Toni Cesta, Ph.D, RN, FAAN 
Consultant and Owner,Case Management Concepts LLC

Bev Cunningham,MS, RN, ACM
Partner and consultant, Case Management Concepts LLC

Please join us for this intense one-day program that will give you the skills to succeed as a case manager or social worker in the new era of value-based reimbursement and accountable care. The world of healthcare is changing so rapidly and so is the role of case management in that world! Whether you are reading or hearing about value-based reimbursement, the Affordable Care Act, the continuum of care, bundled payments, transitions in care, or accountable care organizations, case management is at the center of it all!

Because things are changing so rapidly, it can be a challenge to stay current and knowledgeable in the issues that most greatly impact your role as an acute care case manager or social worker. Reimbursement has changed dramatically as has utilization management, transitional planning and compliance. The Centers for Medicare and Medicaid Services (CMS) has incorporated changes that impact on payments related to readmissions, length of stay and cost of care. Who is in a better place to address these issues than case managers and social workers! Finally, how do you measure your impact on the cost and quality of care and the reimbursement your organization receives for that care?

All these topics and more will be covered in this jam-packed one-day program. The day will start with an overview of the state of the art in case management today, how we got here, and where we are going in the future. From there we will discuss the often-confusing subject of all the roles that occur in best practice departments.

You will learn more about the complimentary, but separate roles of RN case managers and social work case managers. From there, we will address best practice case management department models. We will then review what utilization management and transitional planning really mean under the current CMS rules and the new CMS proposed rules. We will end our series with a discussion on the best ways to measure the outcomes of your case management department and its impact on the organization.

Whether you are new to case management or a seasoned pro, this program will provide you with the latest and most up-to-date topics and information that you will need to be at the top of your game and produce the best outcomes for you, your patients and your organization.

Learning Objectives:

• Understand the history of case management, the current state, and directions for the future.
• Describe contemporary case management roles and models.
• Review the role of utilization management in an era of value-based purchasing.
• Discuss how transitional planning can be done most effectively in the new healthcare environment.
• Ensure that you and your case management department are maintaining compliance.
• Understand the outcome measures you will need to measure the success of you and your case management department.

Who will Benefit:

• Coordinator Utilization Management/Case Management
• Account Management/Executive
• Administrative Director Care Management
• Population Health
• Analyst Clinical Documentation & Care Coordination
• Appeals Manager
• Patient Care Services and Logistics
• Clinical Documentation
• Continuum Care Management
• Integrated Care Delivery
• Medical Director Hospitalists
• Medical and Academic Affairs
• Medical Officer Clinical & Quality Services
• Family Medicine
• Hospitalist Consultants
• Specialist Health Information Management
• Denial Management Specialist
• Resource Management
• Utilization Management
• Transfer Center
• Clinical Operations-Nurse Consultant
• Health Management
• Health Social Work
• Integrated Care Management
• Manager Revenue Cycle

Registration Process - (08:00 am – 08:30 am)

08:30 am – 09:30 am : Module 1 - “The State of the Art in Case Management: 2018 and Beyond”

Case management began moving into acute care settings around 1985 following the introduction of prospective payment. Today case management is found across the continuum of care, most recently returning to the community where its roots began. This module will review where case management came from and how it will work in today’s managed care and government payer environments. Included will be a review of Medicare’s latest programs that impact on the role of the case manager most directly including value-based purchasing, the readmission reduction program, accountable care organizations and others. Take a glimpse into the future in this state-of-the art review.

09:30 am – 09:45 am : Break

09:45 am – 11:00 am : Module 2 - “Roles, Functions and Models for RN Case Managers and Social Workers”

The role of the case manager and social worker is dynamic and constantly changing in response to the changes in health care delivery and reimbursement at the federal, state and local levels. While change remains a constant, there are certain core roles and functions that apply to the work of the social worker and nurse case manager regardless of job setting. In addition, case managers and social workers work within guidelines that provide us with definitions of practice, guiding principles and philosophy statements. This module will include these issues plus a description of the best practice case management models and how the roles of RNs and social workers can be developed to meet the outcomes of a hospital in the era of value-based purchasing. Also included are the best practice staffing ratios based on model selection.

11:00 am – 12:15 pm : Module 3 – “Utilization Management” What Does it Really Mean?”

Utilization management was the first role applied in acute care case management models. It was first known of as utilization review but has evolved into something much more comprehensive than that. Today it encompasses elements of resource management and denials management as well. This module will review the role of utilization management as it applies to today’s contemporary case management models. Included will be best-practice suggestions for your practice with tips and strategies for stream-lining the process and making it as efficient as it can be.

12:15 pm – 01:15 pm : Lunch

01:15 pm – 02:30 pm : Module 4 – “Transitional Planning Under the Current and Proposed CMS Rules”

Discharge planning has become more than just the movement of the patient out of the hospital. It is a “process” that starts at the point of admission and follows beyond discharge. The Centers for Medicare and Medicaid Services have recently added more “teeth” to the process. This module will review the most recent changes from the Medicare program as well as strategies for safely transitioning your patients across the continuum of care. In addition we will review how to engage other members of the interdisciplinary care team in the process of planning for the patient’s movement across the continuum including verbal and written hand-off communication. Transitional planning is no longer a destination but a process! Learn how to be sure that your processes address the complexities of the new healthcare environment.

02:30 pm – 02:45 pm : Break

02:45 pm – 04:00 pm : Module 5 – “Applying Compliance Measures to Your Role as a Case Manager”

As case managers we must be aware of the myriad of compliance issues that we must adhere to in our daily practice. Never has this been more important to our work as case managers than it is now. This program will review the compliance issues most greatly impact on your practice such as the 2-midnight rule, the NOTICE Act, HINNs, the Conditions of Participation, and many others. The Joint Commission and other hospital accrediting bodies are now monitoring these issues when they have deemed status from Medicare, so your compliance is critical to a good hospital survey outcome. This module will help you to identify where you may have compliance practice gaps as well as how to fix them!

04:00 pm – 04:45 pm : Module 6 – “Measuring the Success of Your Case Management Model”

When all is said and done, how do we know that we are doing a good job as case managers. How do we know what our impact is on our patients and on the organization? This module will discuss the latest ways in which case management departments and staff can ensure that they are achieving the outcomes that they hope to achieve. Included will be what the latest outcomes measures are in the field of case management as well as examples of dashboards that you can create to track and trend your results over time.

04:45 pm – 05:00 pm : Wrap-Up / Q & A

How to Deal with the Legal Roadblocks and Expand Access in the Telemedicine Sector

Telemedicine is an excellent way to expand access to care and decrease costs. But despite its bright future, its progress continues to be hampered by legal issues. Although some solutions are better for some problems than for others, you must know the current trends, key issues and legal considerations to reduce your financial, legal and regulatory risk.

In this Virtual Boot Camp, industry veteran Joseph McMenamin will get you up to speed with all the key legal issues you need to be aware of. You will learn about doctor-patient relationship, prescribing rules, licensure, privacy and security issues, and both professional and product liability. You will also learn about informed consent, insurance, clinical practice guidelines and corporate practice issues. McMenamin will provide valuable insights on reimbursement, credentialing and privileging, direct-to-consumer service and home telehealth, the role of FTC, FDA and FCC, and international telemedicine.

McMenamin will discuss state law controls, and use examples to illustrate some of the common approaches. He will also discuss reimbursements and payments controlled by Medicare, including its new and evolving rules governing remote patient monitoring, as well as chronic care management, Medicaid, and commercial payers.

After attending this information-packed Virtual Boot Camp, you will be able to reduce your legal, financial, and regulatory risk by confidently navigating the most complex legal issues. You will also be able to optimize your reimbursements and attract more clinicians and patients.

Session Highlights:-

This session will bring you up to speed with:

• Approaches to managing the problem of multiple licenses
• The case for claiming that care is given at the provider’s location—and the related risks
• The benefits of credentialing by proxy
• The clinical limitations inherent in distance care
• The risks of guidelines
• Privacy law: it’s NOT just HIPAA
• What to include in informed consent documentation specific to telemedicine
• The “webside manner”
• The impact of corporate practice doctrine on telemedicine services
• How to minimize your risk

Session Agenda:-

• Doctor-patient relationship
  • Creation
  • Prescribing pharmaceuticals
    • Controlled substances
• Licensure
  • Geography
  • Exceptions
  • Compacts
  • Multiple licenses
• Privacy 
  • HIPAA
    • Security 
  • COPPA
  • States
• Reimbursement
  • Medicare
  • Medicaid
  • Commercial carriers
• Credentialing and privileging
• Direct-To-Consumer (“DTC”) telemedicine/home TH
• Corporate practice of medicine
• International telemedicine

Session Details:-

Session 1: Know All about Telemedicine

Length: 90 minutes | Time: 1:00 PM ET – 2:30 PM ET
Break:- 2:30 PM ET – 3:00 PM ET

Session 2: Know All about Telemedicine
Length: 90 minutes | Time: 3:00 PM ET – 4:30 PM ET

WHO SHOULD ATTEND?

• Clinicians providing or preparing to provide distance care
• Office managers
• Payers
• ACO or at-risk, value centered provider organizations
• Facilities: hospitals, SNFs, urgent care centers, retail clinics, corrections facilities
• Telehealth champions: CFOs, CXOs
• Telehealth leaders: SVP, VP, Exec. Dir., Dir, Admin, Mgr.
• Compliance officers, change managers, quality officers, risk managers and privacy managers
• Employee health professionals
• Pharmacists
• Revenue cycle professionals
• Marketers/business development professionals
• In-house counsel
• Directors of IT
• Clinical engineering/biomedical professionals
• Medical staff/medical affairs/medical staff servicing professionals
• Health lawyers

This webinar provides an often-overlooked basic overview of the requirements for annual HIPAA training for staff as that training may be completed by an internal compliance officer. The attendee will be provided with a background on the basis for the laws that will provide a higher level of understanding that will be beneficial for building the trainer’s confidence. The attendee will also learn the basic requirements for a Notice of Privacy Practices as well as when authorizations are and are not required for the use and disclosure of a patient’s protected health information. The latter half of the webinar will focus on how to instruct staff in the identification of a breach and what is required of the compliance officer to perform the required process to remedy a breach if it is determined one has occurred.

Learning Objectives:-

• HIPAA Basics
• Notice of Privacy Practices
• Use and Disclosure of PHI
• Physical, Technical and Administrative Safeguards
• HIPAA Breaches
• Business Associates and Business Associate Subcontractors
• Enforcement Actions

Why Should You Attend?

The initial overview of HIPAA requirements and policies will help the attendee determine if his or her practice is compliant and will provide a more comprehensive understanding of the compliance officer so he or she can better instruct and advise his or her staff. Thereafter, the speaker will highlight what “red flags” the Office for Civil Rights looks for when determining whether to audit practice and learn what the compliance officer and staff must do in the event you are selected for a random audit.

Who Should Attend?

• Practice Managers
• Compliance Officers
• MD's and other Medical Professionals
• Office Managers
• Director of Nursing
• Any Business Associates who work with medical practices or hospitals (i.e. billing companies, transcription companies, IT companies, answering services, home health, coders, attorneys, etc)

In FDA-regulated industry, it is imperative that firms should be well aware of recent policy changes and understand what laws and regulations apply for FDA-regulated products on the US market (e.g., food, drugs, biologics, cosmetics and medical devices including in vitro diagnostics).

This conference is intended to discuss best GMP practices for FDA inspection in 2018 including dos and don’ts. This presentation is further intended to help industry better prepare for and manage an FDA inspection in a proactive and effective manner.  In particular, the speaker will discuss practical, actionable, and sustainable guidance on how to communicate including dos and don’ts before, during and after the inspection.  

The speaker will share his actionable tips and advice in view of FDA’s recent policy changes.

This presentation will provide great opportunities to become familiar with what lessons we learned from FDA enforcement and inspection practices.

Areas To Be Covered:

• Laws and Regulations
• 2018 FDA Policy Changes
• FDA Inspection Manuals
• FDA Inspection Types and Depth of Inspection
• How to Avoid Common Deficiencies
• Actionable Inspection Preparation and Management
• Communication with EQ Skills
• Employee Training
• Actual Case Studies
• Speaker’s PASS-IT Suggestions/Recommendations-Dos and Don’ts
• Conclusion

Who Will Benefit:

• CEOs
• VPs
• Compliance Officers
• Attorneys
• Regulatory Affairs
• Clinical Affairs
• Quality Assurance
• R&D
• Consultants
• Contractors/Subcontractors
• Anyone Interested in the FDA Drug Review and Approval Processes

If your urological practice is feeling the pinch thanks to government-imposed reimbursement constraints (plus those set by private and commercial insurance carriers), you’re not alone. Ancillary procedures and services can boost your revenue numbers—but only if you know how to properly and successfully code for them.

Learn from urology coding expert Michael Ferragamo how to incorporate a whole slew of new services into your urological offerings—as well as how to code and bill for them to ensure prompt payment. You’ll discover how to offer procedures that may not have been available to the urologist in the recent past so that you can deliver a more comprehensive, one-stop care and evaluation experience to your patients.

In this coding/practice management training session, Ferragamo will offer real-world strategies for coding the most common urological ancillary services, using insurance and billing forms to clarify his instruction.

Session Highlights:-

This how-to session will cover:

• Shifting procedures from in-hospital to in-office
• Coding for Botox bladder injections
• Billing for PTNS in the office versus the hospital
• Billing for Urolift implantations
• Billing for Rezum procedure
• Reimbursement success for ancillary radiological procedures and sonograms

Who Should Attend:-

This training program will benefit both physician and non-physician providers, as well as: billers, coders, front-office staff, and other professionals interested in ancillary services and strategies for maintaining practice viability and revenue in these difficult times.

Podiatry is a provider specialty in which the coding and reimbursement rely heavily on services performed in the office setting, therefore Podiatry practices need to make sure they know the current coding updates for 2019 that will affect them, as well as implement these changes in a timely manner.

Podiatrists have strict policies, dictated by the State in which they practice, and understanding the scope of practice in their state, and applying rules and guidelines to make sure they are not only submitting correct claims, but they are reporting everything they can for reimbursement, and what is considered inappropriate to bill.

In 2019, there are new diagnoses codes for myalgia and Medicare’s final rule for E&M services will bring a possible major change for podiatrists. Don’t forget the new biopsy and allograft codes for 2019 and revised documentation guidelines for DMEs.

Attend this webinar by expert speaker, Lynn M. Anderanin to get a detailed view and insights on the coding updates in podiatry that will impact your practice in 2019. Get the right information that will result in correct coding and billing for clean submissions of claims. Also, learn about the latest updates and changes for podiatry that are already in effect or will come into effect from January 1, 2019.

Handout: You will receive a PPT with useful information and web resources for ready reference later.

Session Highlights:

• The re-coding of different methods of biopsies
• New allograft codes and when they can be used by Podiatrists
• New changes to Medicare’s Local Coverage Determinations (LCD)
• Latest information on Medicare’s final rule for Evaluation and Management Services (E&M) in 2019 and beyond
• New coding for custom inserts for diabetic patients
• Revised documentation guidelines for DME that make it a little easier to document for diabetic shoes, inserts, and braces
• Training staff to implement the changes

Note: This is an ideal training session for any member of a Podiatry practice involved in the coding utilizing CPT®, HCPCS and ICD-10-CM. If your job involves assisting and determining what should be billed, and work with patients on their insurance eligibility and coverage, you shouldn’t be missing this webinar.

Who Will Benefit:

• Podiatrists
• Nurses
• Coders
• Billers
• Surgery schedulers
• Front desk secretary
• Office manager
• Office administrator

GxP Regulated companies are dependent on validated GxP computerized applications to conduct their day to day operations. These applications are, in turn, depended upon a qualified infrastructure that can be relied upon to provide control and regulatory compliance.

The consequences of the IT Infrastructure being out of compliance can result in the failure of an entire site or geographic region being brought to a standstill while the compliance issue is resolved. It can also result in regulatory citations during a regulatory inspection as both the infrastructure be out of compliance and also cause the computerized applications that are dependent on it to be out of compliance.

The impact of such compliance issues on a regulated company can be significant: it can result in recalls of products, warning or untitled letters, import alerts, injunctions, seizures, legal action, etc. These regulatory actions can have significant financial impact to the company. However, and most importantly, data integrity issues can lead to potential patient harm!! 
Effective IT Infrastructure Qualification on the other hand, confers the following benefits.

• Ensures GxP compliance
• Reduces duplication of effort
• Ensures adherence to standards
• Enhances the flow of information throughout an information system
• Promotes adaptability and agility necessary for a changeable environment
• Ensures interoperability among organizational and external entities
• Maintains effective change management policies and practices

Although all business activities depend upon the infrastructure, planning and projects to ensure its effective management are typically undervalued to the detriment of the organization. According to IDC, a prominent research firm (cited in an article in DM Review), investments in infrastructure management have the largest single impact on an organization's revenue.

Establishment and maintenance of a controlled infrastructure requires that infrastructure needs to be brought into initial compliance with the company's established standards, through a planned qualification process, based upon domestic and international best practices and standards. The qualification needs to be documented and confirmed by Quality Assurance. Once the IT Infrastructure is qualified, the compliant state needs to be maintained by documented standard processes and quality assurance activities. The effectiveness of maintaining the qualified state needs to be monitored and periodically verified.

Agenda:-

Module 1: Introduction and Background

• Infrastructure Qualification and the GaMP5 Lifecycle
• Key Concepts
  • Platforms to run the business applications (e.g. CDMS, IVRS, LIMS, ERP)
  • IT Infrastructure processes that facilitate a capable & controlled IT environment
  • General IT services (e.g. email system, office tools, intranet facilities, file storage)

Module 2: Infrastructure Options

• Infrastructure Services
• Platforms
• Processes
• Personnel

Module 3: Risk Management

• Assessment of Risk Components
• Implementation of Mitigation and Controls
• Change Control to Qualified Components
• Periodic Review

Module 4: Qualification of Platforms

• Overview of Process
• IT Infrastructure LifeCycle
  • Planning phase
  • Specification & Design phase
  • Risk Assessment & Qualification test planning phase
  • Procurement, installation and IQ phase
  • QA & acceptance phase
  • Operation & maintenance phase
  • Retirement (decommissioning / withdrawal phase)
• Procurement
  • Supplier Evaluation
  • Installation & IQ
    • Verification of Documentation
    • Environmental Conditions
    • Servers
    • Clients
    • Networks
• OQ & Acceptance
• Reporting
• Handover

Why you should attend:-

This Virtual Seminar provides a risk-based approach to meeting current regulatory expectations for compliant IT Infrastructure platforms, including the need to identify, qualify and control those aspects impacted by GxP quality and data integrity. It provides current best practices for the design, qualification and operation of an IT Infrastructure with emphasis on the qualification requirements of the major components.

It addresses compliance with international GxP regulations and can be used both for the establishment of new platforms and extensions or existing platforms whether or not they are currently in support of GxP applications.  Finally, this seminar covers a range of IT Infrastructures, from those found in companies operating in a global setting to isolated or semi-isolated GxP Infrastructures.

This Virtual Seminar focuses on the horizontal approach to IT Infrastructure Qualification which includes the following benefits:

• Higher level of standardization throughout the entire lifecycle
• Minimal overlap in documentation
• Minimal overlap in qualification
• Minimal overlap in audits inspections and assessments

Areas Covered in the Session:-

• How does IT Infrastructure Qualification fit into GaMP5 lifecycle
• Quality Management for Infrastructure
• Risk management for Infrastructure Qualification
• Installation & Operational Qualification of Infrastructure Components
• Change control of infrastructure components and settings in a highly dynamic environment
• Involvement of service provider in critical infrastructure processes

Who Will Benefit:-

• VP of IT
• Director of IT
• Quality Managers
• Project Managers (for CSV / IT)
• Validation Specialists
• Database Administrators
• System Administrators
• Directors / Senior Directors of Discovery
• Directors / Senior Directors of Development
• Directors / Senior Directors of Commercialization
• Document Managers
• Training Managers
• Regulators
• Vendors
• Suppliers
• Outsource Service Providers

Case Management Boot Camp (Part 3 of 5) - Emergency Department (ED) Case Management: A Must-Have for any Hospital Case Management Department

Case management models in the acute care setting are constantly evolving and improving. So is true for case management in the emergency department. RN and Social Work case managers working in this fast-paced setting must evaluate patients who will be treated and released, those being placed into observation and those being admitted to an inpatient bed. Therefore, it is imperative that the ED case management model is consistent with the inpatient model yet applied differently in order to address these categories of patients.

During this program, our speaker will discuss the structure of a best-practice ED case management model and the processes the roles should follow. She will also discuss the outcome measures for ensuring that your ED program is making a difference for your organization.

Learning Objectives:-

At the conclusion of these sessions, participants will be able to:

• Describe the changing role of the ED RN case manager.
• Discuss the role of the social work ED case manager and how to identify social determinants of health. 
• Review ways in which to “triage” patients in the ED from a case management perspective.
• Describe EMTALA and how it is applied.
• Evaluate the value-based reimbursement metrics most greatly affected by ED case management.
• Apply the case management roles to the ED setting.
• Discuss ways in which to measure the outcomes of an ED case management model.

Target Audience:-

Anyone involved with transitions in care including RN case managers, case management personnel, social work staff, post-acute care providers, physician advisors, finance directors, quality management and other interested personnel.