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Reimbursement Track
Sponsored by Definitive Homecare Solutions (DHS/CPR+)
Monday, March 10
10:45 a.m. – 12:15 p.m.
 3-A. Coding for the Infusion Reimbursement Professional—Anything But Clear-Cut!
ACPE # 207-999-08-161-L04-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 1.5
Session Summary:
- Explore why coding for infusion therapy is not a straight-forward process.
- Comprehend how, despite regulations designed to simplify and standardize coding, there are still a myriad of areas that prove to be pitfalls for reimbursement personnel.
- Receive a “back to basics” overview of several different coding methodologies—and consider how to clarify many of the misconceptions that abound when submitting claims for infusion therapy.
Faculty: Heather Skow, CPC, CHCP, CCP, CMBS, CHI, Area Reimbursement Manager, Critical Care Systems, Inc., Nashua, NH
Educational Objectives:
- Discuss HIPPA law and terminology as it relates to coding and claiming for home infusion therapy.
- Discuss ICD-9 Coding guidelines for outpatient coding.
- Discuss the Healthcare Procedure Coding System (HCPCS) for alternate-site infusion coding.
- Describe the Current Procedural Terminology (CPT) coding system.
- Discuss key concepts in coding and reimbursement related to managed-care payers.
4:15 – 5:45 p.m.
7-B. Using Information Systems and Technology to Maximize Reimbursement Results
ACPE # 207-999-08-165-L04-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 1.5
Session Summary:
- Examine how information systems and technologies are constantly changing—but the fundamental goals of billing and collections remain the same: presenting information about the drugs dispensed, the supplies and equipment provided, and the nursing services rendered in the correct format/in a timely manner to the responsible party, so as to receive prompt payments.
- Discuss how the core technologies of the information system play a critical role with regard to receiving reimbursement in an efficient manner (and hear how they may also impact not getting reimbursed at all).
- Comprehend the most common reimbursement mistakes and obstacles—and grasp how to fully leverage technology to obtain the maximum benefit from your information system to achieve reimbursement goals.
Faculty: Pete Tanguay, President, Rock-Pond Solutions, Conway, AR
Educational Objectives:
- Explain the cause of, and at least one resolution to, the most common reimbursement problems in the following areas: authorization, contract pricing, unbilled A/R management, electronic billing, staff productivity, collections and A/R management.
- Compare and contrast the roles and responsibilities of the software vendor and the internal management team related to maximizing reimbursement results achieved from the information system.
- List three primary responsibilities of an information system manager and explain why this position is critical for a home infusion provider.
- List the stages in the system life cycle within an organization and explain how reimbursement challenges change through the cycle.
- Give three examples of how data mining can be used to implement a reimbursement audit function that measures error rates and staff productivity to achieve specific reimbursement goals.
Tuesday, March 11
10:45 a.m. – 12:15 p.m.
11-C. Medicare Restructuring Update 2008
ACPE # 207-999-08-171-L03-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 1.5
Session Summary:
- Ascertain the structure in which home infusion therapy claims are adjudicated under Medicare Part B.
- Learn how to identify the Centers for Medicare & Medicaid Services (CMS) contractors that are involved with enrollment, setting policy, processing of claims, appeals and audits.
- Understand how (starting in 2005 and continuing through the present) these contractors and their responsibilities have changed significantly under provisions of the Benefits and Improvement Act of 2000 (BIPA) and the Medicare
- Modernization Act of 2003 (MMA)—including conversion of Durable Medical Equipment Regional Carriers (DMERCs) to Durable Medical Equipment Medicare Administrative Contractors (DME MACs).
Faculty: Pamela Dentino, Reimbursement Project Manager, Option Care Inc., Buffalo Grove, IL
Educational Objectives:
- Identify the role of DME MACs (Durable Medical Equipment Medicare Administrative Contractors) in the Medicare process and how they relate to providers.
- Identify the role of PSCs (Program Safeguard Contractors) in the Medicare process and how they relate to providers.
- Identify the role of QICs (Qualified Independent Contractors) in the Medicare process and how they relate to providers.
- Identify role of the NSC (National Supplier Clearinghouse) in the Medicare process and how they relate to providers.
- Discuss the Medicare competitive bidding program and new accreditation requirements for DMEPOS (Durable Medical Equipment Prosthetics and Orthotics Suppliers).
3:15 – 4:45 p.m.
16-D. Medicare Part D Workshop—Special Focus on Reimbursement Challenges
Part I: Background and Contracting
Please Note: Participants must attend BOTH Parts I (16-D.) and II (21-E.) of the Medicare Part D Workshop to receive Continuing Education Contact Hours—no partial credit is allowed: Total CE credit for Parts I and II is 3.0 contact hours for Pharmacy, as well as Nursing.
ACPE #207-999-08-176-L03-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 3.0
The implementation of Medicare Part D represented the single most significant change in the Medicare program since its inception over 40 years ago. How do these changes affect the typical alternate-site infusion reimbursement department? Join us for this hands-on, three-hour workshop to examine the day-to-day, practical aspects of the Medicare Part D Program. The first session of the Workshop will specifically address the following:
Session Summary:
- Obtain a thorough background on the Part D program, including the key legal elements and benefit structure facets that you should be aware of.
- Understand the core fundamentals of Medicare Advantage programs.
- Review critical Medicare Part D contracting issues—and begin to analyze the Part D program in terms of alternate-site infusion operations.
Faculty: Jeanie Smith, Vice President, Reimbursement, Critical Care Systems, Nashua, NH; Sharon Niewinski, Medicare Reimbursement Specialist, Option Care, Buffalo Grove, IL; and Bruce Rodman, MBA, Vice President, Health Information Policy, National Home Infusion Association, Alexandria, VA
Educational Objectives:
- Describe the legal history of the Medicare Part D Prescription Drug Benefit.
- Explain the critical gaps in coverage for home infusion therapy under the Medication Part D program.
- Discuss reimbursement operations for submitting claims to Medicare Part D plans for home infusion drugs.
- Outline the process for billing flushes, diluents and supplies for home infusion patients with Medicare Part D
- Describe the use of internet applications to assist in submitting claims to Medicare Part D plans.
5:00 – 6:30 p.m.
21-E. Medicare Part D Workshop—Special Focus on Reimbursement Challenges
Part II: Nuts and Bolts, Internet Applications and Best Practices
Please Note: Participants must attend BOTH Parts I (16-D.) and II (21-E.) of the Medicare Part D Workshop to receive Continuing Education Contact Hours—no partial credit is allowed: Total CE credit for Parts I and II is 3.0 contact hours for Pharmacy, as well as Nursing.
Part II of the Medicare Part D Workshop will address the following content areas (in addition to offering attendees opportunities for interactive discussion with the faculty and an expert panel about relevant Part D reimbursement questions):
Session Summary:
- Discover pragmatic, successful approaches for implementing Medicare Part D as an alternate-site infusion provider, while appropriately managing reimbursement challenges.
- Learn how to productively address all the key aspects of Part D internet applications—including eligibility, test claims, queries, available websites, and NCPDP vs. X12 billing.
- Examine critical payer source issues—and hear best practices from a dynamic panel of experts.
Faculty: Jeanie Smith, Vice President, Reimbursement, Critical Care Systems, Nashua, NH; Sharon Niewinski, Medicare Reimbursement Specialist, Option Care, Buffalo Grove, IL; and Bruce Rodman, MBA, Vice President, Health Information Policy, National Home Infusion Association, Alexandria, VA
Educational Objectives:
- Review important considerations when contracting with Medicare Part D plans.
- Identify best practices for contracting with Part D plans.
- Discuss future considerations for participation in providing drugs and services for Medicare Part D patients.
- Identify best practices for implementation of Medicare Part D billing at your infusion organization.
Wednesday, March 12
9:15 – 10:15 p.m.
25-F. Ensuring Private-Pay Collections Success
ACPE #207-999-08-184-L04-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 1.0
Session Summary:
- Discuss how one of the most difficult aspects of infusion reimbursement is effectively collecting receivables from the patients you serve.
- Identify the critical areas to focus your private-pay collection efforts on—and discover key best practices that will successfully drive in more of this valuable revenue.
- Learn how to effectively address these ever-growing receivable accounts that have such a significant impact on your organization’s bottom line.
Faculty: David Bargmann, BS, MBA, Chief Operating Officer, and Lisa Bargmann, BS, Chief Executive Officer, Bargmann Management, LLC dba Homecare Collection Service, Akron, OH
Educational Objectives:
- Identify the financial impact patient receivables have on your business.
- Determine your current patient receivable recovery results to more effectively manage your patient A/R.
- Identify strategies to improve front-end intake processes for regulatory compliance and improved collections.
- List several identified best practices to effectively bill and collect patient pay receivables.
- Describe variable-cost solutions to help improve your bottom line.
10:30 a.m. – 12:00 p.m.
29-G. Critical Contracting—Developing Successful Strategic Contractual Relationships
ACPE #207-999-08-188-L04-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 1.5
Session Summary:
- Examine the essential elements of contracting for small and large companies—from the perspectives of both the home infusion business manager and reimbursement professional.
- Assess the art of negotiation, key strategies for effectively operationalizing contracts and approaches for sub-contracting with home health entities and/or other vendors.
- Discuss the key communications involved in cultivating strategic contractual relationships and learn how to obtain all appropriate documentation required in this process.
Faculty: Shelby Marshall, Vice President, Contract Management & Business Development, Critical Care Systems, Nashua, NH
Educational Objectives:
- Discuss health plan perspectives on negotiating infusion contracts.
- Identify the appropriate individuals within health plans with whom to negotiate.
- Identify negotiation strategies for your organization’s reimbursement and operational objectives.
- Describe concepts for effectively implementing contract requirements.
- Identify key components of vendor subcontract arrangements.
1:30 – 2:30 p.m.
33-H. Medicare Part D: Past, Present and Future Legislative Efforts
ACPE #207-999-08-193-L03-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 1.0
Session Summary:
- Gain historical perspectives on how the Part D program came into existence.
- Join with your colleagues in discussion of the hurdles encountered in the first two years, the success and failures, and the gaps in coverage for home infusion therapies—and hear how NHIA intervened to correct many of these issues.
- Obtain an overview of NHIA’s role in drafting legislation to provide a meaningful benefit (specifically HR 2567), as well as the future prospects for Medicare recipients in need of home infusion therapy—and, most importantly, find out what you can do with your U.S. Representatives and Senators to get legislation passed.
Faculty: Bruce E Rodman MBA, Vice President of Health Information Policy, NHIA, Alexandria, VA; Cynthia E Berry Esq., Attorney at Law, Powell Goldstein LLP, Washington, DC; John R Magnuson, Vice President of Legislative Affairs, NHIA, Alexandria, VA
Educational Objectives:
- State the legislative history leading to the Medicare Part D program, projections of beneficiary counts and costs of the program.
- Describe NHIA’s advocacy actions and results pertaining to deficiencies in Part D for covering home infusion therapy.
- List key steps NHIA undertook in 2007 to obtain meaningful coverage for home infusion for Medicare beneficiaries.
- Recite key strategies NHIA is undertaking in 2008 to support passage of Medicare infusion legislation in the 111th Congress.
- Describe actions that you should be undertaking in support of passing needed Medicare legislation to cover infusion.
2:45 – 4:15 p.m.
 35-I. Ensuring Clinical Documentation Meets the Needs of Your Reimbursement Team
ACPE #207-999-08-195-L04-P
VNA Approver Number:
Pharmacy & Nursing Continuing Education Contact Hours: 1.5
Session Summary:
- Review the everyday communication challenges that frequently exist between clinicians and the reimbursement team.
- Identify what the clinical staff knows about their patients that the reimbursement team needs to know in order to bill on a timely, accurate basis—and realize the benefits of a defined communication process to achieve this goal.
- Assess clinical documentation/communications from the clinical team to the reimbursement staff—and examine alternate communication methods to help further ensure success.
Faculty: Cindy Gricheck, RN, BSN, CRNI® , Manager, Infusion Operations, Air Products Healthcare, Monroeville, PA, and Vicki Wilson, Senior Manager/Consultant, Reimbursement Concepts, Weirton, WV
Educational Objectives:
- List challenges to overcome when communicating pertinent information.
- Define what information needs to be communicated and to whom from the clinical staff to the reimbursement staff and vice-versa.
- Define the elements of successful communications.
- Identify various forms of communication.
- Describe benefits of communication from the clinical personnel to reimbursement department.
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