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BONUS TOOLS

In addition to the expertise and advice presented during this audioconference, you'll also receive a slide presentation of the program materials and these valuable tools:

1. Physician pocket card
2. Poster
3. Physician newsletter

These materials are provided with PDF links.

LEARNING OBJECTIVES

At the conclusion of this program, you'll be able to:

1. Distinguish between an appropriate observation patient and an appropriate inpatient admission for both medical and surgical patients.
2. Recognize external forces that will impact denial rates in 2007 and beyond
3. Explain Transmittal 299 and SE0622 instructions for appropriate use of Condition Code 44 vs. a  Provider Liable Claim
4. Identify billing regulations that impact the outpatient claim for status conversions
5. Predict Reimbursement Changes for Observation in 2008

AGENDA

1. Inpatient/outpatient observation status
   1. Rumor vs. regulation 
      1. Medicare
      2. Commercial
      3. Medicaid
2. One Day Stay national focus 
   1. Using CMS short-term program for evaluating payment patterns electronic (ST-PEPPER) report data to determine improvement strategies
   2. Expansion of recovery audit contractors (RAC) audits nationwide
   3. Expansion of the case management protocol
3. Condition Code 44
   1. Transmittal 299
   2. SE0622 MedLearn Matters clarification of Transmittal 299
   3. Use of Bill Type 121 for provider liable claims
4. Physician advisor vs. Utilization Review (UR) Committee oversight
   1. The role of the UR Committee
   2. The role of the physician advisor
5. Achieving accurate reimbursement 
   1. OPPS observation changes for 2008
   2. Self administered drugs
   3. Inpatient only procedures performed as outpatient
   4. Inpatient admission following outpatient surgery

A question & answer session follows the presentation.

FACULTY

Deborah K. Hale, CCS, president of Administrative Consultant Service, LLC (ACS), has twenty-five years of experience in health care management, including administration, health information management, clinical documentation improvement, case management, and utilization review. She is a member of the American Health Information Management Association and the Healthcare Financial Management Association. She has served as a featured speaker for numerous national, state, and local conferences presented by the Healthcare Financial Management Association, the American Health Information Management Association, medical residency programs, and case management programs.

WHO SHOULD LISTEN?

Director of case management, case managers, UR nurses, physicians, revenue cycle managers

NEW PURCHASE OPTION: Audio Archive

In addition to the regular participation options for HCPro audioconferences - audio tape or audio CD, we are pleased to offer a new option, an audio archive. An audio archive allows you to download the program and play it back at your convenience on your computer or MP3 player. Purchase a tape, CD, or audio archive of the program and listen when you can.

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