Learn the Hottest Coding Issues Every Physician Office Must Know in 2019

Billions of dollars are lost in healthcare spending every year due to medical billing mistakes. And when it comes to Medicare billing, the OIG and CMS are getting increasingly tougher every year. They have zero tolerance for fraud and abuse—as well as inadvertent errors. If a practice is found negligent, it can be prevented from billing Medicare or Medicaid services for years. Don’t let that practice be yours.

Learn the hottest coding issues every physician office must know in 2019 to avoid audit risk scrutiny in this session by medical coding compliance expert Elin Kunz. Kunz will walk you through the new compliance updates for 2019, and also show you where to focus your audit efforts in 2019. She will discuss the proposed E&M documentation changes (which are significant) and how they will impact your audits. She will share strategies and best practices to minimize your audit risk and improve compliance, as well as checklists for E&M Training and continued compliance monitoring. The Medicare fee-for-service improper payment rate fell from 9.51 percent in 2017 to 8.12 percent in 2018, but insufficient documentation continues to be a problem. To avoid such a scenario for your practice, Kunz will provide customized documentation tips to ensure correct coding.

After attending this session, you will be better prepared to improve compliance and minimize audit risk. You will know where to focus your audit efforts in 2019, and which key physician targets to prepare for in 2019.

Session Highlights

This session will bring you up to speed with:

• Compliance update and key physician targets to prepare for in 2019
• Strategies and best practices to minimize your audit risk & improve compliance
• Expert documentation tips to ensure correct coding
• Customized documentation tips for common target areas
• How to ensure continued compliance monitoring

Who Should Attend

• Coding professionals
• Billing specialists
• Practice managers
• HIM directors
• Compliance officers
• Case managers and,
• Physicians, non-physician practitioners such as physician assistants and nurse practitioners

Part of a generalized chargemaster sequence of presentations. Associated with special payment system presentation on APCs and DRGs.

Why Should You Attend? 

• Why are hospital charges and pricing so controversial?
• How did hospital prices become inflated?
• What is this ‘transparent pricing’?
• What are these device-dependent APCs and DRGs?
• What is all the fuss about ‘charge compression’?
• How can we control our cost-to-charge ratios?
• How should we be pricing devices? Supplies? Drugs? Biologicals
• Are we missing charges in connection with supplies and pharmacy items?
• What can we do to adjust our pricing and address charge compression?
• How does all this affect APC and DRG reimbursement?
• How does our pricing structure impact the cost report?

Objectives of the Session: 

• To Appreciate Why Hospital Charges and Pricing Are In The Spotlight
• To Appreciate The Need for Transparent Pricing and Public Relations
• To Understand Why Charges Are Important for APCs and DRGs.
• To Appreciate the Cost Report and Cost-to-Charge Ratios (CCRs)
• To Understand The Concept of ‘Charge Compression’
• To Understand Special Charge Development Techniques
• To Recognize When Charges May Be Inappropriate
• To Recognize When Full Charges Are Not Being Reported
• To Appreciate How Charges and Pricing Impact on the Cost Report
• To Review Action Steps to Adjust Pricing

Agenda of the Session: 

1. Overview of Developing Chargemaster Pricing and Charges
   • The Need For Change
   • Charge Formulas and Mark-Up Formulas
   • Strategies for Adjusting Pricing
   • Transparent Pricing
   • Strategic Pricing
   • Geographic Pricing
   • Pricing Disparities Among Hospitals
2. Types of Payment Systems and Use of Charge Data
   • APCs
     • Increased Packaging
     • Comprehensive APCs
   • DRGs
   • MPFS
   • Cost Based Payments
   • Contractual Payment Strategies
3. Charge-Compression, Cost-to-Charge Ratios and the Cost Report
   • Tiered Pricing for Supplies and Drugs
   • Charge Compression and Cost-to-Charge Ratios
   • Cost Reporting Issues
   • RTI International Recommendations
   • Medicare Changes to the Cost Report for Devices
   • Cost Report Changes for Special Areas
4. CMS Use of Charges to Determine Weights
   • Converting Charges to Costs
   • APCs
   • MS-DRGs – Charge-Based vs. Cost-Based
5. Pricing and Charge Formulas
   • Overall Charge Philosophy
   • Bundling versus Separately Charging
   • Proper Charging Even Though No Separate Payment
6. Making Pricing More Transparent
   • Patient Sensitivity
   • Release of Hospital Chargemaster – What Good Does it Do?
7. Cost Report Impact Through Charges and Pricing Structures
   • Compliance Issues for Establishing Charge Structures
   • Patient Acceptance and Understanding of Charge Structures
8. Chargemaster Coordinator Action Steps

Suggested Attendees: 

• Chargemaster Coordinators
• Billing and Claims Generation Personnel
• Compliance Personnel
• Patient Financial Management Personnel
• Cost Accounting Personnel
• Cost Report Personnel
• Financial Analysts
• Managed Care Contract Personnel
• Revenue Enhancement Personnel
• Chief Financial Officers
• Chief Compliance Officers
• Financial Planners
• Reimbursement Specialists
• Revenue Cycle Specialist
• Public Relations
• Planning Specialists
• All Other Hospital Personnel Interested in Pricing

Comply With GDPR Now to Avoid Heavy Penalties Later

As a U.S. provider, you may think that the European Union’s General Data Protection Rule (GDPR) is not applicable to your patient records, and that only HIPAA and local state rules apply. However, there are scenarios where GDPR’s standards apply to you in this country. The rule also differs substantially from HIPAA in several respects, which may require different handling of records subject to GDPR. Failure to comply with GDPR carries more serious penalties than HIPAA, and a violator must deal with regulators of European agencies that are often unwilling to settle the matter informally.

Learn how to comply with EU’s GDPR in this informative audio conference by industry expert Wayne J. Miller. Miller will discuss examples where American providers are subject to GDPR, such as when a tourist sees a U.S. doctor, or when clinical trials are run for a foreign drug company. He will highlight the specific ways in which GDPR differs from HIPAA when recording confidentiality and security matters, and what additional steps are necessary to comply. Miller will also present an overview of the regulators that enforce GDPR, and the penalties they can impose. Lastly, he will show you how to update existing forms and procedures to be GDPR compliant.

After attending this session, you will know exactly how GDPR applies to you. You will know the difference between GDPR and HIPAA, and situations where HIPAA compliance will not be enough. You will also know which agencies enforce GDPR against providers, and how they do it. Plus, you will know the penalties for violating the new rule.

Session Highlights

The presentation will cover the following topics:

• Top 5 ways GDPR applies to you
• New patient record protections under the EU rule
• GDPR vs. HIPAA
• Situations where HIPAA compliance will not be enough
• Which agencies enforce GDPR against providers
• Penalties for violating the new rule.

Who Should Attend

• Physicians
• Medical groups administrators
• Medical group managers
• Hospitals
• Long term care facilities
• Health-care consultants

Overview:

This lesson will be addressing how practice/business managers (or compliance offers) need to get their HIPAA house in order as HIPAA is now fully enforced and the government is not using kid gloves any more.

It will also address major changes under the Omnibus Rule and any other applicable updates for 2019 and beyond. There are an enormous amount of issues and risks for covered entities and business associates these days. 

I will speak on specific experiences from over 17 years of experience in working as an outsourced compliance auditor, expert witness on HIPAA cases, and thoroughly explain how patients are now able to get cash remedies for wrongful disclosures of private health information. More importantly I will show you how to limit those risks by simply taking proactive steps and utilizing best practices. 

Why should you Attend:

• Be prepared for the ever changing landscape with HIPAA
• This once rarely enforced law has changed and you need to know what's going on!
• Protect your practice or business!
• What factors might spurn a HIPAA audit?are you doing these things?
• Why are the Feds enforcing after all these years?

We will be discussing some of the changes taking place in Washington with the Health and Human Services in regards to the enforcement of the HIPAA laws already on the books. I will go over some of the new changes affecting covered entities and business associates. I will also be discussing factors might cause an unwanted visit or letter from the Office of Civil Rights and how to prepare for the audit and deal with the Feds. 

Areas Covered in the Session:

• Updates for 2019
• Fines
• Portable Devices
• Emailing and Texting
• Business Associates and the increased burden
• Breach Notification
• Paperwork that needs to be Updated
• Risk Factors

Who Will Benefit:

• Practice Managers
• 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)
• MD's and other Medical Professionals

This program will discuss the most problematic standards in the restraint section. It will cover the 50 pages of restraints standards that hospitals must follow according to CMS.

Why Should You Attend:

Do you know that the number one area of deficiencies in the CMS CoP is regarding restraints? CMS issued a memo summarizing all of the deficiencies against hospitals which is updated quarterly.

This program by expert speaker Sue Dill Calloway, RN, MSN, JD, will discuss the most problematic standards in the restraint section. This program also discusses the proposed changes to restraint published in the Hospital Improvement Act. This will help you assess your preparedness if a CMS surveyor shows up at your hospital tomorrow, and enhance your staff’s understanding of all of the 50 pages of the CMS interpretive guidelines.

This session will also discuss the requirements for an internal log and what must be in the log for patients who die in one or two soft wrist restraints. Additionally, it will include what must be documented in the medical record and discuss the reporting requirements for patients who die in restraints and within 24 hours of being in a restraint.

Learning Objectives:

• Know the CMS restraint requirement of what a hospital must document in the internal log if a patient dies within 24 hours with having two soft wrist restraints on
• Why CMS requires that all physicians and others who order restraints must be educated on the hospital policy?
• Understand CMS’ requirements for education of staff on restraint
• What are specific things that CMS requires to be documented in the medical record for the one hour face to face evaluation on patients who are violent and/or self-destructive?

Areas Covered in the Webinar:

This webinar will cover the 50 pages of restraints standards that hospitals must follow according to CMS. It will cover all the CMS requirements on restraints which includes the following sections:

• Right to be free from restraint
• Number of deficiencies
• Providing copy of right to patients
• Restraint protocols
• Proposed changes in the hospital improvement act
  • PA to order and change from LIP to LP
• CMS deficiency reports
• CMS changes effective to internal log and soft wrist restraints
• Most current manual
• Medical restraints
• Behavioral health restraints
• Violent and self-destructive behavior
• Definition of restraint and seclusion
• Manual holds of patients
• Leadership responsibilities
• Two soft wrist restraints, internal log and documentation
• Culture of safety
• Drugs used as a restraint
• Standard treatment
• Learning from each other
• Restraints does not include
• Side rails, forensic restraints, freedom splints, immobilizers
• Assessment
• Need order ASAP
• Order from LIP and notification of attending physician ASAP
• Documentation requirements
• Least restrictive requirements
• Alternatives
• RNs and One hour face to face assessment
• Training for RN doing one hour face to face assessment
• New training requirements
• New death reporting requirements
• Ending at earliest time
• Revisions to the plan of care
• PI requirements
• Time limited orders
• Renewing orders
• Staff education
• First aid training requirement
• Stricter state laws
• Monitoring of patient in R/S
• Joint Commission Hospital Restraint standards and differences from CMS

Who Will Benefit:

All nurses with direct patient care, Compliance Officer, Chief Nursing Officer, Chief of Medical Staff, COO, Nurse Educator, ED Nurses, ED Physicians, Medical staff coordinator, Risk Manager, Patient Safety Officer, Senior Leadership, Hospital Legal Counsel, Chief Risk Officer, PI director, Joint Commission Coordinator, Nurse Manager, Quality Director, Chief Medical Officer, Security Guard, Accreditation and Regulation Staff and others responsible for compliance with hospital regulations and anyone involved in the restraint or seclusion of patients. Persons responsible for rewriting the hospital policies and medical staff bylaws should attend. This also includes staff who remove and apply them as part of their care such as radiology techs, ultra sound technologists, transport staff and others.

• Explain key components of PDGM, specifically helpful for business development and intake staff.
• Evaluate current referral sources to determine admission source, primary diagnosis for home health, and how referrals are obtained for processing.
• Assess current processes to determine potential obstacles impacting timely completion of the referral and admission of the patient.
• Identify and maximize opportunities to strengthen referral source relations through PDGM education and key performance indicators of your patient population.
• Define roles and staffing needs under PDGM to streamline processes and gain efficiencies when on-boarding patients.

Review any changes & bring the Urology CPT changes for 2019

Learn coding techniques that work!

• Learn how surgical practices lose income from improperly coding evaluation and mangement services.
• Learn when and how to bill co-surgeons and surgical assists.
• Signs, symptoms and ill-defined conditions are the key to payment for same day visits and procedures.
• ICD-10! Come learn about this new coding system.
• Modifiers are the key to surgical procedure reimbursement:

            a. The -57 vs -25

            b. Visits during global post-op period

            c. Billing for additional procedures during the global period.

            d. What about -51? Dealing with the -59 modifier; the -53 vs. -52.

Correct reimbursements from Medicare, Managed Care and Private Payers

• Document and code for what you do. Charge and file claims according to your contracts. This principle for doing business with insurances is critical to survival.
• What's new with RAC audits, and what to do if you get the notice.
• What is the secret to knowledgeable & correct "unbundling?" Medicare's "Correct Coding Initiative is the key." We'll discuss the latest.
• What triggers an audit on your claims? Can you afford it?

Advanced coding for Urology Eases Paperwork:-

• We'll give you the latest rule on getting paid for the insertion and removal of an indwelling stent.
• Having problems for ancillary treatment and testing in your office? Let's work through these together.
• Consults: When do you bill a new patient as a consult, and what is the criteria? CMS has specific guidelines. We'll teach you how to determine which to bill.
• Learn to code for multiple related cystos.

Learn How To:-

• Handle Special Urology Situations
• Use the CPT Urology Coding Changes For 2019
• Correlate Diagnoses To CPT Codes
• Bill "E & M" Services During The Post-Operative Period
• Avoid Claim Denials, Down coding & Inquiries
• Code Ultrasound Guidance, Trans-rectal Ultrasound & Prostate Biopsy
• Code Multiple Cystourethroscopy Procedures
• How To Correctly Bill For Multi-Cystos Performed During The Same Session
• How to Use Prolonged Service Codes. They Can Be Correctly Reimbursable!
• How to Assure Income By Using The Correct E & M Codes. Most Physician's Under Code 60% Of The Time

About the speaker:-

Dawn R. Cloud, CPC, CMSCS, CHCI, She has 26 years’ experience in the Medical Industry. She is a Certified Professional Coder through AAPC since 1999, and holds a multi-specialty credential as well as a Certified Instructor credential through PAHCS since 2003. She is the Co-founder of the East Valley Chapter for AAPC in AZ. She has been published in PAHCS newsletters and Family Practice Coding Advisor. She currently works teaching Coding Compliance and Consulting for Specialists. Her specialties cover the gamut of medicine and surgery.