• What are the government's chief points of interest when it examines the activities of health care providers?
• What should your organization do to ensure it can stand up to the scrutiny of government investigators?

This course provides information that can help you achieve outpatient revenue integrity including:

• An expanded version of Outpatient Prospective Payment System (OPPS) updates
• Changes CMS has in store for hospitals in 2011
• Tips for being better prepared to meet challenges

Learn more about the wide variety of CPT^® code changes for 2011 in this presentation which will:

• Focus on codes not discussed in other specialty-specific sessions
• Provide an overview and explanation of added, changed, and deleted codes
• Prepare the coder to implement the code changes

Certified electronic health records (EHR) technology used in a meaningful way is one piece of a broader Health Information Technology (HIT) infrastructure intended to reform the health care system. Under the HITECH Act, the Medicare EHR incentive programs provide payments up to $44,000 over five years to eligible professionals who are "meaningful" users of certified EHRs and the Medicaid EHR program provides even bigger incentives—up to $63,750 over five years to practices with a 30 percent or higher Medicaid population.

Attend this two-part session to learn more about:

• Health outcomes policy priority, care goals, objectives, and measures
• How you may already be meeting meaningful use criteria and what else you have yet to accomplish
• How to implement the EHR and achieve meaningful use

As a current EncoderPro.com user, you possess valuable insight and knowledge you can share with other users and with us. Our mission is to form a network of users to share information, solutions, and their experience. The EncoderPro.com user group helps guide the direction of the product. Network with other users as we share product tips and shortcuts, new solution strategies, and user success stories that will help you maximize your investment. Take a few minutes to tell us what you'd like covered in the upcoming user group meeting by taking this survey.

This course provides a summary of the many exciting changes in Medicare’s 2011 Inpatient Prospective Payment System (IPPS). Where Medicare leads, other payers are sure to follow. Get valuable information on new initiatives that will affect all hospitals including:

• Continuing severity DRG enhancements
• Documentation/coding changes for severity DRGs
• Major changes to the DRG weights that will affect your bottom line
• Expansion of Hospital Acquired Conditions—more conditions, other settings
• More extensive quality reporting
• More quality data available publicly
• Value-based purchasing program
• Further reductions in capital reimbursement
• Possible changes in IME and DSH
• New requirements for Medicare Advantage
• Major changes to the wage index
• Focus on re-admissions and post-acute care
• Medicare and more payers refusing to pay for “never events”

A continuation of Part I, this course provides information that can help you achieve outpatient revenue integrity including:

• An expanded version of OPPS updates
• Changes CMS has in store for hospitals in 2011
• Tips for being better prepared to meet challenges

Can it be true? CMS recently announced that 31 clinical registries qualified for 2010 PQRI, making reporting simple and easy. This session will examine claims and registry options. Learn more about:

• Individual and group measures
• How to report using registry (with or without an electronic record)
• Examples of a registry wizard
• How to capture quality information in your day-to-day workflow

Certified electronic health records (EHR) technology used in a meaningful way is one piece of a broader Health Information Technology (HIT) infrastructure intended to reform the health care system. Under the HITECH Act, the Medicare EHR incentive programs provide payments up to $44,000 over five years to eligible professionals who are "meaningful" users of certified EHRs and the Medicaid EHR program provides even bigger incentives—up to $63,750 over five years to practices with a 30 percent or higher Medicaid population.
Attend this second session to learn more about:

• Health outcomes policy priority, care goals, objectives, and measures
• How you may already be meeting meaningful use criteria and what else you have yet to accomplish
• How to implement the EHR and achieve meaningful use

In October, the WHO will publish the 2011 update for ICD-10-PCS. Join us for a discussion on new, revised, or deleted codes and ICD-10-PCS index changes as well as

• New files, which may include:
• MDC 6 of MS-DRGs Definitions converted to ICD-10 codes
• ICD-10 Reimbursement Mappings
• PCS Final Addenda for 2010
• ICD-10-PCS Body Part Key
• Updated files, which may include:
• ICD-10-PCS to ICD-9-CM General Equivalence Mapping (GEM)
• ICD-9-CM to ICD-10-PCS GEM
• ICD-9-CM to ICD-10-PCS GEM Documentation and User’s Guide

Each year, the HHS Office of Inspector General (OIG) presents a detailed plan of its work for the following year, providing the public with a glimpse into the issues that the government is most concerned about. Health care professionals who familiarize themselves with the content of the OIG Work Plan gain a wealth of information and insight on which risk areas they should closely examine in their own facilities.

This course will answer the questions:

• What are the government's chief points of interest when it examines the activities of health care providers?
• What should your organization do to ensure it can stand up to the scrutiny of government investigators?  

Only about 12 percent of practices take advantage of the e-prescribing bonus offered by the government. E-prescribing is not only affordable and easy to implement, but it also provides multiple benefits to patients and practices. This session will:

• Explain e-prescribing as part of an EHR system or standalone system
• Describe the simple implementation steps
• Define what makes a qualified e-prescribing system
• Demonstrate how you can get started right away and earn your additional bonus for 2011

Increase your clinical coding skills by understanding how the changes to
ICD-9-CM diagnosis codes will affect your coding processes. This in-depth presentation provides you with details concerning the practical application of the new and revised diagnosis codes and coding instruction. Make sure you understand the impact on your coding practices and your bottom line by attending this session which will focus on:

• The rationale for the new and revised diagnosis codes
• How changes in the instructional notes will affect coding
• What everyone needs to know about using the new diagnosis codes correctly
• An overview of official coding guideline changes

2011 may bring several hundred CPT^® and HCPCS code revisions, many of which will be generated from the chargemaster. This information-packed program will focus on updating the facility’s chargemaster for 2011, reporting requirements, and new challenges facing hospitals as well as:  

• Provide a crosswalk of deleted codes to new replacement codes
• Offer recommended revenue code assignment
• Review new CPT^® and HCPCS codes for pharmacy, radiology, laboratory, rehabilitation services, and other ancillary departments reporting services provided from the chargemaster

Don't leave your coding future to Lady Luck. Attend this session and learn how to use your ICD-9-CM coding skills to map to ICD-10 coding and be "ready and able" prior to October 1, 2013. Experience this dynamic training session that will:

• Help coding professionals to become comfortable and proficient in converting to the ICD-10-CM and ICD-10-PCS coding systems
• Focus on engaging the participants with in-class ICD-10-CM and ICD-10-PCS hands-on mapping exercises

Consumer-driven health care is the most noteworthy developments in health insurance since the widespread adoption of health maintenance organizations and preferred provider organizations in the 1980s. Recently, more and more insurers are converting to this method of coverage. The most common consumer-driven health plan is the high-deductible health plan, which is essentially a catastrophic health insurance plan, often linked with tax-advantaged spending accounts (HSAs), with very high deductibles, fewer benefits, and higher cost-sharing than conventional health maintenance organization or preferred provider organization plans. Attend this course to learn:

• The difference between an HSA and an HRA
• What changes the recently passed Health Care Reform Act is requiring
• How these options impact you
• How these options impact your employer
• How these options impact your patients

We’ve gone a year without Medicare Consultations, what’s next? Join this course to explore questions including:

• How are we doing?
• What have we learned?
• Where is our revenue?
• What does the documentation look like?

A continuation of Part I, in-depth continuation of the 2011 CPT^® and HCPCS code revisions will be reviewed, offering attendees more time to review new, deleted, and revised codes impacting the chargemaster. Part II will also continue with the discussions for:

• Pharmacy, radiology, laboratory, rehabilitation services
• Other ancillary departments reporting services provided from the chargemaster

Each year, CMS adds more procedure codes for the acute care setting. These new and revised ICD-9-CM Volume 3 procedure codes represent not only new technologies, but also further differentiate between existing codes and other related services. This session will provide information related to:

• New procedure codes, the documentation required for assignment, and each code’s effect on DRG assignment
• Movement of procedure codes among DRGs, the impact on reimbursement, and how to assess the total facility impact, particularly for high-volume procedures
• Clinical background for each new procedure code, including what coders should expect to see in physician documentation and specific strategies to differentiate between similar services
• New and revised procedure codes that may be considered “non-OR procedures” and may be performed in areas other than the operating room but that affect DRG reimbursement

In this session, we will explore updates to HCPCS Level II codes for 2011. The Health Insurance Portability and Accountability Act (HIPAA) requires these codes for Medicare and all third-party payers for reporting and reimbursement of supplies, drugs, and some professional services. Attendees will:

• Learn about new HCPCS codes and their regulatory changes and associated policies
• Be introduced to reimbursement policies applicable to the new codes
• Discover more about the 2010 RBRVS and CMS mandates from the November Federal Register

Medical necessity is vital, but what happens if the history is lacking? The mysteries of the history component will vanish with this eye-opening session that provides answers to questions such as:

• What elements of the history should be detailed?
• What can be done if we can’t get history elements?
• What makes a history complete?

As a current EncoderPro.com user, you possess valuable insight and knowledge you can share with other users and with us. Our mission is to form a network of users to share information, solutions, and their experience. The EncoderPro.com user group helps guide the direction of the product. Network with other users as we share product tips and shortcuts, new solution strategies, and user success stories that will help you maximize your investment. Take a few minutes to tell us what you'd like covered in the upcoming user group meeting by taking this survey.

ICD-9-CM diagnosis coding and associated physician documentation drives Medicare’s HCC reimbursement model. Health plans, regulators and physicians are all focusing on the components of compliant and accurate HCC revenue. This session will provide:

• Insight into HCC risks and rewards with emphasis on ICD-9-CM diagnosis coding challenges
• Physician documentation best practices
• RADV audit mitigation

You are now accustomed to the fact that ICD-10 will soon be a reality and, you've probably started the implementation process. Unlike other ICD-10-CM educational training courses, this session will take you beyond what you may have learned so far. Join us for an overview of the new classification and learn more about:

• Benefits of ICD-10
• Specificity benefits—examples and practical application
• Correct mapping

This session will discuss the wide variety of CPT^® code changes for 2011 and:

• Focus on codes not discussed in other specialty-specific sessions
• Provide an overview and explanation of added, changed, and deleted codes
• Prepare the coder to implement the code changes

Increase your clinical coding skills by understanding how the changes to
ICD-9-CM diagnosis codes will affect your coding processes. This in-depth presentation provides you with details concerning the practical application of the new and revised diagnosis codes and coding instruction. Make sure you understand the impact on your coding practices and your bottom line by attending this session which will focus on:

• The rationale for the new and revised diagnosis codes
• How changes in the instructional notes will affect coding
• What everyone needs to know about using the new diagnosis codes correctly
• An overview of official coding guideline changes

As a current RevenueCyclePro.com user, you possess valuable insight and knowledge you can share with other users and with us. Our mission is to form a network of users to share information, solutions, and their experience. The RevenueCyclePro.com user group helps guide the direction of the product. Network with other users as we share product tips and shortcuts, new solution strategies, and user success stories that will help you maximize your investment.

Practice administrators must obtain meaningful data quickly. Which reports do they really need?  We must “inspect” to achieve what we “expect”. To do this, we need to understand monthly practice management reports.

Key indicator reports compare results and highlight variances. Key indicator
reports are essential to the management of a medical practice.  Ingenix’s CareTracker Practice Management System provides dashboard analytics.

This session will include a review of efficient reporting tools, types of reports, and areas to watch on a monthly basis to keep your practice running efficiently.

Learning Objectives:      

• Types of reports to choose from
• How to interpret data to quickly spot “red flags”
• Turning information into improvement

Moving to an electronic medical record (EMR) for documenting and capturing clinical care opens up many exciting possibilities, yet creates many new challenges. Given the numerous workflows and variety/types of users and business units that rely on the EMR, it is critically important to produce data that is of the highest integrity. This session will focus on:

• The EMR's impact on day-to-day processes and operations—from the time the service is rendered to when the payment is received
• Managing overall coding and documentation quality, accuracy, and thoroughness
• Analyzing workflows
• Auditing and monitoring outcomes from many different perspectives
• Education and training to ensure the EMR's success.

Your physician may be paid based on the CPT^® codes billed, but proper ICD-9-CM and compliance with HIPAA coding standards are equally important when it comes to getting claims paid. Learn the top bad habits in diagnostic code selection, how to work with your physicians to attain a higher degree of accuracy and compliance in your coding, and how all of this will be affected with ICD-10. In this course, participants will:

• Understand the nuances of ICD-9-CM code assignment and discover how to pinpoint coding guidance in the index, tabular section, appendices, and tables within the code book
• Learn why coding just enough to meet medical necessity requirements is not enough
• Understand some of the most common advanced diagnostic coding errors

Two experienced health care professionals will host a lively discussion around some of the issues in the electronic health record (EHR) environment including legal ramifications. Get perspective from the Veteran's Association through their implementation story and how they monitored the process. Are you ready to hit your own jackpot? In this session we'll cover:

• Legal ramifications of inappropriate use of the functions within your EHR
• A simple, approved solution to resolve compliance issues
• Successes realized from implementation and ways to monitor the process

Many hospitals, clinical staff, billers, and HIM coordinators are now intimately involved with the facility’s chargemaster. Whether a seasoned chargemaster coordinator or an entry-level director, attendees can benefit from this workshop’s focus on basics of the chargemaster and review tools needed to keep this vital document up-to-date. Bring your chargemaster to this workshop, which will cover the daily challenges facing chargemaster coordinators, and include:

• Actual department chargemaster examples
• Demonstrations of the required resource tools and Internet websites
• Instruction on how to conduct a chargemaster review
• Strategies for auditing the UB-04, the window into the well-functioning chargemaster

Become an internal “RAC auditor” and in turn, learn to perform complex reviews on outpatient claims to include ambulatory surgery, ED and ancillary/OPD encounters. Will you approve or deny the claim? What will be your stance? Units, orders, medical necessity, Modifier 25? What will be the reimbursement impact? So many questions, so much to learn. Why wait for the RAC auditors to arrive? Take this opportunity to learn how to:

• Perform complex audits
• Identify risk
• Develop your own internal auditing process
• Better understand the outpatient revenue cycle and the importance of internal auditing for your facility.

Hospitals and providers face the most intense scrutiny from Medicare’s RAC program. Many hospitals have been readying themselves for the onslaught of RAC placing emphasis on inpatient medical necessity appropriateness and DRG assignment accuracy. Outcomes of the demonstration state project as well as results derived from RAC readiness assessments provide guide posts for hospital revenue integrity teams. This session will:

• Present results of nationwide RAC reviews (both medical necessity and coding)
• Offer tools and recommendations for performance improvements

This workshop is designed to prepare and train individuals for the transition from ICD-9-CM to ICD-10-CM and ICD-10-PCS. We will focus on the basic fundamentals of each code set, including the structure and conventions and guidelines with specific chapter and section overviews, emphasizing what is the same and what is different. We will also demonstrate how to apply the guidelines to case scenarios to reinforce the concepts presented. This is a must-attend session for those that must be fully knowledgeable in the code set or are responsible for training others. Strong ICD-9-CM skills and knowledge is a prerequisite to the course.

Part One

1. Introduction and status of ICD-10-CM and PCS drafts
2. ICD-10-CM overview and structure
3. Focus on 7th character and placeholder concepts
4. Coding conventions and guidelines and how they differ from ICD-9-CM
5. Chapter overview with emphasis on those with new concepts and those that are different from ICD-9-CM
6. ICD-10-CM case studies and wrap-up

Part Two

1. ICD-10-PCS overview and structure
2. Coding conventions and guidelines how they differ from ICD-9-CM
3. Using the index and constructing codes from the tables
4. Medical and surgical section overview
5. Root operation definitions and application emphasizing terminology differences from ICD-9-CM
6. Overview of medical/surgical-related section
7. Review of the ancillary sections
8. ICD-10-PCS case studies and wrap-up

President Lyndon Johnson signed the Medicare and Medicaid programs into law July 30, 1965, and Medicare became effective July 1, 1966. Much has changed since those early days, now, Medicare is the nation’s largest health insurance program, covering about 44 million Americans primarily age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The Centers for Medicare & Medicaid Services (CMS) has primary responsibility for the management of the Medicare program and CMS contracts with insurance companies to process claims for services.

Why is the Medicare program so difficult to understand? If you have chosen health care as a new career opportunity or are a seasoned provider, this half-day program will explore coverage issues for Part A, B, C, D, and other program benefits. Join us to discuss topics including:

• Fee schedules
• Coverage determinations
• UB-04 and CMS-1500 claim forms
• CCI edits