2014 AAMAS Annual Meeting

Program of Events

 
Events for Monday, April 07, 2014 Date Time
Registration Apr 7, 2014 7:00 AM to 8:00 AM
 
Workshop 1: Principles of Auditing Bootcamp - Day 1 Apr 7, 2014 8:00 AM to 5:00 PM
 
Auditing Bootcamp Day 1
Presented by: William Malm, ND, RN CMAS

A two day immersion providing the medical auditor with the knowledge, tools, and insight to advance their career. This course requires prior audit experience. Information covered will include professional standards, regulations, investigating/ verifying charges, and other medical audit responsibilities such as compliance, denials/appeals, and contracts/ negotiations. This can serve as a functional review course prior to the CMAS exam however it is not designed specifically to address all areas of the exam.

Lunch is on your own 12pm-1pm.

Separate fees apply:
Members: $400 - After March 21st $450
Nonmembers: $400 - After March 21st $450

Please note the fee is for the two full days. If you wish to take only one day there is no discount offered.

This workshop requires a minimum of 15 registrants

William Malm ND, RN, CMAS
Events for Tuesday, April 08, 2014 Date Time
Registration Apr 8, 2014 7:00 AM to 8:00 AM
 
Workshop 2: Principles of Auditing Bootcamp - Day 2 Apr 8, 2014 8:00 AM to 5:00 PM
 
Auditing Bootcamp- Day 2
Presented by: Bill Malm, ND, RN CMAS

A two day immersion providing the medical auditor with the knowledge, tools, and insight to advance their career. This course requires prior audit experience. Information covered will include professional standards, regulations, investigating/ verifying charges, and other medical audit responsibilities such as compliance, denials/appeals, and contracts/ negotiations. This can serve as a functional review course prior to the CMAS exam however it is not designed specifically to address all areas of the exam.

Lunch is on your own 12pm-1pm.

William Malm ND, RN, CMAS
Workshop 4: Auditing Surgical Claims Apr 8, 2014 1:00 PM to 5:00 PM
 
Auditing Surgical Service Claims
Presented by: Laurie Laxton, RN, BSN, CMAS

Presented both from an operating room nurse and external auditor point of view, attendees will be given a pictorial tour of the entire surgical process from the Preoperative suite, through the Intraoperative procedure, transitioning finally into the PACU. Common and uncommon surgical supplies/charges will be discussed, as well as, an introduction to Anesthesia medications and supplies. The session will end with a meticulous breakdown of operating reports and anesthesia records

Separate fees apply:
Members: $95 - After March 21st $110
Nonmembers: $95 - After March 21st $110

This workshop requires a minimum of 15 registrants

Laurie Laxton RN, BSN, CMAS, RAC-CT
Events for Wednesday, April 09, 2014 Date Time
Registration Apr 9, 2014 7:00 AM to 6:00 PM
 
CMAS Certification Examination Apr 9, 2014 8:00 AM to 12:00 PM
 
CMAS Certification Examination

The CMAS exam will be administered in a 4-hour continuous block. For more information, please refer to the Certification handbook. Anyone having further questions regarding the exam may address them to Ruth Gahan, Certification Council Test Administrator cmastestadmin@aamas.org

Workshop 5: Hospital Bill Auditing Skills - Part 1 Apr 9, 2014 8:00 AM to 12:00 PM
 
Hospital Bill Auditing Skills - Part 1
Presented by: Dave Eklof

This 4 hour workshop will provide the beginning medical auditor with basic principles of auditing and basic techniques on the process of conducting an audit, as well as identifying the tools and resources available to the medical auditor. The attendee will have the opportunity to apply knowledge and skills learned while conducting a sample clinical audit.

Separate fees apply:
Members: $175 - After March 21st $200
Nonmembers: $175 - After March 21st $200

Please note the fee is for the two sessions in one day. If you wish to take only one session there is no discount offered.

This workshop requires a minimum of 15 registrants

David Eklof CMAS
Workshop 6: Introduction to Hospital/Payer Contracting Apr 9, 2014 8:00 AM to 12:00 PM
 
Introduction to Hospital/Payer Contracting
Presented by: Mary Correa

Separate fees apply:
Members: $95 - After March 21st $110
Nonmembers: $95 - After March 21st $110

This workshop requires a minimum of 15 registrants

Mary Correa RN, BS, CMAS, CPHM
Lunch - on your own Apr 9, 2014 12:00 PM to 1:00 PM
 
Certification Council Meeting Apr 9, 2014 1:00 PM to 4:00 PM
 
Workshop 7: Hospital Bill Auditing Skills - Part 2 Apr 9, 2014 1:00 PM to 5:00 PM
 
Hospital Bill Auditing Skills - Part 2
Presented by: Dave Eklof

This 4 hour workshop will provide the beginning medical auditor with basic principles of auditing and basic techniques on the process of conducting an audit, as well as identifying the tools and resources available to the medical auditor. The attendee will have the opportunity to apply knowledge and skills learned while conducting a sample clinical audit.

David Eklof CMAS
Workshop 8: Managing and Using the CDM for Auditing: Focus on Emergency Services Apr 9, 2014 1:00 PM to 5:00 PM
 
Managing and Using the CDM for Auditing: Focus on Emergency Services
Presented by: William Malm, ND, RN, CMAS

This course will cover the basics of the charge master as a review. It will also point out many requirements for charge capture within the emergency department indicating the role of medical records versus that of the charge master. It will cover the charge capture of orthotics as well as the 2015 proposed changes to E & M for Emergency Services. The objective of the course will be to have a comprehensive overview of charge capture within emergency services while identifying common lost charges within the ED. This course will not be covering infusions and injections as that is taught in another course.

The ED Auditing Bootcamp will focus on:

  • Aspects of charge capture and new requirements under the Medicare 2 midnight rule
  • The Chargemaster and how it is used in the ED (each participant will need to bring a copy of their CDM to work with)
  • Commonly missed and misused charge items
  • Soft coding versus hardcoding
  • Mapping concerns with billing systems
  • Management of Self Administered medications and charges to the Medicare patients
  • What will ICD-10 do to the ED

What we will not cover:
  • Infusion and injection coding this should be a requirement to be at the class
  • Pricing pricing is an individual facility choice and will not be discussed or reviewed during the course
  • Compliance issues known compliance issues cannot be discussed during the course as they may break a legal privilege

Separate fees apply:
Members: $95 - After March 21st $110
Nonmembers: $95 - After March 21st $110

This workshop requires a minimum of 15 registrants

William Malm ND, RN, CMAS
New Member /First Time Attendee "Meet and Greet" Apr 9, 2014 5:30 PM to 6:00 PM
  This reception will give new members and first time attendees an opportunity to meet and visit with AAMAS Board members.
Opening Reception Apr 9, 2014 6:00 PM to 8:00 PM
  The Opening Reception is a great time to celebrate AAMAS 20th year as an organization, to network, and to meet the candidates running for office.
Events for Thursday, April 10, 2014 Date Time
Continental Breakfast Apr 10, 2014 7:00 AM to 8:00 AM
 
Registration Apr 10, 2014 7:00 AM to 6:00 PM
 
AAMAS Opening Remarks and Announcements Apr 10, 2014 8:00 AM to 8:30 AM
 
AAMAS Opening Remarks and Announcements
Moderator: Alex Sanchez, RN, MBA, CCM, CMAS
Alejandro Sanchez RN, MBA, CCM, CMAS
Keynote Address: Mastering the Chaos of the RAC/MAC Audits Apr 10, 2014 8:30 AM to 11:30 AM
  Mastering the Chaos of the RAC/MAC Audits
Presented by: Day Egusquiza

Our keynote address will be presented by renowned RAC & MAC Audit expert, Day Egusquiza. In this session, Day will provide an update on recent RAC and MAC hot issues, as well as her operational recommendations and best practices for successfully managing audits and appeals. Day will also discuss lessons learned and will use case study examples to illustrate the findings and recommendations.
Day Egusquiza
Thursday Lunch Apr 10, 2014 11:30 AM to 1:00 PM
  Exhibit Hall open
General Session 1: Determining Level of Care for Patients Requiring... Apr 10, 2014 1:00 PM to 2:15 PM
 
General Session 1: Determining Level of Care for Patients Requiring Hospitalization: Evolving Care Management Models
Presented by: Jeff Frater, Theresa Crothers, Lynn Walter

While the regulations regarding the use of hospitalization services for traditional fee for service Medicare may be in a state of dramatic flux (e.g. 2 Midnight Rule), hospitals struggle to balance the administrative versus clinical elements of determining the correct level of care for a patient who requires hospital services. New rules are introduced while previous rules remain in effect and the future of programs such as the Recovery Audit Contractor (RAC) is unclear.

This program will explore the rule and criteria the hospital must follow for both traditional Medicare, Medicare Advantage plans and the varieties of programs from commercial health insurance plans. The evolving and emerging Care Management model and programs used by hospitals will be reviewed as they move from reactive and retroactive to become prospective and find ways to provide clinicians with supportive guidance and assurance in making level of care determinations. Additionally the program will review various roles for common tools such as InterQual and MCG (formerly Milliman Care Guidelines). Finally the presentation will discuss the potential future state as the Affordable Care Act and accelerated Value Based Purchasing initiatives take affect.

Jeff Frater
Lynn Walter MBA RN, CPC-H
Theresa Crothers RN, CMAS
General Session 2: HIPAA: Before and After the Final Rules Apr 10, 2014 2:30 PM to 3:45 PM
 
General Session 2: HIPAA: Before and After the Final Rules
Presented by: Frank Ruelas

The Health Insurance Portability and Accountability Act (HIPAA) has been a long standing challenge for covered entities and business associates in terms of promoting requirements with its Privacy and Security Rules. This session will provide attendees with a working framework to understand some of the key areas that contribute to the challenge of complying with HIPAA, while also introducing effective approaches that can make the effort more efficient and effective.

Frank Ruelas
General Membership Meeting Apr 10, 2014 4:00 PM to 6:00 PM
 
Events for Friday, April 11, 2014 Date Time
AAMAS Fun Run/Walk Apr 11, 2014 6:00 AM to 7:00 AM
 
Continental Breakfast Apr 11, 2014 7:00 AM to 8:00 AM
 
Registration Apr 11, 2014 7:00 AM to 4:45 PM
 
AAMAS Closing Remarks Apr 11, 2014 8:00 AM to 8:30 AM
 
AAMAS Closing Remarks
Moderator: Allen Shane, BSN, RN, CMAS, CCM, LHRM
Allen Shane BSN, RN, CMAS, CCM, CLNC, LHRM
General Session 3: Appeals: From Basics to Best Practices Apr 11, 2014 8:30 AM to 10:00 AM
 
Appeals: From Basics to Best Practices
Presented by: Tammy Tipton

Tammy Tipton explains how to apply appeals processes to address denials. Presentation focuses on a number of insightful quotes from the healthcare industry and breaks down the information for what it means for day-to-day operations. Presentation materials for participants to take home and use include:

  • Appeal Basics: types of appeals (pre-service/post-claim and claims processing requirements regarding who can appeal, review requirements, response times and what should not be considered an appeal (resubmissions/requests for disclosure)
  • Communicating better - Peer review, disclosure laws and transparency between patient, provider and appeal reviewer
  • Proven strategies for Medical Necessity appeal customizations, denial prevention and what to do when appeal efforts fail
  • Managed Care Contract clauses which address appeals and medical review and how future contracting and ACO regulations will impact denials and appeals.
  • Go-to resources for appeals, ICD-10, standards and regulatory information.
  • Tammy Tipton
General Session 4: ICD 10: Decrypting the Codes Apr 11, 2014 10:15 AM to 11:30 AM
 
General Session 4: ICD 10: Decrypting the Codes
Presented by: Ruth Wingfield

Big changes arrive October 1, 2014 with the long-awaited US ICD-10 implementation. This session addresses the many structural and conceptual differences between the ICD-10 and ICD-9 code sets. Coding scenarios will be discussed to illustrate diagnosis and procedure code assignment with the new ICD-10 codes. The DRG and financial impact of ICD-10 coding will also be reviewed.

Ruth Wingfield RHIA, CCS, CCS-P AHIMA
Friday Lunch Apr 11, 2014 11:30 AM to 12:45 PM
 
Breakout A: Healthcare Provider Contract Compliance - Medical Claim Auditing Apr 11, 2014 12:45 PM to 2:00 PM
 
Breakout A: Healthcare Provider Contract Compliance - Medical Claim Auditing
Presented by:Michael Walrath, JD

Although not everyone uses the same Healthcare provider contract, there is common contract language that remains fairly consistent throughout the industry. Standard language can be state-mandated to protect the insured or be market driven. The medical auditor must understand the basic elements of contract terms and compliance as it relates to the auditing of claims. The medical auditor must also understand how to determine coverage, reimbursement and auditing terms. It is also important to know when you should consult a lawyer or malpractice carrier, or when standard language means non-modifiable.

Michael Walrath
Breakout B: Automation of Admit Orders & Work Item Flow in Cerner Patient Accou Apr 11, 2014 12:45 PM to 2:00 PM
 
Breakout B: Automation of Audit Orders & Work Item Flow in Cerner Patient Accounting
Presented by: Laura Ashmore, CMAS

This dynamic session will focus on the enormously successful integration and automation of Physician orders which automatically calculate Observation Exclusions/Carve Outs from Monitored procedures, R&B charges and Patient Types. In addition, automated clinical and revenue edits routing real-time to the user who made the error for review and correction timely. Laura demonstrates Automation of Physician Orders and Real-time edit review in the new Work Item and Workflow process.

Laura Ashmore CMAS
Breakout C: Panel: Medical Audit: Past, Present, Future Apr 11, 2014 2:15 PM to 4:15 PM
 
Breakout C: Panel: Medical Audit: Past, Present, Future
Panel Members: Ruth Gahan, RN, BSN, CMAS; Ruth Wingfield; Marilyn Balcita, RN, CMAS, CPUR, CICA; Laura Dale, RN, Jonas Blomqvist

This session is designed to prepare the medical auditor for the future of healthcare. Given the changes on the horizon and currently upon us, the experts will discuss what best practice tools, educational preparation, and resource materials are needed to guide medical audit through its ever changing landscape.

Laura Dale
E. Jonas Blomqvist CMAS
Marilyn Balcita RN, CMAS, CPUR, CICA
Ruth Wingfield RHIA, CCS, CCS-P AHIMA
Ruth Gahan RN, BSN, CMAS

Nursing

This continuing nursing educational activity was approved by the Arizona Nurses’ Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

The maximum number of contact hours an attendee can obtain is:
Pre Conference Workshops - 21 contact hours
Conference - 11.25 contact hours

AAPC

This program has the prior approval of AAPC for continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Preconference Workshops - Maximum of 21 CEU's
Conference - Maximum of 10.5 CEU's

CMAS

This program has been approved for CMAS continuing education units (CEU's) by the Certification Council of American Association of Medical Audit Specialists.

Pre conference workshops - Maximum 21 CMAS CEU's
Conference - Maximum of 12.75 CMAS CEU's

 
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