2010 NHIA Annual Conference & Exposition

Reimbursement Track

Monday, April 12

1:45 – 3:15 p.m.

3-A. Improving Your Success with Medicare Reimbursement

 

 

Faculty: Pamela Dentino Olson, Corporate Reimbursement Manager, Walgreens-OptionCare, Gurnee, IL; and Sherry Owens, Regional Reimbursement Manager and Monica Williams, Regional Reimbursement Supervisor, Walgreens-OptionCare, Dallas, TX

Continuing Education Contact Hours:
Pharmacy and Nursing—1.5
ACPE #
VNA#

• Discover the options for home infusion delivery within the Medicare program today—including best practices for ensuring adequate reimbursement of infusion therapies provided within the scope of Medicare Parts B and D.
• Grasp what specific medical documentation is required prior to start of care, claim submissions and/or appeals—and acquire vital communication strategies to utilize with referral sources to assure you proactively obtain such needed documentation.
• Take home tools that will help you identify and navigate the most common obstacles in submitting Medicare claims and collecting payments.

Objectives:

1. List techniques for ensuring reimbursement of therapies billable to Medicare B, beginning with intake and concluding with receipt of payment.
2. Describe the process flow for managing a Medicare D home infusion patient from intake to payment.
3. Identify the most common obstacles to successful payment for care rendered to Medicare beneficiaries.

Tuesday, April 13

10:45 – 11:45 a.m.

7-B. Understanding and Reducing The Costs Of Billing and Getting Paid

 

 

Faculty: Pete Tanguay, President, Rock-Pond Solutions, Conway, AR

Continuing Education Contact Hours:
Pharmacy and Nursing — 1.0
ACPE #
VNA#

• Realize the opportunities that exist for improved operational efficiency within your reimbursement department.
• Examine metrics that can be used to measure the effectiveness of operational process improvements.
• Receive tools and techniques that you can apply in your own organization to reduce the internal costs of the reimbursement department.

Objectives:

1. Review the reimbursement process from patient referral through payment for services.
2. Identify and explain the fixed and variable reimbursement costs.
3. Identify and explain the most common factors that contribute to increasing or decreasing reimbursement cost.
4. Provide cost reduction strategies with specific measurement targets.

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3:15 – 4:45 p.m.

11-C. Reimbursement Operations and Rapid Change: A Crash Course in Express Modifications

 

Faculty: Louise Mock, Director of Financial Services, Vital Care Inc., Meridian, MS

Continuing Education Contact Hours:
Pharmacy and Nursing — 1.5
ACPE #
VNA#

• Analyze the options for organizing your reimbursement department—reviewing the strengths and weaknesses of each, as you identify opportunities for quick and meaningful changes.
• Evaluate the impact of standardizing operational processes within the reimbursement department.
• Learn how to create assessment tools that will provide transparency of operations and allow process updates and improvements on the fly.

Objectives:

1. Identify reimbursement work flow process pros and cons via case study analysis.
2. Describe several useful forms of standardization in a reimbursement department.
3. Discuss tools that can be used to increase the transparency of reimbursement operations.

Wednesday, April 14

10:45 a.m. – 12:15 p.m.

15-D. Revenue Cycle Quality Assurance Techniques—Are You Prepared For An Audit?

 

Faculty: Judith Rooney, RN, MSHL, CHC, Senior Vice President & Chief Compliance Officer, Chartwell Diversified Services, Inc., Ballston Spa, NY; and Cynthia Watson, Director of Reimbursement, Coram Infusion Services, an Apria Healthcare Company, Denver, CO

Continuing Education Contact Hours:
Pharmacy and Nursing — 1.5
ACPE #
VNA#

• Gain valuable insights into the benefits that a revenue cycle-focused quality assurance program can bring to your organization.
• Take home practical information you can apply to “audit proof” your own reimbursement practices.
• Walk through unfavorable audit results—learning proactive steps you can take to prevent this from happening at your organization.

Objectives:

1. Understand why providers are accountable for sound revenue cycle practices.
2. Discuss how a revenue cycle quality assurance program can benefit your organization.
3. Identify the differences between auditing and monitoring.
4. Describe quality assurance best practices that have been proven successful.
5. Describe three (3) common unfavorable audit results and how to avoid them.

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2:45 – 3:45 p.m.

19-E. Mastering Specialty Pharmacy Reimbursement Challenges

 

 

Faculty: Rodney Wright, President, Tanyr Healthcare, LLC., Southlake, TX

Continuing Education Contact Hours:
Pharmacy and Nursing — 1.0
ACPE #
VNA#

• Understand the term “specialty pharmacy” from a historical perspective—where did it come from, what has it evolved to mean today and how might this impact the traditional home infusion therapy (HIT) provider.
• Discuss difficulties faced by HIT companies when delivering therapies customarily considered in the specialty pharmacy space.
• Strategize steps you can take to overcome specialty pharmacy market challenges to service the full spectrum of infusion therapy patient needs.

Objectives:

1. Differentiate between home infusion pharmacy and specialty pharmacy medications and services.
2. Describe two challenges home infusion providers face in the specialty pharmacy market.
3. List 3 methods for overcoming specialty pharmacy market challenges.

Thursday, April 15

9:00 – 11:00 a.m.

23-F. Billing and Collection 101: Best Practices for Commercial Reimbursement Success!

 

Faculty: Lynda Clay, Director of Medicare & Medicaid Reimbursement, Critical Care Systems, Nashua, NH; Pamela Dentino Olson, Corporate Reimbursement Manager, Walgreens-OptionCare, Gurnee, IL; Linda Payne, President, Reimbursement Concepts, Weirton, WV; Pearl Shores, MBA, Shores Enterprises, Escondido, CA; and Clay Stribling, Esq., Attorney, Brown & Fortunato, PC, Amarillo, TX

Continuing Education Contact Hours:
Pharmacy and Nursing — 2.0
ACPE #
VNA#

• Join this experienced panel for a case study-based presentation on the best practices of foundational billing and collection techniques.
• Obtain strategies for successful intake, billing and collections activities when working with commercial payors.
• Review federal regulations that govern claims collection practices—and how to familiarize yourself with state-specific collections law.

Objectives:

1. Review the key factors that impact successful reimbursement from commercial insurers.
2. Examine and critique a best practices case study for intake documentation.
3. Discuss successful claims collection techniques that incorporate federal claims collection laws.
4. Examine and critique a best practice case study for claims collections.

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11:15 a.m. – 12:15 p.m.

27-G. Effectively Transitioning from ICD-9-CM to ICD-10-CM

 

 

Faculty: Marcia Castillo, RHIT, CCS, Surveyor & Auditor, DNV Healthcare, Amarillo, TX

Continuing Education Contact Hours:
Pharmacy and Nursing — 1.0
ACPE #
VNA#

• Differentiate between the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) and the ICD-10-CM (Tenth Revision) diagnosis coding systems, from both historical and forward-looking perspectives.
• Recognize the challenges associated with a comprehensive diagnosis coding system overhaul—as seen from both provider and payor points of view.
• Understand key steps that should be taken to prepare your organization for the rapidly approaching conversion from ICD-9-CM to ICD-10-CM.

Objectives:

1. Describe the benefits of, and challenges anticipated with, transition to ICD-10 coding.
2. Compare differences between ICD-10 and ICD-9 coding systems.
3. List the steps that can be taken to facilitate a successful transition to ICD-10.

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2:15 – 3:45 p.m.

31-H. Productively Billing and Collecting from TRICARE—What You Need to Know!

 

Faculty: Cynde Derryberry, Director of Reimbursement, Infusion Partners, LLC., Division of Critical HomeCare Solutions, Decatur, IL; and Bruce E. Rodman, MBA, Vice President, Health Information Policy, National Home Infusion Association, Libertyville, IL

Continuing Education Contact Hours:
Pharmacy and Nursing — 1.5
ACPE #
VNA#

• Receive an overview of TRICARE (the military’s health care program that covers care outside of military facilities) and its associated reimbursement methodology—inclusive of the coverage benefits related to home infusion therapy.
• Devise strategies for quickly identifying and addressing a variety of common TRICARE reimbursement challenges, in order to attain successful claims adjudication with this payor system.
• Hear an update regarding industry-wide advocacy efforts with the Department of Defense to further enhance appropriate alternate-site infusion therapy coverage for TRICARE beneficiaries.

Objectives:

1. Explain the TRICARE Management Activity (TMA) healthcare services.
2. Review TRICARE reimbursement methodology.
3. Describe TRICARE Coverage Benefits as they relate to home infusion therapy.
4. Develop strategies for identifying and responding to potential reimbursement challenges with TRICARE benefits as patients are admitted to service.
5. Describe industry advocacy efforts with regards to Tricare coverage of home infusion therapies.