Reimbursement: Trends and Strategies in Emergency Medicine

Schedule subject to change. Check back closer to the event for the final schedule.

Tuesday - January 12, 2021 -  All times CST

8:00 am - 9:00 am

Coffee House Chats

9:00 am - 11:00 am

Exhibit Showcase Open

10:00 am - 11:00 am

Deep Dive into MACRA Optimization for ED Providers 
Panel Discussion Presented by Brault  

11:00 am - 12:30 pm

2021 Reimbursement Update and National Trends
Michael A. Granovsky, MD, CPC, FACEP; David A. McKenzie, CAE

The latest hot off the presses information pertaining to RVUs, the Conversion Factor, CPT coding changes, and updates to the CMS quality programs.

Objectives:

  • Identify critical factors impacting 2020 emergency medicine reimbursement.
  • Review the updated 2020 RVU values for key ED services.
  • Identify the highlights of 2020 CPT and CMS regulatory changes impacting emergency physician payments. 

12:30 pm - 1:15 pm

ED Workforce; The Future of The Department’s Most Valuable and Expensive Resource
Aisha T. Terry, MD, MPH, FACEP

The ED workforce is evolving. Providers remain our most precious resource. Learn best practices to understand the workforce and its future to set your group up for financial success.

Objectives:

  • Review the current state of the ED workforce
  • Analyze trends as the ED workforce is evolving
  • Describe strategies to optimize your ED staffing and position your group for financial success

1:15 pm - 1:30 pm

Break

1:30 pm - 2:30 pm

Health Plan Threats to Fair Coverage for EM & Strategies to Address: Out of Network (OON) Federal & State & Other Health Plans Tactics
Edward R. Gaines, III, JD, CCP

OON issues & efforts by health plans at the federal and state levels continued despite COVID-19 while other health plans tinkered with a prudent layperson (PLP) and payor practices that threaten EM reimbursement—what has emerged and how should EM address these threats?

Objectives:

  • Analyze key features of potential federal & state OON laws & how to succeed in the dispute resolution process
  • Review PLP threats and strategies + the new PLP 2.0 model provisions
  • Provide strategies regarding physician groups legal responses to health plan tactics

2:30 pm - 3:30 pm

Telehealth: Oh What A Year It's Been! 2021 Reimbursement and Regulatory Update
Michael A. Granovsky, MD, CPC, FACEP; Robert Park, MD

Telehealth grew exponentially with COVID. The speaker will review the rapidly growing telemedicine companies along with the latest reimbursement opportunities and regulatory requirements.

Objectives:

  • Review COVID driven telemedicine growth and its use in acute care
  • Discuss ED service line reimbursement using telehealth technology
  • Analyze the best practices for integrating telehealth into the continuum of ED practice

3:30 pm - 4:30 pm

Trends, Innovations, and Challenges: Getting Paid in 2021 and Beyond
Panel Discussion Presented by ZOLL Data Systems

3:30 pm - 5:30 pm

Exhibit Showcase Open

5:30 pm - 6:15 pm

Mix & Mingle with faculty pair (capped at 30 attendees) 

Speakers: Michael A. Granovsky, MD, CPC, FACEP and Edward R. Gaines, III, JD, CCP

Wednesday - January 13, 2021

8:00 am - 9:00 am

Coffee House Chats

9:00 am - 11:00 am

Exhibit Showcase Open

10:00 am - 11:00 am

Virtual Case Study: A Unique Collaboration of Solutions to Enhance Emergency Medicine Patient Yield
Panel Discussion presented by Medlytix, LLC, CueSquared, Inc., and Pendrick Capital Partners

11:00 am -12:00 pm

The State of the States: Medicaid Expansion and The Future of State-Sponsored ED Reimbursement
Michael A. Granovsky, MD, CPC, FACEP; Adam T. Krushinskie, MPA

Each year the payment landscape grows more complex. Federal and state payment regulations are redefining the ED payer mix. Medicaid challenges include evolving state mandates for co-pays, work requirements, and denial of the prudent layperson standard. Can you navigate the maze?

Objectives:

  • Describe the latest Medicaid and Managed Medicaid impacts on physician reimbursement
  • Review the key state regulatory elements influencing patient responsibilities
  • Identify defense strategies to uphold the prudent layperson standard for emergency care

12:00 pm - 1:00 pm

How Is Your Billing Company Doing? Monitoring Revenue Cycle Performance: Metrics You Need to Measure
Jeffery Bettinger, MD, FACEP

How do you know if your billing company is doing a good job for you? The speaker will review relevant industry benchmarks related to revenue cycle management and how to use them to evaluate billing performance.

Objectives:

  • Identify key industry benchmarks for revenue cycle management performance
  • Understand the terminology used in the billing company industry
  • Utilize specific metrics to evaluate your receivables management and identify problem areas

1:00 pm - 1:30 pm

Break

1:30 pm - 2:30 pm

The View from the C-Suite: What Are We Looking For?
Brahim Ardolic, MD, FACEP

The speaker, an ED physician turned hospital CEO, will discuss how hospital administrators view emergency department success and explain ways to have your ED viewed as a valuable partner to the C-Suite.

Objectives:

  • Describe methods for effective messaging of your value to the C-suite.
  • Discuss key metrics that hospital CEO's value
  • Identify strategies to monitor, report, and improve ED performance as viewed by your CEO

2:30 pm - 3:30 pm

MACRA and MIPs Reporting Complexities for 2021: Strategies for Success
Pawan Goyal, MD, MHA, CBA, PMP, FHIMSS, FAHIMA; Bill Malcom, MS, MBA, PMP; Aisha Terry, MD, MPH, FACEP

MIPS reporting For 2021- Can You Solve The Puzzle?

Objectives:

  • Identify the barriers to successfully meeting the MIPS reporting requirements
  • Develop strategies to ensure your group’s financial success under MIPS
  • Analyze the various approaches to reporting ED Quality measures

3:30 pm - 5:30 pm

Exhibit Showcase Open

5:30 pm - 6:30 pm

80’s Trivia Night
Presented by ZOTEC Partners

On-Demand Learning

On-demand courses are flexible, convenient, and faculty-taught. Each course is approximately one hour in length.

Regulatory Victories and COVID Lessons Learned
Michael A. Granovsky, MD, CPC, FACEP; Jeff Davis

COVID launched a myriad of waivers and reimbursement programs. What are the lessons learned, current and ongoing requirements, and what does the future hold?

Objectives:

  • Review the COVID reimbursement programs, what worked, what didn’t, and how to position our group for success
  • Analyze best practices learned from the COVID reimbursement experience
  • Describe strategies to ensure your group’s financial survival

The New Normal: How to Succeed & Thrive in the COVID-19 & Regulatory Environment for EM—Changes, Challenges, Updates & Case Studies
Edward R. Gaines, III, JD, CCP

The COVID pandemic cause an unprecedented Congressional & Agency response & created huge potential impacts for clinicians—meanwhile, regulators continued pursuing “non-compliant” activities by physicians & hospitals—how does EM thrive in this post CARES Act environment?

Objectives:

  • Describe the ongoing “Patients Over Paperwork” initiatives & meaning to EM
  • Review the CMS and DOJ audit and enforcement initiatives for clinicians to be forewarned and forearmed
  • Analyze additional EM compliance risks and mitigation ideas

ACEP's Alternative Payment Model Applications for MIPS Reporting and Future Reimbursement
Jeffery Bettinger, MD, FACEP

ACEP's proposed Alternative Payment methodology, The Acute Unscheduled Care Model (AUCM), allows sophisticated groups to accept upside and downside risk attributable to their discharge disposition decisions. The AUCM model provides incentives to safely discharge Medicare beneficiaries from the emergency department (ED) by facilitating and rewarding post-discharge care coordination.

Objectives:

  • Describe the latest activity related to emergency medicine APMs, including the Auto Unscheduled Care Model (AUCM)
  • Review the specific financial risks and benefits associated with ACEP's AUCM Model
  • Identify strategies to determine if an APM is right for your practice

How CEDR Allows You to Meet MIPS Reporting Requirements 2021
Bill Malcom, MS, MBA, PMP; Aisha Terry, MD, MPH, FACEP

What are the advantages of a (Quality Clinical Data Registry) QCDR? How to leverage (Clinical Emergency Department Registry) CEDR to successfully meet MIPS reporting requirements.

Objectives:

  • Review strategies for MIPS success utilizing CEDR
  • Gain an understanding of ACEP’s quality initiatives
  • Understand how your organization can participate in CEDR and E-Qual

Integrated Service Lines in the Age of Bundled Payments: Where Does the ED Add Value?
Rebecca Parker, MD, FACEP

The ED is the hub of the health care delivery system. Increasingly ED groups are being asked to provide integrated solutions involving outpatient care, Observation care, and Inpatient Hospital Medicine. The successful ED group of the future will be able to add value broadly across the spectrum of care.

Objectives:

  • Incorporate into practice disease-specific practice guidelines, as opposed to those limited to Emergency Medicine
  • Develop strategies to improve patient outcomes for an episode of care
  • Improve collaboration with other service lines and specialties to improve patient safety, patient outcomes and optimize reimbursement