Reimbursement Course Descriptions

Course Descriptions from the 2018 Conference for your reference.

2018 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 2018 emergency medicine reimbursement
  • Review the updated 2018 RVU values for key ED services
  • Identify the highlights of 2018 CPT and regulatory changes impacting emergency physician payments

 

ACA/AHCA Realities, and Value Models Analysis Through the RUC/CPT Process

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: How Can Emergency Medicine Prosper?

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 today's models being developed
  • Develop strategies to optimize success under APMs

 

ED Benchmarking and Throughput Strategies to Impress Your Hospital C-Suite

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

Benchmarking - 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 key drivers of patient thoughtput
  • Identify strategies to monitor, report, and improve throughput
  • Identify goals and metrics for key components of the ED care process
  • Describe methods for successful messaging of your benchmarking performance

 

ERISA Challenges: Navigating the Claims and Appeals Process

The Employee Retirement Income Security Act (ERISA) sets minimum standards for health plans in private industry. Understanding how these laws impact the appeals process a is important for successfully managing your ED claims for patients covered under ERISA plans.

Learning Objectives:

  • Review the basics or ERISA and how it relates to claims appeals 
  • Understand how ERISA claims work in the ED setting 
  • Develop strategies for successful ERISA appeals

 

How CEDR Allows You to Meet MIPS Reporting Requirements

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 (E-QUAL) 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

 

How I Learned to Stop Worrying and Love the HHS OIG’s Compliance Program Resource Guide + Hidden Traps for the Unwary in Post Billing with TCPA and FDCPA

There is little defense in today’s healthcare enforcement scheme for “not knowing” how claims are billed in the clinicians’ name and provider number. Knowing the coding and billing potential pitfalls can lead to compliance programs that may mitigate the enforcement and audit risks. While one size does not fit all, compliance programs must also have essential features so that they are deemed “effective” if and when government officials come calling. Post billing challenges of communicating with patient’s mobile phones via voice or text should be considered given today’s “high deductible health plan” environment where the patient is the largest payor outside of the governmental plans.

Learning Objectives:

  • Describe and update ED group practice and RCM compliance risks and operationalizing compliance standards
  • How should the OIG’s corporate compliance program (CCP) effectiveness resource guide be used to assist in gap analysis and changes to the CCP? 
  • Describe the hidden traps for the unwary with the Telephone Consumer Protection Act (TCPA) and Fair Debt Collection Practices Act (FDCPA) and strategies to mitigate risks to the ED group and RCM

 

Integrated Service Lines in the Age of Bundled Payments: Where Does the ED Add Value?

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.

Learning 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

 

MACRA and MIPs Reporting Complexities for 2018: Strategies for Success

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

 

Payors Gone Wild Are Back—How to Address Unfair Payor Practices, Policies, Claim Appeals, Medicaid Issues and Out of Network (OON) Restrictions

Several commercial health plans have targeted emergency medicine (EM) with coding policies, restrictive diagnosis lists and practices that challenge the “prudent lay-person” (PLP) protections that EM fought hard to obtain over 20 years ago in most states and the federal law. Over 20 states and 125+ separate bills in the past year sought to limit or severely restrict OON balance billing and many are aimed at EM. Maintaining a steady state reimbursement environment is ever more challenging.

Learning Objectives:

  • An environmental assessment of unfair payor reimbursement practices—Medicare, Medicaid and commercial health plans--and how to fight back
  • Discuss Medicaid PLP issues and strategies in light of Medicaid reform proposals for the ED
  • Updates on the work of the OON state and federal landscape, how to respond and resources available in the fight

 

Private Payer Delivery Model Changes: The Payers Perspective

Market forces are reshaping the private payer health care delivery process. It is of paramount importance to understand the role of Emergency Medicine in future commercial payer delivery models.

Learning Objectives:

  • Review the current state of commercial payer healthcare delivery evolution
  • Analyze opportunities for Emergency Medicine to add value in the next generation of private payer healthcare realities
  • Develop strategies for success and creating a win-win with private payer value models

 

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

 

When Payer Relationships Fail: Litigation and Pre-Litigation Strategies

Today's payer relationships are becoming increasingly tense. Learn from an experienced expert how to come out on top. An industry leader who has fought many battles will share tricks of the trade and how to employ legal strategies when all else fails.

Learning Objectives:

  • Understand your legal rights in payer disputes
  • Review the history of private payer actions
  • Develop a plan for pre-litigation and litigation success