Monday-Wednesday, JULY 10 – 12, 2017
Hampton Inn – Richland, WA
Sarah Mendiola, Washington & West
Part 1: Denials Management Starts with Patient Access
From Patient Access to Managed Care Contracting, this is a three part series which will provide tools to navigate the complex world of denials management and strategies to maximize revenue recovery. Methods to effectively combat denials due to lack of authorization, patient ineligibility, pre-existing condition exclusions, untimely submission of claims, underpayments, and inappropriate payer discounts will be presented. You will learn the knowledge of Patient Access challenges that can lead to denials; & solutions for overcoming these challenges, including how to craft your strongest appeal letter to maximize success.
Part 2: Understanding the Impossible, Medicare Advantage
More than 30% of beneficiaries are enrolled in a Medicare Advantage plan. The rules these plans create and the rules they have to follow are a hybrid of commercial insurance standards and Medicare regulations, and knowing those rules are key to getting claims paid and denials overturned. You will learn how the financial structure of Medicare Advantage can turn denied claims into a major revenue source for plans; How Medicare policies—like the Two-Midnight Rule and Rebilling-filter into Medicare Advantage; How joining a plan’s network can limit a provider’s appeal rights and why it may be in a provider’s best interest not to contract in some instances; & How providers can reduce Medicare Advantage denials and maximize appeal successes.
Part 3: Catching up with Commercial Payers through Contract Management
In order to understand how the contract terms impact a Provider’s ability to achieve appropriate payment for the services delivered, it is essential that the contract terms anticipate the tactics of payers, contain terms fair to both parties, and give Providers strong appeal and enforcement rights. During this interactive workshop, attendees will work in small groups and analyze actual contract terms for strengths and weaknesses in the provisions. After small group review, we will discuss each provision with the group as a whole and determine how the language could be changed to be fairer to the Provider. This presentation has often led to lively discussions!
Jim Sheldon-Dean, Lewis Creek Systems
HIPAA Guidance Update: Providing Access to Individuals and Communicating with Family & Friend
Overview of HIPAA Regulations: Learn the origins and purposes of HIPAA including the Privacy and Security Rule History and Objectives. Learn what the Breach Notification Requirements are including the benefits and results.
Access to PHI—A Priority Topic at HHS: Learn what the Patient Rights of Access is including The Access and Amendment Processes, Also learn what is involved with the Patient Rights and Communications. What is the latest guidelines from the 2016 HHS Guidance on Access of PHI, and updates? You will gain knowledge of the Individual Access and the 21st Century Cures Act and how that will impact you.
Communications Issues with Individuals, Family, and Friends, and the organization: Learn about the Individual Rights in regards to Communications and how to deal with new technologies like texting. Learn what is the Allowable Disclosures for Payment Purposes, and guidance on communications with family and friends. The Bigger Picture: Leaning from the Mistakes of Others: Don’t repeat the same mistake by learning the issues identified in breaches, audits and enforcement actions. Learn about the emerging issues with business associates and hackers.
Manda Scott, Virginia Mason Memorial
Leading through Healthcare Changes and Challenges
Understanding yourself and others are key to achieving personal and professional success. With healthcare organizations experiencing drastic change, how do leaders support their teams to promote a positive work environment and keep themselves sane? In this session you will be able to: Understand change and transition, Identify the phases of transition management, Use techniques to coach others, Understand your own communication style and recognize the style and needs of others.
Andrew Busz, WSHA
Get the latest legislative update from the Washington State Hospital Association and how will it impact your facility.