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Overview: The idea of providing health care treatments and insurance coverage according to "medical necessity" determinations seems eminently reasonable. Its obvious ethical thrust is to discourage unnecessary, wasteful or fraudulent practices. As practically implemented, however, "medical necessity" regulations and determinations have proven remarkably controversial and elusive. First of all, the language connected with medical necessity is inherently vague. Language to the effect that a treatment is medically necessary if it is "likely to achieve a significant practical improvement," is "realistic," or "reasonable" will predictably cause disputes between payors and providers of care. Second, the persistence of these disputes calls into question whether evidence based practices have evolved to a point where they are all that reliable and useful. Third, medical necessity determinations incur problems as to who should ultimately make them: payors, health providers or the courts. Obviously, whoever controls the definition of medical necessity controls the flow of health care dollars. While ethical theory can offer important insights about our moral obligations, it remains unable to reliably translate its theoretical principles and rules bearing on harms, benefits and justice into informing medical necessity determinations. Thus, resolving disputes over medical necessity have taken a procedural approach that looks to the interpretation of contractual language in insurance policies, often at the bench of an administrative law judge. This presentation will advance a reasonable set of strategies whereby a convincing case can be made for certain care interventions qualifying as "reasonable and necessary." Why should you Attend: Despite their central importance as a locus for determining reimbursement, "medical necessity" regulations and determinations have proven remarkably controversial and vexing for at least the last 20 years. Yet, whoever controls the definition

Overview: Many medical entities are increasingly struggling to manage revenue effectively. Self pay is on the rise due to high deductibles. Bad debt is increasing. What is your plan to manage these areas? Staff trained in denial management? Variances? Are they handling these areas in a timely manner? Payers have time limits in which dollars can be salvaged. Missing those strategic times mean dollars lost. Don't leave money on the table. We will discuss multiple avenues in which strong training and timely action can equal $$$. Why should you Attend: Don't lose hard earned revenue. Learn tips to strategic follow up, when and how to manage the appeal process. Is the claim appealable? Partial payments and why? Today's industry of high dollar deductibles create the necessity to expend additional efforts on self-pay accounts. There is a significant difference in collecting small co-pays and managing large balances. Bad debt creep? What is your plan for managing these areas? Areas Covered in the Session: Hire the right staff - Then engage in ongoing education Variances and denial management Billing compliance Coding for specificity, co-existing conditions and correct modifiers Supporting medical necessity CCI edits and unbundling Productivity Claims follow up Payer processing edits Additional development requests Handling problem claims and appeals Who Will Benefit: Coders Billers Revenue cycle Physicians, mid-level providers Nurses Claims follow-up Managers Speaker Profile Dorothy D. Steed is an Independent Healthcare Consultant and Educator in Atlanta. She was a Medicare specialist for a large hospital system and a physician coding audit supervisor for another hospital system, with 38 years of experience in healthcare. Additionally, she is an instructor at a state technical college in Atlanta, provides auditing & training in both facility and physician services, and has been a speaker at several healthcare conferences. Ms. Steed has written articles for

Overview: Discussions, presentation, and webinars regarding HIPAA regulations are usually addressed from the perspective of what the regulations entail, the necessity of compliance with the regulations, and the consequences of willful neglect or non-compliance. This presentation addresses HIPAA regulations from a different perspective - from a personal perspective - from the perspective of the person in charge of moving an organization or facility toward full compliance with HIPAA. The by-product of this presentation will be both an understanding of, and a detailed job description for, a position mandated in the regulations - the HIPAA Security/Privacy Officer. Why should you attend: The HIPAA regulations are numerous, complicated, often vague, and affect every person working in a healthcare facility. Compliance with HIPAA will require a unique individual to lead the charge - an individual whose education, background, experience, and demonstrated skill sets offer the opportunity for that person to succeed in achieving the goals of that position. This is a new position to most healthcare facilities. So understanding who this person should be, what is required of the person with this job title, and with whom this person will interface is vital to every healthcare organization with the goal of achieving full compliance with HIPAA. Areas Covered in the Session: Position goals Position requirements (education, experience, skill sets, etc.) Position responsibilities Stay abreast of regulations Initiate compliance with HIPAA (according to regulations) Ensure continuous progress toward full compliance Develop appropriate security/privacy policies & procedures Oversee and deliver appropriate training programs to all employees Track compliance with HIPAA regulations at the facility & individual levels Track access to PHI Investigate and resolve HIPAA violations Apply sanctions to HIPAA violators Manage any information security personnel Prepare a department

Overview: This webinar will explain the details of how to report and what to report on the OSHA Injury and Illness report. It will include an explanation of how to determine if an injury is work related, if an injury is new or ongoing, and what the differences are between first aid and medical treatment. A specific list of what constitutes injuries, illnesses and first aid treatment will be provided, along with practical examples of how to determine if an injury should be reported. In addition, examples of the forms used to report injuries, as well as annual summaries will be presented. Why should you attend: OSHA Injury and Illness Record keeping provides a window for regulators to see into your business to determine if the work environment is safe or if there are problems. Correct reporting of injury and illness data and a clear understanding of what to report and how to report it is a key necessity to avoid potential inspections and fines. Areas Covered in the Session: Injury and Illness reporting Determination of workplace relatedness Differences between first aid and medical treatment Determination of case as new or ongoing How to count total lost days Advantages that a company can provide to reduce risks of inspections and fines Who Will Benefit: Safety Personnel HR Personnel Managers Executives Speaker Profile Kenneth S. Weinberg is an independent consultant in environmental health and safety. Dr. Weinberg has consulted for several companies in the areas of OSHA Injury and Illness reporting, as well as auditing for OSHA inspections. He has worked as the Director of Safety at Mass. General Hospital in Boston for almost twelve years, and has written several books on the topics of health care safety, OSHA, and Indoor Air Quality. He has also written several articles for prominent national safety publications, and serves on the editorial advisory boards for safety publications. He Also has been Administrator of the Health Care Divisio0n of the American Socie

Overview: Discussions, presentation, and webinars regarding HIPAA regulations are usually addressed from the perspective of what the regulations entail, the necessity of compliance with the regulations, and the consequences of willful neglect or non-compliance. This presentation addresses HIPAA regulations from a different perspective - from a personal perspective - from the perspective of the person in charge of moving an organization or facility toward full compliance with HIPAA. The by-product of this presentation will be both an understanding of, and a detailed job description for, a position mandated in the regulations - the HIPAA Security/Privacy Officer. Why should you attend: The HIPAA regulations are numerous, complicated, often vague, and affect every person working in a healthcare facility. Compliance with HIPAA will require a unique individual to lead the charge - an individual whose education, background, experience, and demonstrated skill sets offer the opportunity for that person to succeed in achieving the goals of that position. This is a new position to most healthcare facilities. So understanding who this person should be, what is required of the person with this job title, and with whom this person will interface is vital to every healthcare organization with the goal of achieving full compliance with HIPAA. Areas Covered in the Session: Position goals Position requirements (education, experience, skill sets, etc.) Position responsibilities Stay abreast of regulations Initiate compliance with HIPAA (according to regulations) Ensure continuous progress toward full compliance Develop appropriate security/privacy policies & procedures Oversee and deliver appropriate training programs to all employees Track compliance with HIPAA regulations at the facility & individual levels Track access to PHI Investigate and resolve HIPAA violations Apply sanctions to HIPAA violators Manage any information security personnel Prepare a department budget Hold Bu

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