West Texas Regional Meeting

Agenda and Information

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Up to 7.5 CPE Credits Available
Sponsored by the Lone Star Chapter of HFMA, Sponsor#1140. All sessions are presented as Group Live and there are no prerequisites.

Conference Location:
International Cultural Center
Texas Tech University
601 Indiana Ave. | Lubbock, Texas 79401
map | directions

Thursday, October 6, 2011

7:30 - 8:15 am Registration & Continental Breakfast

8:15 - 9:15 am

Creating an Engaged Workforce
Course 1110-01 | CPE: 1.0 | Level: Intermediate | No Prerequistes

Course Description: Changes in healthcare continue to challenge leaders to become more transformational and learn how to leverage the power of effective teams in the workplace. Leaders must know how to engage the wisdom of their employees and help all levels in an organization understand their contribution to mission, vision and values. Leaders must demonstrate authenticity and learn new skills to accomplish their goals in a complex, ever-changing environment.

Learning Objectives: After this session, attendees will be able to (1) Create a shared purpose and focus for the day; (2) Gain a better understanding of self and others; (3) Learn about how we can apply knowledge of our DiSC style; (4) Reinforce the leader’s role in organizational performance; (5) Gain an understanding of how to involve employees and colleagues in creation of an engaged workforce.

Target Audience: Healthcare Leaders

Dorothy Sisneros - Founder and Partner, Thunderbird Leadership Consulting |Dorothy Sisneros is the founder and a Managing Partner of Thunderbird Leadership Consulting. Prior to Thunderbird’s formation in 2007, Dorothy was the founder and principal of Sisneros and Associates (1999). Dorothy knows the power of effective teams in the workplace and she is skilled at guiding leaders to engage the wisdom of their employees; helping people at all levels understand their contribution to mission, and assisting leaders to develop the authenticity and skills to accomplish their goals in a complex environment. While the majority of Dorothy’s work over 30 years (as an employee and then as a business owner) has been with hospitals, physician practices and clinics, she has also worked extensively within higher education in the community college system. Dorothy has extensive experience in service excellence, leadership, strategic planning, talent management and organizational dynamics. She has served in a variety of leadership roles including Director of Cardiac/Pulmonary Rehabilitation, Department Chair/Faculty and District Director of Executive Talent/Succession Planning. Dorothy is a seasoned executive coach, facilitator, trainer, and strategic partner. Dorothy earned a B.S. in Education, M.S. and M.B.A. She is a DiSC facilitator and a member of SHRM and ASTD. She is a Founding Fellow of the American Association of Cardiovascular and Pulmonary Rehabilitation.

9:15 - 9:30 am Refreshment Break

9:30 - 10:45 am

Medicare Cost Report Appeals and CMS Ruling 1498-R
Course 1110-02 | CPE: 1.5 | Level: Intermediate | Prerequisites: Basic knowledge of the Medicare Cost Report Appeals process

Course Description:This discussion is intended to take a look at the Centers for Medicare and Medicaid Services’(“CMS”) Ruling 1498-R and the impact that it is having on appeals pending before the Provider Reimbursement Review Board (“Board”). This Ruling has left many of us with unanswered questions, such as: should a remand be requested, should a request for Expedited Judicial Review (“EJR”) be filed or should Providers take a wait and see approach? It will also look at the Board’s reaction to the Ruling and what steps they have taken in response. The discussion should provide a basic overview of the Ruling, offer some guidance on how to proceed and answer any specific questions that may arise.

Learning Objectives: After this session, attendees will be able to Determine better how to proceed with their Medicare Cost Report Appeals pending before the Board in conjunction with CMS Ruling 1498-R.

Target Audience: Medicare Cost Report Audit and Reimbursement Staff

Kristin DeGroat - Associate, Quality Reimbursement Services, Inc | Ms. Kristin DeGroat is an Associate with Quality Reimbursement Services (QRS). For the last seven (7) years, Ms. DeGroat has been responsible for managing hundreds of appeals and numerous reopening requests for various hospitals in approximately 30 states. Ms. DeGroat has also mediated dozens of appeals that have settled favorably for various Providers. As a licensed Attorney and member of the Health Law Section of the State Bar of Texas, Ms. DeGroat has been fortunate enough to provide not only management of appeals and reopenings, but also in-house legal assistance and expertise by evaluating contracts, business associate agreements, confidentiality agreements and agreements governing HIPAA. Ms. DeGroat is constantly expanding her knowledge base and that of QRS’ Clients and personnel by researching case law and attending and speaking at seminars on various Medicare Cost Report Appeals topics.

10:45 - 11:45 am

PPACA and ACOs: A Business Shift for Health Care Organizations
Course 1110-03 | CPE: 1.0 | Level: Basic | No Prerequisites

Course Description: The Patient Protection and Affordable Care Act (PPACA), the better known as healthcare reform legislation of March 2010, will challenge health care organizations to create new business arrangements to accept and distribute global payments with their providers. With the development of ACOs, providers will need to come together for a defined patient population and will be charged with providing quality care and reducing overall costs associated with this care. Reimbursements will be bundled so that similar services are grouped together and compensated using a single or global payment.

Learning Objectives: After attending this session, participants will learn (1) historical review of prior reimbursement models, i.e. capitation arrangements; (2) review of PPACA legislation and milestones for enactment; (3) alignment strategies and governance models for ACOs; (4) risk-sharing, risk-assumption, and risk-avoidance models; (5) implications for health care organizations; (6) scalable information technology solutions; (7) review of ACO rules/regulations as currently published implications of Meaningful Use Stage 2.

Target Audience: Senior leadership of health care organizations as well as practice management team members

Kevin Burchill, Esq., FACHE - Director, Beacon Partners | Kevin Burchill has 25 years of healthcare experience, with a primary focus on hospital administration. Mr. Burchill has true depth and breadth of experience in strategic planning, physician contracting, and operational turnarounds, including postbankruptcy situations. He has operated in the c-suite throughout his professional career with solid communication lines to the governing board, senior teams, and medical staff leadership. His extensive hands-on experience includes small and rural hospitals (including conversion to Critical Access Hospital designation), community hospitals, hospital mergers/affiliations, state-wide not-for-profit hospital networks, community teaching hospitals, long-term acute care hospitals (LTAC), skilled nursing facilities (SNF), physician service companies as well as forprofit experiences with three nationally-recognized companies.

11:45 - 1:00 pm Lunch

1:00 - 2:00 pm

Is Outsourcing the Solution?
Course 1110-04 | CPE: 1.0 | Level: Basic | Prerequistes: An understanding of the internal costs, management of, and overall importance of the revenue cycle

Course Description: I will be presenting and discussing the prospect of outsourcing the management of the physician revenue cycle to outside venders. The changing dimensions and turmoil within the healthcare industry, reimbursement cuts, increased regulations and healthcare reform all make the internal management of the revenue cycle more tumultuous than ever before. Consider the advantages and potential pitfalls of outsourcing the work and make a decision that best fits the interests of your organization and the providers within it.

Learning Objectives:After this session, attendees will be able to understand the impacts of the changing industry and the management of the revenue cycle. What are the cost, hidden and obvious and where are the opportunities for enhanced savings and revenue?

Target Audience: CEO, CFO, revenue vice presidents and directors, physician leadership, and practice management

Sean McDonagh - Executive Director, Client Services, SPi Healthcare| Sean McDonagh brings over two decades of healthcare industry experience into his role at SPi Healthcare as Executive Director, Client Executives. Prior to SPi Healthcare, Sean served in a variety of leadership roles at Beacon Partners, one of the largest privately held healthcare management consulting firms in the United States. Most recently, he was Client Services Manger, responsible for the overall success of field engagements. He also served as Practice Director for Beacon Partners’ GE/Allscripts practice, responsible for over 30 consultants. Prior to that he served as a senior consultant. Sean has held positions in Revenue Cycle Leadership within the for profit sector as well as Academic leaders such as Brigham and Women’s, Massachusetts General and Boston’s Children’s hospitals.

2:00 - 2:15 pm Refreshment Break

2:15 - 3:15 pm

Denials Management: Controlling and Avoiding Denials
Course 1110-05 | CPE: 1.0 | Level: Strategic | No Prerequisites

Course Description: As health care reform continues to impact claim reimbursement, health care providers struggle to master the payer billing nuances resulting in claim denials and reduced compensation. This session will address understanding the root cause of claim denials, how to avoid denials by way of process solutions and ensuring denial reversal can be controlled through robust appeals and follow up.

Learning Objectives: After this session, attendees will be able to understand how to categorize and prioritize denials focusing on appeals and denial reversals resulting in cash acceleration and denial reduction.

Target Audience: CEOs, CFOs, Managed Care Contract Negotiators, Senior Clinical and Revenue Cycle Managers, Physician Practice Management Staff

Robin Gates -Senior Consultant, Deloitte Consulting LLP | Robin Gates is a Senior Consultant with Deloitte Consulting LLP in the Service and Operations Extended Business Office Solutions practice. She has over 15 years of experience in the health care revenue cycle, including 3 years of consulting with Deloitte. In her career, she has managed cash acceleration projects, centralized intake transformation and revenue cycle process improvement projects. She has experience in home health care, physician based care, long term acute care hospitals, durable medical equipment and mental health care.

3:15 - 4:15 pm

ICD-10 Conversion: A Strategic Enterprise Opportunity
Course 1102-06 | CPE: 1.0 | Level: Strategic | Prerequisites: Basic knowledge of the healthcare delivery process from actual hands-on treatment / diagnoses to the documentation of that treatment to the revenue cycle process.

Course Description: The conversion to ICD-10 will occur on 13 October 2013; 24 months from the date of this meeting. During these next 24 months, an enormous amount of effort, time and money will be expended to meet this deadline. However, if the conversion to ICD-10 is addressed as a Strategic Opportunity, with a focus on all stakeholders involved in the process, the change can and will be positive in terms of improved quality of services offered, improved revenue cycle management and enhanced data mining.

Learning Objectives:After this session, attendees will be able to understand the inter-operability and interconnectivity required between clinical and business functions within the delivery of healthcare services necessary to not only convert to ICD-10 but also to enter the new age of healthcare delivery reform.

Target Audience:CEOs, COOs, CNOs, CFOs, Managed Care Contract Negotiators, Senior Clinical and Revenue Cycle Managers, Physician Practice Management Staff

Gloria Doehling - President and Consultant, Doehling Consulting| Ms. Doehling has a depth and breadth of healthcare education and many years of real life hands on experience that span the healthcare provider operations industry. In her career, she has focused on business performance and process improvement beginning as an industrial engineer who specialized in healthcare through senior level executive position in operations, business development, revenue cycle management and revenue integrity to clinical coding. In the healthcare industry where change is a constant, she uses her drive for new knowledge to produce efficient and efficacious processes associated with quality outcomes for her clients. After working in the C-Suite of tertiary community and quaternary teaching hospitals, Ms. Doehling developed her skill at bridging the gaps between the finance, clinical and operations processes to coalesce the processes between Case Management, the Revenue Cycle and the delivery of quality healthcare. She now consults with healthcare organizations to share that knowledge and in bringing the local staff together to improve processes.