HCM Marketplace

AUDIOCONFERENCE ON TAPE OR CD

sponsored by Part D for Long-Term Care: Explaining the New Medicare Drug Benefit

presented on April 13, 2006

Since the launch of the Medicare Part D prescription drug benefit, facilities are seeing considerable financial losses for drugs that aren’t covered by the new plans.

Now that February has rolled around, nursing homes are receiving surprises in their mailboxes—pharmacy bills to your SNF that might contain charges in the thousands because your residents weren’t signed up for the correct PDP and you were unsure of the regulatory boundaries for handling drug coverage.

How do you get the coverage for the drugs your residents need without paying for them yourself?

You and your facility need to learn the appeals process to get necessary drugs added to resident formularies. Let the experts at HCPro explain this confusing process to you and your staff during the 90-minute audioconference, The Part D Appeals Process for Long-Term Care. Speakers Lee Heinbaugh and Janet Potter, MAS, CPA, will provide an overview of the appeals process, and provide essential information on prior authorization, Medicare Part D versus Part B, therapy protocols, and more. They’ll also address the clinical issues of the process, as well as offer tips on how to streamline the appeals process to suit your facility’s needs—and avoid getting hit with staggering drug bills.

Stop losing valuable drug reimbursement. Listen to The Part D Appeals Process for Long-Term Care today!

AGENDA:

1. Overview of the appeals process
   1. Structure and essentials of the Part D appeals process
   2. Areas of the process that are likely to provide the most trouble
2. Navigate the system
   1. Steps of the appeals process
   2. CMS’ requirements for appeals
   3. PDP appeals forms–where to locate them and what information to include on them
3. Clinical issues
   1. What is needed from physicians
   2. How the step therapy protocols affect long-term care facilities
   3. The requirements for prior authorization
   4. Differentiating  between coverage under Medicare Part B and Medicare Part D
4. Streamlining the process      
   1. Policies and procedures to help your facility to better use the appeals process
   2. Helpful checklists, "how to's," and reminders
5. Conclusion
   1. What's ahead for Part D in 2006
   2. How new admissions operate with no transition period for the first time
   3. Other Part D problems that have developed since the program’s inception

Purchase a tape or CD of the program and listen when you can. It's a perfect training tool for new staff or as a refresher for veteran staff.

ABOUT THE SPEAKERS:

Lee Heinbaugh is a Consultant with Pharmacy Management Group, LLC.  Her experience includes Medicaid, Medicare and other third party payment and reimbursement issues including business office operational reviews, cost report preparation as well as traditional accounting and bookkeeping services.

Janet Potter, MAS, CPA, is a Senior Healthcare Consultant at FR&R Healthcare Consulting, Inc.  She specializes in Medicare billing, bookkeeper training issues, HIPAA, Medicare prescription drug plans, Medicare regulatory issues, as well as Medicare and Medicaid reimbursement for skilled nursing facilities.

WHO SHOULD LISTEN:

Administrators, DONs, MDS coordinators, Medicare case managers, admissions personnel, charge nurses, business office personnel, and social workers

PROGRAM MATERIALS:

Program materials will be provided with PDF links.

• Audioconferences

• Other Long-Term Care Products