With the new year fast approaching, it is imperative that hospitals are ready for the various changes that are being proposed and going into effect with the updated Joint Commission National Patient Safety Goals.

In this session, our expert will cover all of the Joint Commission National Patient Safety Goals (NPSGs) for hospitals as well as resources available to help hospitals comply with the National Patient Safety goals. Additionally, our expert will be going over all of the specific changes that were made over the past few years, including medication reconciliation standards, CMS revised blood transfusion, and more.

After this webinar participants will be able to:

1. Describe the NPSG relates to reducing catheter associated infections.
2. Recall the proposed changes to NPSG 15 on prevention of suicide.
3. Discuss the infection control goals and how to prevent multi-drug resistant organisms and why not doing this can cost the hospital a lot of money.
4. Recall that TJC allows a one person verification process for checking the blood if accompanied by bar coding.
5. Recall the current five medication reconciliation standards and that CMS is looking at this issue in their revised worksheets.

Agenda topics:

Target Audience:

Anyone who is involved in implementing and following the Joint Commission National Patient Safety Goals (NPSGs), including but not limited to: Joint Commission Coordinator, Quality Improvement staff, chief nursing officer (CNO), patient safety officer, nurse educator, all nurses with direct patient care, pharmacist, pharmacy staff, infection preventionist, nurse manager, chief medical officer (CMO), nursing supervisor, nurse manager, nursing director, policy and procedure team, compliance officer, risk manager, hospital legal counsel, and medication team members.  

The world of healthcare is changing rapidly and so is the role of case management in that world! Federal fiscal year 2019 promises to bring new and exciting changes that will impact your work as a case management professional. 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 a case manager. Each year we bring you the latest and greatest in the field of acute care case management. We hope to do the same for you again this year! Reimbursement has changed dramatically as has utilization management, transitional planning and compliance. CMS has incorporated changes that impact on payments related to readmissions, length of stay and the cost of care. Who is in a better place to address these issues than case managers! 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 five-part series. The program 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 including a review of acute care reimbursement. 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 webinar series 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.

Part I (January 29th): A Review and Preview of Acute Care Case Management and Reimbursement Strategies for 2019 (90 Min each)(1 PM EST)

Part II (Feb 12th): Acute Care Case Management Roles, Models and Staffing Ratios: Who Does What and When? (90 Mins each)(1 PM EST)

Part III (Feb 27th): Utilization Management: What Does it Really Mean? And Where Should it Reside? (90 Mins each)(1 PM EST)

Part IV (March 12th): Discharge And Transitional Planning Under The Current and Proposed CMS Rules (90 Min each)(1 PM EST)

Part V (March 27th): Measuring The Success Of Your Case Management Department: Do You Make the Grade? (90 Mins each)(1 PM EST)

After this webinar participants will be able to:

1. Understand how hospital stays are reimbursed under the DRGs and prospective payment.
2. Review managed care, the different products and what case management’s role is.
3. Discuss bundled payments and other new payment models under the Centers for Medicare and Medicaid Services (CMS).
4. Understand the changing roles of case management professionals across the continuum of care.
5. Understand the role evolution of case managers.
6. Describe the different skill sets and roles of RN case managers and social work case managers.
7. Review specialty case management roles and determine new or updated roles for your contemporary case management department.
8. Understand the evolution of case management models.
9. Describe the advantages and disadvantages of each model.
10. Identify the best model for to ensure a contemporary case management department.
11. Describe the differences between utilization review and utilization management.
12. Discuss the best strategies for managing utilization reviews and other issues relate to utilization management.
13. Identify ways in which a strong utilization management process can reduce payment denials.
14. Understand transitional planning as a process not an outcome.
15. Discuss the new CMS changes related to transitional and discharge planning and how they can impact your practice.
16. Identify best strategies to transition patients across the continuum of care.
17. Describe contemporary outcome measures for case management.
18. Review how to create a workable case management dashboard.
19. Understand how benchmarks can be applied to your CM dashboard.

Target Audience:

Anyone involved with or interested in case management, including but not limited to: CEOs, CFOs, COOs, CMOs, CNOs, CE Directors, Department Directors, Quality Improvement Staff, Physicians, Nurses (all levels), Compliance Officers, CMS Liaisons, TJC Liaisons, Registration Staff, Safety Officers and Staff, Pharmacy Staff, Ethics Committee Members, Consumer Advocates, Risk Managers, Legal Counsel, Behavioral Health Staff, Psychiatry Staff, Social Workers, Discharge Planners, Case Managers, Hospice Staff and Regulatory Affairs Staff.

If you’re wondering about the new Targeted Probe and Educate (TPE) Audits, you’re not alone. By and large, hospice staff don’t understand the new TPE audits, nor do they know how to navigate through these payment scrutinies. This can lead to payment denials, and seriously impact your reimbursement in 2019.

Learn how the new TPE process works and what auditors will likely be looking for in 2019 in this informative session by hospice compliance guru Jnon  Griffin. Gain a solid understanding of the data analysis used to select hospices for TPE audits and of how the TPE process works. Discover what these audits are looking for, so you’ll have a better chance to ensure your documentation is up-to-par.

After attending this audio conference, you’ll walk away with a firm grasp on how the new TPE process works and how to effectively document and analyze data so you can potentially avoid these audits. You’ll get firsthand feedback on the TPE audits and process, with a special emphasis on real-world strategies for quality, compliance, and billing issues.

Session Highlights

This how-to session will cover:

• The TPE audit definition and what the process is like for these audits
• Strategies and tips for staying compliant and avoiding increased audits
• How to improve your documentation and billing processes, so you can minimize Medicare payment denials

Who Should Attend

This program is designed for hospice educators, QAPI/PI, executives, compliance staff, billers, nurses, and leadership

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

This seminar will review the regulatory requirements for investigating an OOS Investigation. The responsibilities of the analyst, the supervisor and QA will be discussed. A detailed flow chart will be used to help the attendees clearly understand the steps and the order in which they are to be performed. The structure of an Investigation report which properly documents the investigation will be discussed.

The lack of or Inadequate procedures for handling out of specification (OOS) situations and failure investigations are amongst the most frequently found deviations in FDA warning letters. Most companies have procedures but either they are not adequate or are not followed. This seminar will guide attendees through the entire process from detection an out-of-specification result to informal and formal laboratory and batch investigations.

Learning Objectives:

• Learn the responsibilities of analysts and supervisors
• Listen to what the FDA looks for in terms of human errors
• Describe when a full investigation should be triggered
• Describe the frequency for re-testing and re-sampling
• Learn how to implement the corrective and preventive action plans (CAPA)

Areas Covered in the Session :

Session 1:
Guidelines for Detecting an OOS or Atypical Result

• Definition Atypical or Out of Specification Result?
• Review of the FDA Guidance for Industry on Investigating OOS Test Results
  • Phase I: Initial Laboratory Investigation
  • Phase II: Full Scale Investigation
• Root Cause Analysis Methods
  • 5 Whys
  • Flow Charts
  • Checklists
  • Fishbone Diagrams

Session 2:
Testing the hypotheses regarding potential root causes

• Retesting
• Considering Other Batches

Session 3:
Developing a proper CAPA plan to address any Corrective Actions

• How to properly document findings
• Example of a proper OOS investigation write up

Who Should Attend:

• Quality Assurance Departments
• Quality Control Departments
• Research and Development Departments
• Regulatory Affairs Departments
• Compliance Departments
• Laboratory Staff
• Training Departments
• GMP auditors
• Consultants

Being in compliance with HIPAA involves not only ensuring you provide the appropriate patient rights and controls on your uses and disclosures of protected health information, but you also have the proper policies and procedures in place. If audited or the subject of a compliance review you will be required to show the government you have all the necessary documentation in place for safeguarding patient Protected Health Information and indicate how you addressed all required privacy safeguards.

Why You Should Attend:

With a substantial increase HIPAA data breaches and increased government enforcement, organizations must understand patient’s rights for access to their health records under the HIPAA Privacy Rule. Attendees will leave the course clearly understanding of all the requirements that must be in place for meeting this rule for the protection of personal health information their organizations maintain, create, transmit, or store. After completing this course, a healthcare provider will have a clear understanding for what needs to be place when it comes to meeting these HIPAA requirements for medical records.

Areas Covered in the Session :

• Why was HIPAA created?
• Who Must Comply with HIPAA Requirements?
• What is the HIPAA Privacy Rule?
• What is Protected Health Information
• What are Permitted and Authorized Disclosures?
• What are Rights do Patients have under HIPAA?
• What is a HIPAA data breach and what happens if it occurs?
• What are the penalties and fines for non-compliance and how to avoid them?

Who Should Attend:

• Compliance Officer
• HIPAA Privacy Officer
• HIPAA Security Officer
• Medical/Dental Office Managers
• Practice Managers
• Information Systems Manager
• Chief Information Officer
• General Counsel/lawyer
• Practice Management Consultants

Get 1.0 AAPC CEU.

The webinar will focus on identification of a breach and what the required process is to remedy a breach if it is determined one has occurred, The initial overview of HIPAA requirements and policies will help the attendee determine if his or her practice is compliant.

Overview:

The collection of laws and regulations known commonly as HIPAA is comprised of two federal statutes and three federal rules:

The Health Insurance Portability and Accountability Act of 1996 ("HIPAA"),the Health Information Technology for Economic and Clinical Health Act of 2009 ("HITECH"), the Privacy Rule (found at 45 C.F.R. 164.500 et. seq.), the Security Rule (found at 45 C.F.R. 164.300 et. seq.) and the Breach Notification Rule (found at 45 C.F.R. 164.400 et. seq.). 

The three rules were amended and combined in 2013 into what is known as the HIPAA Privacy, Security, Enforcement and Breach Notification: Final Omnibus Rule. The federal Office for Civil Rights ("OCR") has the duty and responsibility to investigate complaints or reports of potential HIPAA violations and to continuously monitor entities required to comply with HIPAA ("Covered Entities") for compliance. OCR began a preliminary pilot program for random compliance audits of Covered Entities in 2015.

The OCR looks at several areas of HIPAA compliance when performing an audit including:

• Does the Covered Entity have a Notice of Privacy Practices? Is the notice complete? Is the notice posted and distributed properly?
• What are the patients' rights to request privacy protections, access to or an accounting of disclosures of their protected heath information ("PHI")?
• What are the Covered Entities administrative requirements for the security of PHI?
• Does the Covered Entity have proper Authorizations for Use and Disclosure of PHI available for patient use?
• Are there proper administrative, physical and technical safeguards in place on the premises of the Covered Entity?

All medical practices must have a designated Security Officer who is responsible for HIPAA security. The designated Security Officer should perform regular internal Compliance Risk Assessments as well as staff training sessions to ensure that all of the proper protections are in place and are functioning properly. 

OCR is on schedule to begin its second round of HIPAA audits in early 2016 and plans to include many more types of Covered Entities than were included in the first phase as well as Business Associates (as defined by HIPAA) of Covered Entities. 

One of the essential items that OCR will be looking for is the proper performance of an internal Compliance Risk Assessment and the implementation of any necessary plans to cure any problems that are discovered as a result of the Compliance Risk Assessment.

Although OCR will not be publicly posting any audit results, the results are not confidential and the potential financial consequences of a poor audit are substantial. Any Covered Entity or Business Associate who has not yet performed an internal Compliance Risk Assessment should plan to do so immediately and should begin to prioritize the necessary changes which result based upon the level of risk involved in each deficiency. 

Why should you Attend: HIPAA compliance is one of the most cited and least understood laws in the typical medical practice. Although HIPAA has been in place for decades, it has changed rapidly in the last ten years due to the rapid proliferation of technology in medicine. 

In addition to these progressive changes, the law itself underwent a major overhaul in 2013 resulting in any practice that has not updated their HIPAA materials since that time being out of compliance. The speaker will highlight the major changes that must have been implemented after the 2013 HIPAA updates. Thereafter, the attendee will 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 identification of a breach and what the required process is to remedy a breach if it is determined one has occurred.

The federal Office for Civil Rights, the government entity tasked with enforcing HIPAA began a preliminary pilot program in 2015 to ensure a certain number of random compliance audits of Covered Entities. 

The initial overview of HIPAA requirements and policies will help the attendee determine if his or her practice is compliant. Thereafter, the speaker will highlight what "red flags" the Office for Civil Rights looks for when determining whether to audit a practice and learn what to do in the event you are selected for a random audit. 

Areas Covered in the Session:

• Determining level of Compliance with HIPAA
• Recognizing Areas that need to be Brought into Compliance
• Learning how to Analyze a Breach
• Current Trends in Enforcement Actions

Who Will Benefit:

• Physicians
• Health Care Providers
• Practice Mangers
• Administrators
• Privacy Officers
• Office Managers
• Medical Record Clerks
• Non-Clinical Health Care Employees and Contractors
• Business Associates of Health Care Providers

Do you understand the latest government audit and contractor trends?  This webinar will provide insight into Unified Program Integrity Contractors (UPICs) and how they relate to Zone Program Integrity Contractors (ZPICs) and Medicaid Integrity Contractors (MICs).  These trends include the "2 in 1" audits initiated by UPICs and recent tactics, including serial record requests, probe audits, "secret" patient interviews, and auto-denied claims.  Learn how to prepare for and recognize these trends during an audit. From the 10 questions every staff person should know, to testing your organization's record production capabilities, this program will empower you to prepare for and defend against government audits.

Highlights:-

• Current hospice audit trends
• The government’s focus and potential risk areas
• How hospices prepare for and address on-site auditors, including interviews of hospice personnel
• Methods for implementing and improving audit preparation and response processes

• TAKE-AWAY TOOLKIT
  • 10 questions every hospice employee should be able to answer
  • Checklist for hospice audit interviews and conferences
  • Preparation for actual onsite auditor questions and requests
  • Sample dashboard data points
  • Sample request lists for patient and business records

Who Should Attend?

This informative session will benefit hospice CEOs, COOs, officers, and compliance managers and directors.

CMS Hospital Improvement FINAL Rules Nursing, Medical Records, Infection Control, Antibiotic Stewardship Program, Restraints, QAPI, and more

CMS has finalized some significant changes to the hospital conditions of participation (CoPs) that every hospital should know, including critical access hospitals. It was 393 pages long and combined three laws into one. This includes changes to nursing, medical records, infection control, QAPI, patient rights, H&Ps, and restraint, and seclusion. 

Most have an effective date of November 29, 2019, with two exceptions. The normal implementation date is 60 days but Critical Access Hospitals will have 6 months to implement an antibiotic stewardship program and 18 months to implement a QAPI program since their QAPI requirements were completely written.

It will also require all hospitals to have an antibiotic stewardship program and what the program should include. Also, a great part of this document included things that CMS has found to be problematic in hospitals that are already a requirement in the hospital CoPs. CMS also clarified a number of existing requirements and a number of federal regulations that are already final which makes this webinar an excellent resource.

Session Outline:-

Introduction 

• Interpretive guidelines and survey procedure to be issued
• How to get a copy of the CoP manual, survey memos, etc.
• Why revise the CoPs

Psychiatric Hospitals

• Non-physicians writing in progress notes
• How often progress notes must be written

Emergency Preparedness

• Staff training every two years
• Exercises twice a year
• EP policies and procedures
• Emergency plan

H&P Changes

• When is H&P required
• Assessments instead in healthy outpatients
• Medical staff policy requirements
• Considerations

Patient Rights and Medical Records

• Restraint  changes
• Change from LIP to the licensed practitioner (LP)
• Physician Assistants (PAs) to order and evaluate
• Non-discrimination under OCR 1557
  • Written policy prohibiting
  • Inform each patient on the prohibition against discrimination
  • Inform on how to file a complaint
  • Currently, already law and CMS decides NOT to include in the CoPs
• Medical Records section was not implemented
  • Content of medical records
  • Document complications and hospital-acquired conditions
  • Diagnosis in the outpatient record in 7 days
  • Discharge instructions and transfer summaries

QAPI

• Quality indicator data including patient care data
• Medicare Quality Reporting Data
• Hospital readmission data
• Hospital-acquired conditions (HACs) and 5 changes

Nursing Services and Outpatient Departments

• Staffing-adequate number
• Supervisory staff
• Need to respond immediately when needed
• Nursing care plans
• Policies and procedures
• CNO must evaluate nursing staff including agency staff
• All outpatient departments must identify if RN must be present
• Outpatient policy required
• P&P must be reviewed by MEC
• Orders for drugs and biologicals
• Verbal  orders

Look Back Program and the Lab

• Notification of tainted blood
• Patient notification process
• The time frame for notification

Autopsies

• The deleted requirement to get in unusual cases
• Coroner cases

Four swing bed changes

• Dental 
• Activity program and assessment and plan of care
• Social worker
• Residents performing services

Infection Control and Antibiotic Stewardship

• Hospital-wide surveillance
• CDC outpatient assessment tools
• Following nationally recognized standards and best practices
• Infection control hospital-wide QAPI program
• Infection control program and policies requirements
• Qualified infection preventionist
• Requirements for the antibiotic stewardship program
  • The qualified leader who must be appointed by the board
  • Active program and evidenced-based use of antibiotics
  • Document improvements and reduction of CDI
  • Board responsibilities
  • Responsibilities of the leader of the antibiotic stewardship program
• Antibiotic stewardship policies
• Tracking all infections
• QAPI leadership
• Competency-based staff training

Objectives:-

• Recall that hospitals have requirements in the CMS CoPs on an antimicrobial stewardship program
• Discuss that CMS change  the term LIP (licensed independent practitioner) to LP (licensed practitioner) so PAs can order restraint and seclusion and do assessments if allowed by the hospital
• Describe that the hospital must have policies that describe which outpatient areas require an RN
• Recall CMS removed the section that required hospitals to conduct autopsies in cases of unusual deaths

Who Should Attend?

• Pharmacist
• Chief Nursing Officer
• Health Information Management
• Infection Preventionist
• Antimicrobial Stewardship Team Members
• Nurses
• Nurse Educators
• Chief Medical Officer
• QAPI Director and Staff
• Patient Safety Officers
• Regulatory and Compliance Officers
• Physician Assistants (PAs)
• Patient Advocate
• Risk Management
• Hospital Legal Counsel
• MEC Chair
• Board Members
• Anyone involved in Implementing the Hospitals' CoPs

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.