Reimbursement Course Descriptions

Course Descriptions from the 2017 Conference for your reference.

2017 Reimbursement Update and National Trends

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

Learning Objectives:

  • Identify critical factors impacting 2017 emergency medicine reimbursement
  • Review the updated 2017 RVU values for key ED services
  • Identify the highlights of 2017 CPT and regulatory changes impacting emergency physician payments


ACA Realities, Out of Network Payments, and Value Models

Each year the payment landscape grows more complex. Federal and state payment regulations are redefining the ED payer mix. Can you navigate the maze?

Learning Objectives:

  • Describe the latest ACA impacts on physician reimbursement.
  • Review the key regulatory elements influencing out of network payments.
  • Develop strategies to promote fair coverage for your patients.
  • Identify the key features of evolving value models.


Alternative Payment Models (APMs): Salvation from MIPS or a Sentence of Hard Times to Come?

CMS has a 5 percent bonus available for those meeting the tough APM requirements, with an added incentive of being excused from the MIPS complexities. Gear up to understand your group’s options.

Learning Objectives:

  • Discuss the alternative payment model design process.
  • Review the impact of federal regulations that will define APMs.
  • Identify successful possible APM programs and todays models being developed.
  • Develop strategies to optimize success under APMs.


The Business Case for Freestanding EDs

Free standing emergency departments are growing rapidly in many states. Do they represent an efficient way to deliver acute care, or a threat to the traditional hospital-based system? You need to know the latest strategies for success.

Learning Objectives:

  • Discuss the growing role of Freestanding EDs 
  • Review the impact of Freestanding EDs on the traditional health care delivery system
  • Identify the components of a Freestanding ED business plan
  • Develop strategies to optimize Freestanding ED financial success


Canary in the Coal Mine: The Maryland Experience

Maryland has uniquely launched a statewide health budget under a population management alternative payment model. We have a unique opportunity to learn from the solutions that promoted ED value.

Learning Objectives:

  • Discuss the state wide alternative payment model governing Maryland reimbursement.
  • Review the impact of real world hospital spending pressure on physician practice.
  • Identify successful programs helping to make physician groups value added partners.
  • Develop strategies to optimize success under a population health model.


Commercial Payer ED Reimbursement, ACOs, Bundles and The Future

Commercial payer policies are changing rapidly. Find out what is being measured and ED payment methodologies that will work for your group.

Learning Objectives:

  • Analyze commercial payer pressures related to resource utilization and quality
  • Review the key components of evolving private payer provider compensation models
  • Describe strategies for commercial payer relationship success
  • Analyze metrics important to ACO and shared savings program success


Drowning in a New Alphabet: MACRA and MIPs Complexities for 2017: A Roadmap to Avoid Big Penalties

PQRS is being retired, but we may long for the devil we know. Are you prepared for the next round of quality programs influencing up to 18 percent of physician reimbursement?

Learning Objectives:

  • Develop strategies to ensure your group’s financial success under MIPS reporting requirements.
  • Identify the barriers to successfully transitioning from PQRS to MIPS.
  • Analyze the basics of CMS alternative payment models.
  • Review opportunities for the 5 percent CMS alternative payment bonus.


Flatlining: How Healthcare Could Kill the U.S. Economy - And How We Can Stop it

Healthcare was one of the main topics of discussion during the election, and it will continue to be one of the biggest issues for the new administration. Many people are left wondering: what does the future of healthcare look like? For the past several decades, the healthcare segment of the U.S. economy has been growing at an alarming rate. Many economists now believe that healthcare is poised for a major collapse if something isn’t done. The speaker will break down the complex system that is healthcare in the U.S. and helps people gain a deeper understanding of the issues that will arise in 2017 and beyond. Participants will explore and discuss how recent changes in healthcare will affect medical practices and predict how healthcare is likely to evolve over the next decade. The presenter will share critical actions that medical groups should take to survive the future changes to our system. Finally, we will discuss the cure - seven areas where decisive action is needed to create a more sustainable model for healthcare.

Learning Objectives:

  • Describe the macro-economic factors and pressures that are affecting the healthcare industry.
  • Evaluate recent changes in healthcare that will affect medical practices, and predict how healthcare is likely to evolve over the next decade. 
  • Develop a plan of strategies and tactics that medical practices can utilize to succeed and prosper in the future.

How to “Hold Serve” and to Avoid the “Double Bagel” in ED Coding, Billing, Audits and Compliance

The audit landscape continues to change with MACs, RACs and the OIG. The DOJ’s agenda appears to be driven largely by qui tam Relators, who are often clinicians or senior management, while DOJ’s approach to individual management responsibility has changed. Risk mitigation and management can be achieved with understanding of key risks and the strategies to address the risks. HIPAA security also can be enhanced with common sense and straightforward solutions.

Learning Objectives:

  • Describe the federal government’s legal and regulatory structures impacting Medicare and Medicaid, including the DOJ’s new approach to individual management accountability.
  • Survey MAC, RAC and OIG auditors for ED specific areas of interest
  • Review specific forward looking risk areas such as billing for residents, non-physician practitioners and the EHR documentation issues associated with these practice settings.
  • Outline key HIPAA security issue and steps to avoid the hidden traps.


How to “Save Par” by Managing The Out of Network (OON) and Balance Billing Issues

The OON and balance billing issues are one of the hottest topics in not only EM but across the medical specialties, hospitals and the media. Several large states have implemented restrictions or bans on OON balance billing and many others are considering it. Solutions and strategies will be discussed along with late breaking updates and developments.

Learning Objectives:

  • Review key federal and state developments in OON laws and regs, their goals, objectives and focus.
  • Describe creative solutions being proposed by EM physicians and stakeholders.
  • Identify the strategies to address current laws to avoid hazards.

MIPS Compliance with Data Driven Quality Initiatives

The American College of Emergency Physicians (ACEP) has developed the Clinical Emergency Data Registry (CEDR), as part of its ongoing commitment to provide the highest quality of emergency care. CEDR is a qualified clinical data registry (QCDR) designated by CMS for the 2016 Performance Year and beyond. CEDR is the first Emergency Medicine specialty-wide registry at a national level, designed to measure healthcare quality, outcomes, practice patterns and trends in emergency care. Learn how CEDR will provide a unified method for ACEP members to collect and submit Physician Quality Reporting System (PQRS) data, Maintenance of Certification (MOC), Ongoing Professional Practice Evaluation (OPPE), and other related and applicable quality and patient outcome elements to meet quality improvement and regulatory requirements.

The American College of Emergency Physicians (ACEP) has launched the Emergency Quality Network (EQUAL) with the support of the Center for Medicare & Medicaid Innovation’s (CMMI) Transforming Clinical Practice Initiative (TCPI). E-QUAL plans to support up to 24,000 emergency clinicians to move healthcare towards the triple aim of better health outcomes, more effective health care and lower costs.

ACEP is connecting EDs across the U.S. interested in demonstrating the value of emergency care through learning collaboratives designed to support ED Directors, front-line clinicians, practice managers, and reimbursement and coding staff with QI activities that also meet regulatory and educational requirements, as well as, meet the intent of Merit-based Incentive Payment System (MIPS).

Learning Objectives:

  • Learn about MACRA and MIPS as they relate to Emergency Medicine
  • Gain understanding of ACEP’s quality initiatives
  • Understand how your organization can participate in CEDR and E-Qual


Observation Economic Drivers

ED physicians are masters of throughput and efficiency. Hospital leaders are drawing on this skill set and asking ED groups to run observation units. Should you embrace the challenge?

Learning Objectives:

  • Discuss the role of Observation as an additional service line
  • Identify the key factors contributing to Observation unit success
  • Develop strategies to optimize Observation value and financial success


Payer Negotiations: Strategies to Maximize Success with the Movement to Value-Based Reimbursement

Payers are pushing rapidly away from fee for service reimbursement towards various types of value based or risk based payment models. These payers employ professional negotiators and advanced tactics to achieve their objectives. Robust detail regarding provider information and utilization is at their disposal. Knowledge of negotiating strategies, new reimbursement methods and understanding the payers tactics are critical to having ED value successfully recognized.

Learning Objectives:

  • Discuss strategies to evaluate one’s own position and the position of their opponent.
  • Identify the best course of action for your practice when analyzing new payment models.
  • Analyze strategies for success in the negotiation process with payers pushing for value based reimbursement.
  • Describe strategies when confronted with risk based contracts and ACO type arrangements.


Strategic Compensation Structures in the Age of Alternative Payment Models

As pressure mounts to deliver the right care in the right setting groups are being faced with aligning provider incentives with future payment methodologies. Do you have a compensation plan for the future?

Learning Objectives:

  • Describe effective management strategies related to productivity and quality based compensation.
  • Review the key components of effective incentive programs.
  • Analyze measurement strategies to promote successful participation in ACOs and bundles.


Struggling Back To Baseline: Enterprise EMR Challenges: ICD-10 and PQRS Scribe Solutions

Enterprise EMRs are here to stay. Are you struggling to get back to baseline? Learn the latest techniques to get your ED back on track.

Learning Objectives:

  • Identify key ICD 10 and PQRS EMR documentation challenges.
  • Analyze the ROI for a scribe program.
  • Identify productivity baselines, benchmarks, and best practices.
  • Review productivity solutions accelerating the return to baseline.

Time is Money: How Do You Measure Up? ED Benchmarking Best Practices and Solutions

Increasingly, the perception of the ED by the C suite is based on measurements against benchmarks and best practices. Successful messaging of ED benchmark performance has become a key element of strengthening the value-added partnership with your hospital.

Learning Objectives:

  • Discuss the elements of an effective benchmarking plan.
  • Identify goals and metrics for key components of the ED care process.
  • Describe methods for succesful messaging of your benchmarking performance.
  • Discuss the development, implementation, and implications of the Emergency Medicine Qualified Clinical Data Registry (CEDR).

 Turn the Tables: Patient Throughput Strategies to Increase Revenue 

For optimized groups, throughput is the final frontier for staff satisfaction and economic success. Group financial performance is increasingly dependent on identifying key ED bottlenecks and developing solutions to ensure smooth patient flow.

Learning Objectives:

  • Discuss key drivers of patient thoughtput.
  • Identify strategies to monitor, report, and improve throughput.
  • Discuss the development, implementation, and implications of the Emergency Medicine Qualified Clinical Data Registry (CEDR).