Education Session: Two Sides of the Same Coin: How Revenue Integrity and Compliance Work Together

June 11, 2019
7:30 AM - 5:30 PM
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DoubleTree by Hilton Hotel Tinton Falls – Eatontown
700 Hope Road
Tinton Falls, NJ 07724
 Directions

7:30am – 8:20am       Registration and Breakfast 

8:20am - 8:30am        PROGRAM START TIME: NJ Revenue Integrity and CARE Forums Introduction and Kickoff 

8:30am - 8:40am        NJHA Update 

8:40am - 9:00am         Welcome - Induction of Officers and Announcements of Scholarship Recipients 

9:00am - 10:00am      Hot Topics in Compliance and Revenue Integrity 

The session brings together stories from the OIG as well as examples of remediation to enhance compliant billing. Highlights include the collaboration between Compliance, Case Management, Coding and Revenue Integrity, helping attendees achieve greater compliance and accurate billing and reimbursement.                                   

Session Objectives:

  • Overview of major recent Compliance enforcement activities and their related impact to healthcare entities
  • Discuss Revenue Integrity initiatives that attendees could implement in their organizations
  • Attain a deeper understanding of the necessary interplay between Compliance and Revenue Integrity within a healthcare organization

Presenter:
Nancy Toll Perilstein
Senior Manager Risk and Financial Advisory,  Deloitte and Touche LLP

Rob Senska, Esq., MBA  

10:00am - 11:00am    Appropriate Use Criteria: A Revenue Integrity and Compliance Perspective

The 2014 Protecting Access to Medicare Act included a provision requiring clinicians consult with appropriate use criteria (AUC) through a qualified clinical decision support mechanism (CDSM) when ordering advanced imaging services (i.e., SPECT/PET MPI, CT and MR) in order to receive payment approval from the Centers for Medicare and Medicaid Services (CMS). Following several delays, the implementation of this requirement is set for January 1, 2020.  This session will provide the audience with an overview of the program requirements and strategies for preparation. 

Session Objectives: 

  • Provide an overview of Appropriate Use Criteria and the impact to Revenue Integrity and Compliance
  • Offer providers tangible strategies as they prepare for implementation

Presenters: 
Leslie V. Boles, CCS, CPC, CPMA, CHC, CPC-I
Compliance Audit Manager,  Saint Peter’s Healthcare System
Gloria Johnston, MBA, RN, RHIT
Chief Health Information Officer,   HealthAdvanta

11:00am - 11:15am     Break 

11:15am - 12:30pm    Total Knee Arthroplasty: How to Preserve Revenue in the Outpatient World

It is now more than a year since CMS removed TKA from the inpatient only list. Providers need to maintain revenue streams in the present regulatory and reimbursement environment. Equally important is achieving profitability for outpatient TKA cases. This session will give attendees an overview of the regulatory, reimbursement, and clinical operations issues in achieving financial sustainability for TKA in a new environment.

Session Objectives:

  • How to adapt to Medicare’s removal of TKA from inpatient only list
  • Review clinical criteria for inpatient vs outpatient and discuss authorization requirements and the importance of clinical documentation for all payers
  • Feedback from MACs, QIOs and other auditor groups
  • Discuss the reimbursement and financial impact of performing TKA inpatient vs outpatient

Presenters:

Christine Gordon
Director of Reimbursement, Virtua Health System

Nancy Toll Perilstein
Senior Manager Risk and Financial Advisory, Deloitte and Touche LLP

Kate S. Gillespie, MBA, RN, NE-BC
AVP Orthopedic Service Line,  Virtua Health

Moderator:                   

Debbie Minnucci, CHC, CPC
Compliance Audit Specialist,  Hackensack Meridian Health

12:30pm - 1:15pm      Lunch

1:15pm – 2:30pm       Strategies to Protect Revenue During System Conversion

Many hospitals and health systems have plans to convert from their main EHR platform to a new vendor, or to upgrade their existing EHR system. When undergoing a conversion of this scale, proactive planning from the Revenue Integrity and Compliance teams can mean the difference between a quick return to baseline revenue vs experiencing decreased cash flow and other unforeseen costs to your organization.  The panel discussion will focus on ways to uncover strategies to protect your organization’s financial health as you work to mitigate risks and manage the many pitfalls that can potentially impact your revenue stream during such a transition.

Session Objectives:                                                 

  • Overview of project management best practices from a Revenue Integrity perspective for a system conversion
  • Discuss recommendations on pre-conversion projects and current state analysis
  • Provide guidance on go-live revenue monitoring practices and key metrics

Presenters:

Lori Pietropola, CPA
Director of Revenue Cycle Operations and Revenue Integrity, Virtua Health

Thomas Barnes
General Manager and Practice Director, Revenue Cycle Services, e4 Services

Moderator:

Elaine Dunn, DHA, RRT, RPSGT, CPCO
Vice President Integration Services, Craneware

2:30pm – 2:45pm     Break 

2:45pm – 4:15pm       The Impact of Drug Diversion on Revenue Integrity and Compliance

Drug diversion can be defined as any act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient. Drug Diversion raises many problems for health care organizations. Diversion can be hidden by billing when a drug is not administered, is not billed correctly, or is charged to the wrong account. Attendees will learn how Revenue Integrity and Compliance departments can address issues of wrongful billing for drugs and how hospitals can raise awareness about drug diversion in their organizations.

Session Objectives:                                                 

  • Overview of the drug diversion regulatory environment in New Jersey
  • Strategies for preventing drug diversion and monitoring drug billing accuracy within your organization
  • The importance of collaboration between Revenue Integrity and Compliance in addressing drug diversion
  • How to build and foster a program to combat drug diversion

Presenters:    

Ken Bevenour, R.Ph, MBA
Corporate Director, Pharmacy Services, Jefferson Health New Jersey

Barbara Piascik
Chief Compliance Officer, Bergen New Bridge Medical Center

Eva Goldenberg, Esq., CHC, CHPC
Vice President Corporate Compliance and Internal Audit, Chief Compliance Officer, Privacy Officer, Research Integrity Officer, Atlantic Health System

Moderator:

Craig Dolan, R.Ph, PharmD, MBA
Vice President, Strategy, McKesson Pharmaceutical Solutions and Services

4:15pm - 4:30pm        Closing

4:30pm - 5:30pm        Happy Hour


EDUCATION CREDITS

 

NEW JERSEY BOARD OF ACCOUNTANCY CONTINUING PROFESSIONAL EDUCATION CREDITS

Based on our understanding of the New Jersey State Board of Accountancy’s continuing professional education (CPE) requirements, Sponsor No. 185, this course is currently approved for  7 CPE credits, 1 hour in accounting and 6 hours in Specialized Knowledge.

 

AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES CONTINUING EDUCATION CREDIT

The New Jersey Chapter of the Healthcare Financial Management Association is authorized to award 6 hours of pre-approved Category II (non-ACHE) continuing education credit for this program toward advancement, or recertification in the American College of Healthcare Executives.  Participants in this program wishing to have the continuing education hours applied toward Category II credit should indicate their attendance when submitting application to the American College of Healthcare Executives for advancement or recertification.

 

AMERICAN ACADEMY OF PROFESSIONAL CODERS CONTINUING EDUCATION CREDIT

This session has been approved for 6 AAPC credits.

 

SUPREME COURT OF NEW JERSEY BOARD ON CONTINUING LEGAL EDUCATION

Based on our understanding of the Supreme Court of New Jersey Board on Continuing Legal Education mandatory continuing legal education program requirements, this course will qualify for 7.2  credits.  NJ HFMA is an approved service provider (#1098).


REGISTRATION INFORMATION:

  • Registration is available by clicking the icon below.
  • Make checks payable to HFMA - NJ CHAPTER, and please mail at least 10 days prior to the event.
  • Registration must be received three working days prior to the event.
  • REFUNDS WILL BE GRANTED ONLY IF CANCELLATION IS RECEIVED 48 HOURS PRIOR TO THE MEETING.
  • Dress is Business Casual.
  • Mail payment to:           

HFMA – NJ Chapter 
Laura Hess
P.O. Box 6422
Bridgewater, NJ08807

  • Phone number for questions is (908) 963-2505.
  • In the event of questionable weather or other emergency affecting a significant number of members, please check the Chapter website no earlier than two hours prior to the start of registration for the event to confirm status of event.

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