwork for physicians
Utilizing other teams and technology to help sell a CDI program to physicians


3:00 p.m. – 3:15 p.m.: Break

3:15 p.m. – 4:45 p.m.: Metrics and Analytics. Sam Antonios, Via Christi Health.

Understand main metrics that drive performance of a CDI program
Understand how to examine certain operational metrics using analytical tools and benchmarking
Review potential for advanced analytics in advancing hospital reimbursement and quality


4:45 p.m. – 5:00 p.m.: Open Q&A

5:00 p.m. – Adjourn


Speakers

Sam Antonios, MD, MMM, FACP, SFHM, CPE, CCDS

Sam Antonios

Sam Antonios, MD, MMM, MD, MMM, FACP, SFHM, CPE, CCDS, is the chief medical officer and the medical director for information systems at Via Christi Health in Wichita, Kansas, having experience in leadership roles as the medical director for utilization management, CDI, and technology deployments and analytics. In his role as chief medical officer, he oversees staff functions, strategy, and quality initiatives. Antonios is also a member of the ACDIS Advisory Board.


Megan Cortazzo, MD

Megan Cortazzo, MD

Megan Cortazzo, MD, is an assistant professor of physical medicine and rehabilitation at the University of Pittsburgh School of Medicine, and currently serves as the Medical Director CDI and HIM for the University of Pittsburgh Medical Center (UPMC). Prior to that role, she served as Vice Clinical Chair of outpatient services for the department of physical medicine and rehabilitation.


James S. Kennedy, MD, CCS, CDIP, CCDS

James S. Kennedy, MD, CCS, CDIP, CCDS

James S. Kennedy, MD, CCS, CDIP, CCDS, is the founder and president of CDIMD, a Nashville- based physician and facility advisory and consulting firm that advocates ICD-10-pertinent clinical documentation and coding integrity essentials to healthcare revenue cycles and quality measurement. As a coding and CDI expert with more than 17 years of experience and as a frequent speaker to medical staff, HIM, and CDI associations, Kennedy is nationally recognized for his subject matter expertise, communication skills, and problem-solving approach. He is a past ACDIS Advisory Board member.


Trey La Charité, MD, FACP, SFHM, CCS, CCDS

Trey La Charité, MD, FACP, SFHM, CCS, CCDS

Trey La Charité, MD, FACP, SFHM, CCS, CCDS, is the medical director for CDI and coding at the University of Tennessee Medical Center (UTMC) in Knoxville, Tennessee. A past ACDIS Advisory Board member, La Charité is a regular presenter at the ACDIS pre-conference physician advisor boot camp. Besides being a hospitalist, he is a clinical assistant professor of internal medicine and is the curriculum director of the residency program’s hospitalist rotation. He is the medical director of the outpatient CDI initiative for UTMC’s primary care network.


Brett B. Senor, MD, CRC, CCDS

Brett B. Senor, MD, CRC, CCDS

Brett B. Senor, MD, CRC, CCDS, is a Physician Associate for Enjoin, where he provides guidance and support for CDI quality initiatives and MS-DRG assurance programs. He is board-certified in internal medicine and has served as a hospitalist and physician advisor for a large metropolitan healthcare system in North Carolina. In his current role with Enjoin, he assists in the development of content and provides education and training to support the quality and risk- adjustment service lines, working with providers, clinical documentation improvement specialists, and coders.


Beth Wolf, MD, CCDS, CPC

Beth Wolf, MD, CCDS, CPC

Beth Wolf, MD, CCDS, CPC, is the medical director of HIM at Roper Saint Francis Healthcare in Charleston, South Carolina. Wolf is a practicing physician with 18 years of experience, currently working in a 657-bed not-for-profit hospital system with nearly 800 physicians on staff. As a leader, physician, and CDI professional, Wolf improves data reliability and aligns CDI efforts with physician and system priorities. She specializes in palliative medicine and understands the importance of an accurate patient story; to the patient, the clinicians, the hospital, and the payers. Wolf is board certified in clinical informatics and serves as a physician consultant for 3M.



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Date and Time

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Gaylord Palms Resort & Convention Center

6000 West Osceola Parkway

Kissimmee, FL 34746

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Refund Policy

No Refunds

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